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Antimicrobial consumption and bacterial resistance pattern in patients admitted in I.C.U at a tertiary care center
Sonal Saxena1, Megha Priyadarshi2, Arpita Saxena3
1Department of Microbiology, Lady Hardinge Medical College, New Delhi, India.
Background:
Throughout the world multi drug resistant nosocomial infections are one of the leading causes of death and morbidity among hospitalized patients. Antimicrobial resistance [AMR] has become a major problem in treatment of such infections. High consumption of antimicrobials particularly in ICUs is often described as the most important factor leading to AMR.
Objective:
The aim of the study was to study the magnitude of antimicrobial resistance amongst nosocomial pathogens and the antimicrobial prescription patterns of patients admitted in intensive care unit.
Methods:
The study was conducted in I.C.U of a tertiary care government hospital in Delhi over a period of 4 months, on 100 patients admitted in I.C.U. Depending on clinical suspicion laboratory samples were collected and subjected to antimicrobial sensitivity testing. Antimicrobial prescription of these patients were collected from I.C.U records and analyzed.
Observations:
Staphylococcus aureus and Klebsiella species were the most common organism [23%]. Among patients where causative organism was isolated, two or more organisms were isolated from 50% of the samples. Most of the Klebsiella species and Acinetobacter species were resistant to beta lactam group of antibiotics such as cephalosporins and piperacillin-tazobactam. 60% of isolates of S. aureus were found to be MRSA while none of the S. aureus were resistant to linezolid and vancomycin. All patients were prescribed two or more antimicrobials while 66% patients were prescribed 3-5 antimicrobials. Commonest combination was beta lactam with metronidazole followed by levofloxacin with metronidazole with addition of aminoglycosides or linezolid as third drug. Total 20 antimicrobial agents were used in the treatment of the patients. Among these consumption [in DDD/100bed days] of metronidazole was highest [100.9] followed by fluconazole [76.6] and levofloxacin [62.7].
Conclusion:
High usage of antimicrobial consumption has been noted in this study, prompting institution of measures to formulate and adherence to antimicrobial policy strictly.
Insights
High antimicrobial use in intensive care units (ICUs) drives antimicrobial resistance (AMR). This study found significant resistance in nosocomial pathogens and extensive antimicrobial prescribing, necessitating strict policy adherence.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Critical Care Medicine
Background:
- Multidrug-resistant nosocomial infections pose a significant global health threat, increasing patient mortality and morbidity.
- Antimicrobial resistance (AMR) complicates the effective treatment of these infections.
- High antimicrobial consumption, especially in intensive care units (ICUs), is a primary driver of AMR.
Purpose of the Study:
- To investigate the prevalence of antimicrobial resistance among nosocomial pathogens.
- To analyze antimicrobial prescription patterns in intensive care unit (ICU) patients.
Main Methods:
- A 4-month study in a tertiary care government hospital's ICU involving 100 patients.
- Laboratory samples were collected for antimicrobial sensitivity testing based on clinical suspicion.
- Antimicrobial prescriptions were reviewed from ICU records.
Main Results:
- Staphylococcus aureus and Klebsiella species were the most frequent pathogens. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 60% of S. aureus isolates.
- High resistance rates were observed for beta-lactam antibiotics among Klebsiella and Acinetobacter species.
- All patients received multiple antimicrobials, with high consumption of metronidazole, fluconazole, and levofloxacin.
Conclusions:
- The study highlights substantial antimicrobial resistance and high antimicrobial consumption in the ICU setting.
- Strict formulation and adherence to an antimicrobial policy are crucial to combat AMR.
- Interventions are needed to optimize antimicrobial prescribing practices in critical care.
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