PURPOSE: To assess the pattern of infection and organisms isolated in an ICU of a tertiary care teaching hospital.
METHODS: Patients admitted to the ICU of Vallabhbhai Patel Chest Institute were followed up prospectively. Haemogram, Chest X rays and bacterial and fungal cultures from sputum, urine, blood, endotracheal tube (ET) were taken at admission and later from the suspected sites of infection. Infections were defined according to criteria of the Centers for Disease Control and Prevention.
RESULTS: 98 patients (80 males and 18 females) were studied. The reasons for admission to ICU were acute hypercapnic respiratory failure (86), cardiac disease (3), refractory hypotension(3), hypoxic respiratory failure(2) and upper airway obstruction, dyselectrolytemia, refractory spasm, metabolic acidosis (one each). Prior diagnoses were COPD (63), bronchial asthma (18), Interstitial lung disease(7), bronchiectasis (4)and bronchiolitis obliterans, obesity hypoventilation syndrome, post tubercular obstructive disease (one each); and three did not have any prior illness. Infections identified were community acquired tracheobronchial(CATB) 21, hospital acquired tracheobronchial (HATB)10, ICU acquired tracheobronchial(IATB)10, hospital acquired asymptomatic urinary tract infection(HAAUTI) 5, community acquired pneumonia(CAP)2, community acquired asymptomatic urinary tract infection(CAAUTI)3, Ventilator associated pneumonia(VAP)2,ICU acquired symptomatic urinary tract infection(IASUTI)2, hospital acquired pneumonia(HAP)1 and community acquired blood borne infection(CABBI)1. Pseudomonas (6) and Acinetobacter (5) were common in CATB infections while Acinetobacter (7) and Pseudomonas (6) were frequent in HATB and IATB infections. Pseudomonas (4) was common in IASUTI and CAAUTI while Staphylococcus aureus(3) was common in HAAUTI. Aspergillus and Staphylococcus aureus were isolated from two cases of VAP and Aspergillus was the cause in HAP. E.coli, Nocardia were the causes in CAP. E.coli were present in CABBI. Pseudomonas (3) and Staphylococcus aureus (2) were isolated from ET aspirate.
CONCLUSION: Infections were identified in 57 (58.2%) patients admitted to ICU; 27 (27.6%) had community acquired and 30 (30.6%) had hospital acquired infections. Gram negative bacteria and Staphylococcus aureus were the common organisms from the infected patients.
CLINICAL IMPLICATIONS: This study may enable the physicians to decide the antibiotic policy in ICU of a developing country.
DISCLOSURE: Hemant Kalra, No Financial Disclosure Information; No Product/Research Disclosure Information