Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India
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 d...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2015-01-01
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| Series: | Lung India |
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| Online Access: | http://www.lungindia.com/article.asp?issn=0970-2113;year=2015;volume=32;issue=5;spage=441;epage=448;aulast=Ghanshani |
| _version_ | 1811300777722904576 |
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| author | Rajesh Ghanshani Rajeev Gupta Bhagwan Swarup Gupta Sushil Kalra Raghubir Singh Khedar Smita Sood |
| author_facet | Rajesh Ghanshani Rajeev Gupta Bhagwan Swarup Gupta Sushil Kalra Raghubir Singh Khedar Smita Sood |
| author_sort | Rajesh Ghanshani |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T06:57:18Z |
| format | Article |
| id | doaj.art-c42adf6d7dca4428aff19e89dd7123d5 |
| institution | Directory Open Access Journal |
| issn | 0970-2113 0974-598X |
| language | English |
| last_indexed | 2024-04-13T06:57:18Z |
| publishDate | 2015-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
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| series | Lung India |
| spelling | doaj.art-c42adf6d7dca4428aff19e89dd7123d52022-12-22T02:57:13ZengWolters Kluwer Medknow PublicationsLung India0970-21130974-598X2015-01-0132544144810.4103/0970-2113.164155Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in IndiaRajesh GhanshaniRajeev GuptaBhagwan Swarup GuptaSushil KalraRaghubir Singh KhedarSmita SoodObjectives: 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.http://www.lungindia.com/article.asp?issn=0970-2113;year=2015;volume=32;issue=5;spage=441;epage=448;aulast=GhanshaniAcinetobacter baumanniidrug resistanceepidemiologygram-negative infectionsintensive care unitsKlebsiella pneumoniae |
| spellingShingle | Rajesh Ghanshani Rajeev Gupta Bhagwan Swarup Gupta Sushil Kalra Raghubir Singh Khedar Smita Sood Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India Lung India Acinetobacter baumannii drug resistance epidemiology gram-negative infections intensive care units Klebsiella pneumoniae |
| title | Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India |
| title_full | Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India |
| title_fullStr | Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India |
| title_full_unstemmed | Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India |
| title_short | Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India |
| title_sort | epidemiological study of prevalence determinants and outcomes of infections in medical icu at a tertiary care hospital in india |
| topic | Acinetobacter baumannii drug resistance epidemiology gram-negative infections intensive care units Klebsiella pneumoniae |
| url | http://www.lungindia.com/article.asp?issn=0970-2113;year=2015;volume=32;issue=5;spage=441;epage=448;aulast=Ghanshani |
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