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Multicenter Observational Study to Evaluate Epidemiology and Resistance Patterns of Common Intensive Care
Ramesh Venkataraman1, Jigeeshu V Divatia2, Nagarajan Ramakrishnan1
1Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.
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.
Insights
Intensive Care Unit (ICU)-acquired infections in India are most commonly ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSI), and catheter-associated urinary tract infections (CAUTI). Multidrug-resistant Gram-negative bacteria dominate, with Staphylococcus aureus being uncommon.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Limited data exists on the microbiology of Intensive Care Unit (ICU)-acquired infections in India.
- Common ICU infections include ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and catheter-related bloodstream infections (CRBSI).
Purpose of the Study:
- To investigate the microbiology and antimicrobial resistance patterns of ICU-acquired infections in India.
- To evaluate the outcomes associated with these infections.
Main Methods:
- A multicenter observational study (MOSER study) conducted between August 2011 and October 2012.
- Included patients in the ICU for ≥48 hours with infections acquired within 14 days of ICU admission.
- Collected demographic, clinical, and microbiological data, with follow-up until hospital discharge or death, including 6-month survival.
Main Results:
- Out of 381 patients, VAP was most common (223 cases), followed by CRBSI (81 cases) and CAUTI (42 cases).
- Acinetobacter was the most frequent isolate in VAP; Klebsiella was most common in CAUTI and CRBSI.
- High rates of multidrug resistance were observed: 87.5% for Acinetobacter, 75.5% for Klebsiella, 61.9% for E. coli, and 58.9% for Pseudomonas. Staphylococcus was rare (2.4%).
- Mortality rates were 26% for VAP, 11.9% for CAUTI, and 34.6% for CRBSI.
Conclusions:
- Ventilator-associated pneumonia (VAP) is the most prevalent ICU-acquired infection in India, followed by CRBSI and CAUTI.
- Multidrug-resistant Gram-negative bacteria are the predominant pathogens.
- Staphylococcus aureus is infrequently implicated in Indian ICU infections.
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