Silent crisis in the intensive care unit: Current antimicrobial resistance landscape in an Indian hospital

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Antimicrobial resistance (AMR) is a significant global health threat, particularly impacting intensive care units (ICUs) where patients face increased susceptibility to multidrug-resistant organisms (MDROs).
• Effective empirical antibiotic therapy in ICUs relies on understanding local resistance patterns of common bacterial pathogens.
• This study investigated the prevalence and antimicrobial resistance profiles of bacteria isolated from ICU patients in a tertiary care hospital in northwestern India.

Purpose of the Study:

• To determine the spectrum of bacterial pathogens causing infections in the ICU.
• To assess the antimicrobial resistance patterns, including carbapenem resistance, MRSA, and VRE prevalence.
• To provide data for optimizing empirical treatment strategies and informing infection control measures in critical care settings.

Main Methods:

• A retrospective observational study was conducted over one year (January-December 2024) in a tertiary care teaching hospital.
• Clinical specimens from ICU patients were processed using standard microbiological techniques.
• Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK-2 Compact system, with results interpreted according to Clinical Laboratory Standard Institute guidelines.

Main Results:

• Of 8858 samples, 2507 (28.3%) yielded positive cultures. Gram-negative bacteria (60.4%) predominated, with Klebsiella pneumoniae (34.4%) and Acinetobacter baumannii (23.6%) being most frequent. Carbapenem resistance was high: 88.4% for K. pneumoniae and 98.4% for A. baumannii.
• Among Gram-positive isolates, Enterococcus spp. (44.6%) and Coagulase-negative Staphylococcus (39.9%) were most common.
• Prevalence rates for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) were 58% and 39.7%, respectively.

Conclusions:

• The ICU harbors a substantial burden of multidrug-resistant organisms, characterized by high rates of carbapenem resistance, MRSA, and VRE.
• These findings emphasize the critical need for robust antimicrobial stewardship programs and stringent infection control practices within the ICU.
• Continuous surveillance of antimicrobial resistance is essential for guiding empirical therapy and improving patient outcomes in critical care settings.