Epidemiology of Intensive Care Unit Infections and Impact of Infectious Disease Consultants in Managing Resistant Infections

Abstract

Choice of empiric antibiotics in India have generally been guided by western data and guidelines. However, validity and applicability of western guidelines in the Indian setting is not known. The aim of our study was to explore microbial prevalence and resistance patterns in a tertiary care Intensive Care Unit (ICU) in India and to determine whether western guidelines are still valid for use in the Indian setting. We also wanted to evaluate the impact of infectious disease specialist consultation on the appropriateness of initial antibiotic choice and de-escalation practices. Prospective observational study from January 2009 to July 2009, in a setting of 600 bed multispecialty tertiary care hospital. Relevant samples from patients suspected to have infection were cultured and sensitivity testing was performed according to standard procedures. Only the first positive cultures from each patient were used for analysis of the 401 patients admitted to ICU during the study period 25% had positive cultures. 60% of the cultures grew Gram negative organisms with E. coli, Pseudomonas and Acinetobacter species being the commonest isolated pathogens. Mortality among culture positive patients in the Intensive Care Unit (ICU) was 31%. Culture and sensitivity patterns of organisms in Indian ICUs differ from that in the west. Gram negative organisms are most commonly cultured. Initial antibiotic choice when made using western guidelines seem to be appropriate only in (48.4%) of patients. When choosing empiric antibiotics in acutely ill Indian ICU patients, modifications to western guidelines need to be done using local microbial prevalence and resistance patterns.