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VOLUME 22 , ISSUE 4 ( 2018 ) > List of Articles

RESEARCH ARTICLE

Antibiotic prescription, organisms and its resistance pattern in patients admitted to respiratory ICU with respiratory infection in Mysuru

Raja Dhar, Sneha Limaye, M Mahendra, BS Jayaraj, KS Lokesh, SK Chaya, Vivek Veerapaneni, Rajesh Swarnakar, Shrikant Ambalkar, PA Mahesh

Keywords : Antibiotic resistance, mortality, pneumonia, respiratory infection

Citation Information : Dhar R, Limaye S, Mahendra M, Jayaraj B, Lokesh K, Chaya S, Veerapaneni V, Swarnakar R, Ambalkar S, Mahesh P. Antibiotic prescription, organisms and its resistance pattern in patients admitted to respiratory ICU with respiratory infection in Mysuru. Indian J Crit Care Med 2018; 22 (4):223-230.

DOI: 10.4103/ijccm.IJCCM_409_17

License: CC BY-ND 3.0

Published Online: 00-04-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim of Study: Respiratory infections account for significant morbidity, mortality and expenses to patients getting admitted to ICU. Antibiotic resistance is a major worldwide concern in ICU, including India. It is important to know the antibiotic prescribing pattern in ICU, organisms and its resistance pattern as there is sparse data on Indian ICUs. Materials and Methods: We conducted a prospective study from August 2015 to February 2016. All patients getting admitted to RICU with respiratory infection who were treated with antibiotics were included into study. Demographic details, comorbidities, Clinco-pathological score (CPI) on day1 and 2 of admission, duration of ICU admission, number of antibiotics used, antibiotic prescription, antimicrobial resistance pattern of patients were collected using APRISE questionnaire. Results: During study period 352 patients were screened and 303 patients were included into study. Mean age was 56.05±16.37 and 190 (62.70%) were men. Most common diagnosis was Pneumonia (66%). Piperacillin-tazobactam was most common empirical antibiotic used. We found 60% resistance to piperacillin-tazobactam. Acinetobacter baumanii was the most common organism isolated (29.2%) and was highly resistant to Carbapenem (60%). Klebsiella pneumoniae was resistant to Amikacin (45%), piperacillin (55%) and Ceftazidime (50%). Conclusion: Piperacillin-tazobactam was the most common antibiotic prescribed to patients with respiratory infection admitted to ICU. More than half of patients (60%) had resistance to the empirical antibiotic used in our ICU, highlighting the need for antibiogram for each ICU. Thirty six percent of patient had prior antibiotic use and had mainly gram negative organisms with high resistance to commonly used antibiotics.


