PATTERN OF ANTIBIOTIC RESISTANCE OF BACTERIAL PATHOGENS IN PATIENTS ADMITTED IN MEDICINE ICU OF TERTIARY CARE CENTRE

Abstract

Introduction: Antimicrobial resistance (AMR) has emerged as a critical global health crisis, particularly affecting hospitalized patients in intensive care units (ICUs), where the use of broad-spectrum antibiotics is common and often empirical. The emergence of multidrug-resistant (MDR) organisms, including Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA), has posed significant treatment challenges. In India, AMR is fuelled by inappropriate antibiotic use, lack of regulation, environmental contamination, and high patient density in healthcare facilities. Despite growing awareness, there remains a paucity of ICU-specific data, particularly from tertiary care centers. This study was therefore undertaken to evaluate the microbial profile, antibiotic resistance patterns, and demographic associations of infections among patients admitted to the Medicine ICU of a tertiary care hospital in Agra, India.

Objectives: To study the prevailing pattern of antibiotic resistance in bacterial pathogens among patients admitted to the Medicine ICU, of Tertiary Care Center Study the incidence of Nosocomial bacterial infections in patients admitted to the Medicine ICU, of Tertiary Care Centre. Study the Demographic pattern of the most frequently occurring bacterial infections, in patients admitted to the medicine ICU, in a Tertiary Care Center.

Methods: This was a prospective, observational, and analytical study conducted over 12 months (January 2023 to January 2024) in the Medicine ICU at S.N. Medical College and associated hospital, Agra (U.P.), in collaboration with the Departments of Pharmacology and Microbiology. The study enrolled 140 patients aged over 18 years with either pre-existing or hospital-acquired (nosocomial) infections. Exclusion criteria included pregnancy, lactation, outpatient cases, and those already on empirical antibiotics before sample collection. Specimens such as urine, blood, sputum, pus, and stool were collected from each patient and sent for microbial culture and sensitivity testing. Data, including age, gender, infection type, organism isolated, and resistance/sensitivity profiles, were recorded and analyzed using Microsoft Excel.

Results: The Majority of patients were between 36 and 50 years and above 65 years. Out of 140 patients, the prevalence of ICU infections showed male predominance. The microbial Profile showed Escherichia coli as the most common organism, while urine and sputum were the most common specimens. Old infections showed predominance over Nosocomial infections.

Conclusion: This study revealed that Escherichia coli, Enterococcus spp, and Klebsiella pneumoniae were the predominant pathogens isolated from ICU patients, with urine being the most common source of infection. Antibiotic resistance was alarmingly high, especially to clindamycin, penicillin, and doxycycline, while Fosfomycin, Meropenem, and Ofloxacin showed relatively better efficacy. No statistically significant correlation was found between microbial distribution and either age or gender. The high prevalence of multidrug-resistant organisms, especially in nosocomial infections, underscores the need for stringent infection control policies, rational antibiotic prescribing practices, and regular antibiogram-based surveillance. This data provides a vital foundation for formulating local empirical antibiotic guidelines and implementing effective antibiotic stewardship programs in ICU settings.