Clinical profile, bacterial profile and outcomes in an intensive care unit of a tertiary care hospital in south India: one year study

Ajay Kumar Sarvepalli, Prakash Kalakappa Dharana


Background: Infections still remain as one of the major cause of mortality in low and lower- middle-income countries as reported by Global Burden of Diseases study. Intensive care units (ICU) are a major source of infections in tertiary care hospitals. Widespread multi-drug resistant gram positive and gram negative bacterial isolates are also associated with infections in ICU. A hospital based epidemiological study was to determine the risk factors; bacterial isolates, antibiotic sensitivity and outcomes in ICU patients.

Methods: This prospective study was done at Narayana Medical College and Hospital for 12 months from 1st February 2015 to 31st January 2016. All the risk factors were noted. Patient’s outcome noted as death, recovery and transfer to palliative care. Data entry and analysis performed in Microsoft excel, p valve < 0.001 was considered significant.

Results: Three hundred and thirty patients were included in the study (age: 56.16±15 years, 57.6% males). 159 (48.2%) were direct admissions, 103 (31.2%) were transfers from other hospitals. Major cause of admission was neural (29.1%) followed by cardiovascular (21.8%). HTN (52.4%) was major co-morbidity followed by type-2 DM (47.3%). 51.9% culture positivity (n = 539) was observed with sputum 83.6% and blood 24.2%. Gram-negative pathogens were predominant which includes Acinetobacter baumanii (13.8%), Escherichia coli (20%), Klebsiella pneumoniae (14.3%), Pseudomonas aeruginosa (9%), Enterobacter aerogenes (5.1%). Candida Sp and MRSA, VRE were isolated. In the study 255(77.3%) recovered, 38(11.5%) progressed to death and 37(11.2%) transferred to palliative care. Higher mortality was noticed with Acinetobacter baumani (81.6%).

Conclusions: High prevalence of gram-negative bacterial infections and multi-drug resistant isolates was noted in Indian ICUs.


Acinetobacter baumanii, APACHE-2, Gram-negative infections, Intensive care units, Klebsiella pneumoniae, Pseudomonas aeruginosa

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Murray CJ, Lopez AD. Global mortality, disability and the contribution of risk factors: Global burden of disease study. Lancet. 1997;349:1436-42.

Leon D, Walt G. Poverty, inequality and health: an international perspective. Oxford: Oxford University Press; 2001:217-56.

Airol E, Getaz L, Stoll B, Chappuis F, Loutan L. Urbanization and infectious diseases in a globalized world. Lancet Infect Dis. 2011;11:131-41.

John TJ, Dandona L, Sharma VP, Kakkar M. Continuing challenge of infectious diseases in India. Lancet. 2011;377:252-69.

Spencer RC. Epidemiology of infection in ICUs. Intensive Care Med. 1994; 20(4):2-6.

Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995;274:639-44.

Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. EPIC II group of investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323-9.

Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National nosocomial infections surveillance system. Crit Care Med. 1999;27:887-92.

Hanberger H, Diekema D, Fluit A, Jones R, Struelens M, Spencer R, et al. Surveillance of antibiotic resistance in European ICUs. J Hosp Infect. 2001;48:161-76.

Rosales SP, Ramos MF, Cherit DG, Frausto MS, Ramos VG. Prevalence of infections in intensive care units in Mexico: a multicenter study. Crit Care Med. 2000;28:1316-21.

Alberti C, Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med. 2002;28:108-21.

Malacarne P, Langer M, Nascimben E, Moro ML, Giudici D, Lampati L, et al. Building a continuous multicenter infection surveillance system in the intensive care unit: findings from the initial data set of 9,493 patients from 71 Italian intensive care units. Crit Care Med. 2008;36:1105-13.

Clinical laboratory standard institute. 2007. Performance standards for antimicrobial susceptibility testing; Seventeenth informational supplement M100-S17, 16th edition. Clinical laboratory standard Institute. Wayne.

Rosenthal VD, Bijie H, Maki DG, Mehta Y, Apisarnthanarak A, Medeiros EA, et al. International nosocomial infection control coalition (INICC) report, data summary of 36 countries for 2004-2009. Am J Infect Control. 2012;40:396-407.

Phua J, Koh Y, Du B, Tang YQ, Divatia JV, Tan CC, et al.; MOSAICS study group management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ. 2011;342:32-45.

1 in 4 ICU patient gets sepsis, 1 in 2 dies. Available at http:// articles. Times hand- hygiene. Accessed on 1 August 2013.

Kapadia F, Singh M, Divatia J, Vaidyanathan P, Udwadia FE, Raisinghaney SJ, et al. Limitation and withdrawal of intensive therapy at the end of life: Practices in intensive care units in Mumbai, India. Crit Care Med. 2005;33:1272-5.

Patwardhan RB, Dhakephalkar PK, Niphadkar KB, Chopade BA. A study on nosocomial pathogens in ICU with special reference to multiresistant acinetobacter baumannii harbouring multiple plasmids. Indian J Med Res. 2008;128:178-87.

Ravi KP, Suresh D, Sankalp P, Ramesh V, RamasubramanianV, Ramakrishna N. Epidemiology of intensive care unit infections and impact of infectious disease consultants in managing resistant infections. Am J Infect Dis. 2013;9:30-3.

Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan and the UK: a molecular, biological and epidemiological study. Lancet Infect Dis. 2010;10:597-602.

Deshpande P, Rodrigues C, Shetty A, Kapadia F, Hegde A, Soman R. New Delhi metallo-beta lactamase (NDM-1) in enterobacteriaceae: treatment options with carbapenems compromised. J Assoc Physicians India. 2010;58:147-9.

Ganguly NK, Arora NK, Chandy SJ, Fairoze MN, Gill JP, Gupta U, et al. Global antibiotic resistance partnership (GARP)-India working group. rationalising antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011;134:281-94.