Burden of Infections in ICU: Strategies to Control
Journal Title: GUJARAT CANCER SOCIETY RESEARCH JOURNAL - Year 2014, Vol 16, Issue 2
Abstract
Patients are admitted in Intensive Care Unit (ICU) for close monitoring and constant medical care with life threatening illness. This is a study analysis is to know the rates of infections occurring in patients admitted in ICUs (Medical, Surgical and Neuro Oncology) of the hospital and to come out with the strategies and guidelines to prevent infections. This is a laboratory based study analysis focusing on ICUs Infections. The method of study analysis included manual as well as computer assisted analysis (WHONET software). The study analysis was for one year (2013) a total of 238 patients were admitted with different malignancies like solid tumor and hematological malignancies in the ICUs. Overall infection rate in ICU was 43.69%. The data showed 92.3% infection in patients with interventional procedures, where as it was 47.1% in patients without interventions. Catheter associated blood stream infections in medical, surgical and neuro ICU was 16.04%, 42.85% and 46.15% respectively. The infection in peripheral line catheter was 23.3% and in central line catheters was 38.46%. Infections other than blood stream infections were called routine infections. Routine infections in medical, surgical and neuro ICU were 55.8%, 75% and 63.8% respectively. Amongst the gram positive cocci, staphylococcus aureus was 10.5% followed by coagulase negative staphylococcus (3.94%). Amongst the gram negative organisms 32.89% of Acinatobacter baumannii followed by Pseudomonas 27.6%, E. coli 14.47%, Klebseilla 11.8% and Enterobacter. 7.8% of Candida species of the fungi caused infection. The antibiotic sensitivity of the isolates shows the gram positive cocci in blood culture were resistant to ampicillin, gentamycin, ciprofloxacin, tigecycline, erythromycin, levofloxacin, penicillin G and ranged from 26% to 93%. The antibiotics sensitive to GPC were tigecycline, linezoid, tetracyclin, vancomycin and teicoplanin, which ranged from 60- 93%. 60% of the MRSA causing infections were detected. T h e G N B s w e r e r e s i s t a n t t o a m p i c i l l i n , piperacillin/tazobactum (62%), cephalosporin group (66 to 85.7%), amikacin and gentamycin (48 and 52%), imipenem and m e r o p e n e m ( 4 3 a n d 2 4 % ) , c i p r o f l o x a c i n , trimethoprim/sulfamethoxazole, aztreonam, cefazolin, tobramycin, ceftazidime showed resistance ranging from of 67 to 85.7%. The antibiotics which can be used for treatment are amoxicillin / clavulanic acid, meropenem, amikacin, aztreonam. The GNBs resistant to antibiotics were ESBL and Carbapenemase producers which inactivated the cephalosporin and carbapenem group of antibiotics. 72.7% of the E. coli and Klebsialla were ESBL producer and around 11.1% of the GNBs were carbapenemase producer. There is a growing concern about the bacteria developing resistance to the existing antimicrobial drugs as per the current study. Moreover the cost of the antibiotics like carbapenams, linezolid, vancomycin are too high. Therefore multidimensional approach including (1) Bundle (Care Bundle) of infection control interventions (2) Education (3) Surveillance (4) Performance feedback of infection control practices should be implemented to reduce the morbidity and mortality. Of all the strategies hand hygiene remains the corner stone in controlling healthcare associated infection.
Authors and Affiliations
Parijath Goswami, Jayshree Thakkar, Indira Mackwan, Mona Darji
Keywords
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