Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India

• Main Authors: Rajesh Ghanshani, Rajeev Gupta, Bhagwan Swarup Gupta, Sushil Kalra, Raghubir Singh Khedar, Smita Sood
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2015-01-01
• Series: Lung India
• Subjects: Acinetobacter baumannii; drug resistance; epidemiology; gram-negative infections; intensive care units; Klebsiella pneumoniae
• Online Access: http://www.lungindia.com/article.asp?issn=0970-2113;year=2015;volume=32;issue=5;spage=441;epage=448;aulast=Ghanshani

Objectives: To determine the prevalence of infections, risk factors, and outcomes in a medical intensive care unit (ICU), we performed a hospital-based study. Materials and Methods: Consecutive patients were enrolled and details of risk factors and bacteriological data were obtained. Outcomes were death/transfer to palliative care or recovery. Statistical analyses were performed. Results: Four hundred and eighty-seven patients were admitted during the study period (age 55.6 ± 19 yr, men 68%). Diseases responsible were respiratory (37%), gastrointestinal/liver (22%), neurological (20%), renal (8%), and trauma (6%) related. Majority of admissions were direct (45%) or transfers from other hospitals (41%). Most important comorbidities were hypertension (41%), diabetes (31%), and chronic obstructive pulmonary disease (15%). Median APACHE-2 score was 13.0 (IQR 1–25). Antibiotics were administered in 98%. Bacteriological cultures were positive in 28% (n = 623). Respiratory infections were the most common (45.5%) followed by blood (23.3%) and urinary (16.1%). Gram-negative bacteria were common–Acinetobacter baumannii (20.9%), Klebsiella pneumoniae (19.7%), Escherichia coli (18.3%), and Pseudomonas aeruginosa (14.0%). There a high prevalence of resistance to common antibiotics. Patients with positive cultures were older, transferees (46 vs 37%, P = 0.07), with respiratory disease (48 vs. 33%, P = 0.003), with more than two comorbidities (33 vs 21%, P = 0.009), and higher APACHE-2 score (17.7 ± 8 vs. 13.3 ± 8, P = 0.07). Three hundred and fifty-two (72.3%) recovered, 68 (13.9%) died, and 67 (13.8%) were transferred to palliative care. Survival was associated with younger age, lower APACHE-2 score, negative cultures, and shorter duration in ICU (P < 0.05). Mortality was greater in patients with Acinetobacter (OR 2.36, 1.17–4.73), Klebsiella (OR 2.81, 1.33–5.92), Pseudomonas (OR 8.03, 2.83–22.76), or Enterobacter (OR 6.73, 1.29–35.12) infection. Conclusions: There is high prevalence of infections in patients in a medical ICU in India. Gram-negative bacteria are the most prevalent and resistance to antibiotics is high. Risk factors are age, hospital transfers, APACHE-2 score, and multiple comorbidities.