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  1. The Burden of Lung Disease-ERS White book 2013. Available from: http://www.erswhitebook.org/chapters/the-burden-of-lung-disease/. [Last cited on 2017 Jul 25].
  2. Esposito S, Leone S. Antimicrobial treatment for intensive care unit (ICU) infections including the role of the infectious disease specialist. Int J Antimicrob Agents 2007;29:494-500.
  3. Poor Compliance with the Antibiotic Policy in the Intensive Care Unit (ICU) of a Tertiary care Hospital in India. The Journal of Infection in Developing Countries; 2013. Available from: https://jidc.org/index.php/journal/article/view/24334948. [Last cited on 2017 Dec 29].
  4. Weber RJ, Kane SL, Oriolo VA, Saul M, Skledar SJ, Dasta JF, et al. Impact of Intensive Care Unit (ICU) drug use on hospital costs: A descriptive analysis, with recommendations for optimizing ICU pharmacotherapy. Crit Care Med 2003;31:S17-24.
  5. Tavallaee M, Fahimi F, Kiani S. Drug-use patterns in an intensive care unit of a hospital in iran: An observational prospective study. Int J Pharm Pract 2010;18:370-6.
  6. Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000;162:505-11.
  7. Micek ST, Ward S, Fraser VJ, Kollef MH. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 2004;125:1791-9.
  8. Lentino JR, Lucks DA. Nonvalue of sputum culture in the management of lower respiratory tract infections. J Clin Microbiol 1987;25:758-62.
  9. American Thoracic Society-Bronchoalveolar Lavage 2012. Available from: https://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/critical-care-procedures/bronchoalveolar-lavage.php. [Last cited on 2018 Jan 04].
  10. Meyer KC, Raghu G, Baughman RP, Brown KK, Costabel U, du Bois RM, et al. An official American thoracic society clinical practice guideline: The clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med 2012;185:1004-14.
  11. Search Results CDC; 2017. Available from: https://www.cdc.gov/search/index.html. [Last cited on 2018 Jan 04].
  12. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017;43:304-77.
  13. Fridkin SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med 2001;29:N64-8.
  14. 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.
  15. Jarvis WR, Martone WJ. Predominant pathogens in hospital infections. J Antimicrob Chemother 1992;29 Suppl A:19-24.
  16. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510-5.
  17. Radji M, Fauziah S, Aribinuko N. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of fatmawati hospital, Indonesia. Asian Pac J Trop Biomed 2011;1:39-42.
  18. Refdanita R, The Sensitivity pattern of microorganisms against antibiotics at the intensive care unit of fatmawati hospital Radji M, Aribinuko N, Pauline E. Jakarta 2001–2002. Makara J Health Res 2010;8:41-8.
  19. Agarwal R, Gupta D, Ray P, Aggarwal AN, Jindal SK. Epidemiology, risk factors and outcome of nosocomial infections in a respiratory intensive care unit in North India. J Infect 2006;53:98-105.
  20. Prashanth K, Badrinath S. Nosocomial infections due to Acinetobacter species: Clinical findings, risk and prognostic factors. Indian J Med Microbiol 2006;24:39-44.
  21. Ghanshani R, Gupta R, Gupta BS, Kalra S, Khedar RS, Sood S. Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India. Lung India Off Organ Indian Chest Soc 2015;32:441-8.
  22. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323-9.
  23. Centers for Disease Control and Prevention (CDC). Nosocomial enterococci resistant to vancomycin--United States, 1989-1993. MMWR Morb Mortal Wkly Rep 1993;42:597-9.
  24. Archibald L, Phillips L, Monnet D, McGowan JE Jr., Tenover F, Gaynes R, et al. Antimicrobial resistance in isolates from inpatients and outpatients in the United States: Increasing importance of the intensive care unit. Clin Infect Dis 1997;24:211-5.
  25. Weinstein RA. Controlling antimicrobial resistance in hospitals: Infection control and use of antibiotics. Emerg Infect Dis 2001;7:188-92.
  26. Goel N, Chaudhary U, Aggarwal R, Bala K. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit. Indian J Crit Care Med 2009;13:148-51.
  27. Mathai AS, Oberoi A, Madhavan S, Kaur P. Acinetobacter infections in a tertiary level intensive care unit in northern India: Epidemiology, clinical profiles and outcomes. J Infect Public Health 2012;5:145-52.
  28. Gopalakrishnan R, Sureshkumar D. Changing trends in antimicrobial susceptibility and hospital acquired infections over an 8 year period in a tertiary care hospital in relation to introduction of an infection control programme. J Assoc Physicians India 2010;58 Suppl:25-31.
  29. 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.
  30. Mannan MA, Kashem MA, Mohammed FR, Rabbani R, Islam MM. Microbiological Profile of severe lower respiratory tract infection in intensive care unit of a tertiary care center of Dhaka, Bangladesh. Bangladesh Crit Care J 2015;2:53-6.
  31. Kumari HBV, Nagarathna S, Chandramuki A. Antimicrobial resistance pattern among aerobic gram-negative bacilli of lower respiratory tract specimens of intensive care unit patients in a neurocentre. Indian J Chest Dis Allied Sci 2007;49(1):19-22.
  32. Singh AK, Sen MR, Anupurba S, Bhattacharya P. Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU. J Commun Dis 2002;34:257-63.
  33. Navaneeth BV, Belwadi MR. Antibiotic resistance among gram-negative bacteria of lower respiratory tract secretions in hospitalized patients. Indian J Chest Dis Allied Sci 2002;44:173-6.
  34. Treatment Guidelines for Antimicrobial Use in Common Syndromes. ICMR Guidelines. 2017. Available from: http://icmr.nic.in/About_Us/Guidelines.html. [Last cited on 2017 Dec 06].
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