Multicenter Observational Study to Evaluate Epidemiology and Resistance Patterns of Common Intensive Care Unit-infections

Ramesh Venkataraman; Jigeeshu V Divatia; Nagarajan Ramakrishnan; Rajesh Chawla; Pravin Amin; Palepu Gopal; Dhruva Chaudhry; Kapil Zirpe; Babu Abraham

doi:10.4103/ijccm.IJCCM_394_17

Multicenter Observational Study to Evaluate Epidemiology and Resistance Patterns of Common Intensive Care Unit-infections

Indian J Crit Care Med. 2018 Jan;22(1):20-26. doi: 10.4103/ijccm.IJCCM_394_17.

Authors

Ramesh Venkataraman¹, Jigeeshu V Divatia², Nagarajan Ramakrishnan¹, Rajesh Chawla³, Pravin Amin⁴, Palepu Gopal⁵, Dhruva Chaudhry⁶, Kapil Zirpe⁷, Babu Abraham¹

Affiliations

¹ Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.
² Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
³ Department of Pulmonary and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India.
⁴ Department of Medicine and Critical Care, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
⁵ Division of Critical Care, CARE Hospitals, Hyderabad, Telangana, India.
⁶ Department of Pulmonary and Critical Care Medicine, Postgraduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India.
⁷ Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India.

Abstract

Background: There is limited data regarding the microbiology of Intensive Care Unit (ICU)-acquired infections, such as ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and catheter-related bloodstream infections (CRBSI) from India.

Objectives: To explore the microbiology and resistance patterns of ICU-acquired infections and evaluate their outcomes.

Materials and methods: This was a multicenter observational study, conducted by Indian Society of Critical Care Medicine (MOSER study) between August 2011 and October 2012. Patients in the ICU ≥48 h with any ICU-acquired infection within 14 days of index ICU stay were included. Patient demographics, relevant clinical, and microbiological details were collected. Follow-up until hospital discharge or death was done, and 6-month survival data were collected.

Results: Of the 381 patients included in the study, 346 patients had 1 ICU infection and 35 had more than one ICU infection. Among patients with single infections, 223 had VAP with Acinetobacter being the most common isolate. CAUTI was seen in 42 patients with Klebsiella as the most common organism. CRBSI was seen in 81 patients and Klebsiella was the most common causative organism. Multidrug resistance was noted in 87.5% of Acinetobacter, 75.5% of Klebsiella, 61.9% of Escherichia coli, and 58.9% of Pseudomonas isolates, respectively. Staphylococcus constituted only 2.4% of isolates. Mortality rates were 26%, 11.9%, and 34.6% in VAP, CAUTI, and CRBSI, respectively.

Conclusion: VAP is the most common infection followed by CRBSI and CAUTI. Multidrug-resistant Gram-negative bacteria are the most common organisms. Staphylococcus aureus is uncommon in the Indian setting.

Keywords: Catheter-associated urinary tract infections; Gram-negative bacteria; Intensive Care Unit-acquired infections; catheter-related bloodstream infections; multidrug resistance; ventilator-associated pneumonia.