Profile of Drug Resistant Gram Negative Bacteria from ICU at a Tertiary Care Center of India

Abstract

Infections are one of the most serious and dreaded complication in hospital settings especially for patients admitted in Intensive Care Units. Risk factors like decreased immunity and prevalence of multidrug resistant organisms in the surroundings along with multitude of drugs administered predispose the patient to infections. To formulate policies that are critical to effective treatment of such infections and prevent development of antibiotic resistance, there should be data of bacterial etiologies and infection patterns. Aims: Detection of MDR pathogens like Enterobacteriaceae and Acinetobacter spp as indicator of assessing the cleanliness and adherence to basic standard infection control and prevention procedures. The study determines the prevalence and microbiological profile of MDR pathogens in ICU. Methodology: This prospective study was conducted at Lady Hardinge Medical College and associated tertiary hospital, New Delhi between January and December 2016. A total of 158 clinical specimens were collected from the ICUs and analyzed by standard microbiological methods, disc potentiation and modified hodge test for the identification of ESBL-producing and carbapenemases production respectively. Results: Out of 158 ICU isolates analysed, 104(65.8%) were from the Family Enterobacteriaceae with Escherichia coli being the predominant. Among the Genus Acinetobacter 54(34.4%), A. baumannii was 40(74.1%) and A. lwoffii 10(25.9%). Distribution among 104 isolates of Enterobacteriaceae submitted was: E. coli 42(26.5%), Klebsiella spp 52(32.9%) and Proteus spp 10(6.3%). Prevalence of ESBL producing was 22.7% and carbapenemases positive -9.6%. All the pathogens were sensitive to colistin, Low resistance was observed with E. coli, moderate resistance with gentamicin ranged from 14.3% to 59.2%, and High resistance observed with Amoxicillin-Clavulanate, piperacillin-tazobactam, meropenem and imipenem. Conclusion: The study finding has revealed the presence of MDR pathogens with ESBL and carbapenemases enzymes capable of compounding patient management and infection control measures.