PATTERN OF ANTIMICROBIAL RESISTANCE IN ICU ALONG WITH CONCERNS IN FUTURE.

Abstract

Background : On World Health Day 2011, WHO’s statement read “Combat drug resistance: no action today means no cure tomorrow”.  Eleven years on, antimicrobial resistance remains a global crisis. Drug resistance claims up to 700,000 lives globally each year, and is poised to reach ten million per year by 2050. Experts have classified antimicrobial resistant pathogens into 3 categories:

1. Multi drug resistant organism (MDRO) - non-susceptible to at least 1 agent in 3 antimicrobial categories


2. Extensively drug-resistant organism (XDRO)—non-susceptible to at least 1 agent in all but 2 or fewer antimicrobial categories.


3. Pan-drug-resistant—non-susceptible to all agents in all antimicrobial categories

Infections with such resistant pathogens have limited therapeutic options and are life threatening.  MDROs significantly contribute to mortality and morbidity in ICU patients, with increased duration of hospital stay as well as cost of care.

MDROs are identified through in vitro culture and drug susceptibility tests. Common MDROs in healthcare settings include (MRSA, VRE, ESBL producers, CRE etc.).  MDR and XDR organisms are common in Indian health care settings, with a large multi-centric study in the country having identified MDR Staphylococcus aureus, Enterococcus sp., Pseudomonas aeruginosa, Acinetobacter baumanii, and Enterobacteriaceae (E.coli, Klebsiella sp.) as causes of concern.It is important to know the MDRO pattern of a healthcare institute to devise new antibiotic guidelines and adopt better infection control practices so that nosocomial outbreaks may be reduced.

Materials & Methods including: Samples received from the ICU in the Bacteriology laboratory of urban tertiary health care centre in South India for culture and sensitivity testing were screened for MDRO. Urine samples were screened using CHROM agar, while other samples were cultured using Blood agar and Mac Conkey agar. Isolates were identified by conventional biochemical testing. Antibiotic sensitivity patterns were studied using Kirby Bauer disk diffusion method and interpreted as per CLSI guidelines. Data were analysed using Microsoft Excel software.

Result: Our study found a significantly higher prevalence of MDROs and P-XDROs compared to NMDROs (P = 0.004). The predominant isolates were E. coli and K. pneumoniae, showing high levels of resistance while showing susceptibility with carbapenems.

Common resistance mechanisms included PMQR genes, ESBLs and mcr genes, carbapenemases.  Cephalosporin and carbapenem resistance were widespread, limiting treatment options to higher level antibiotics that usually are not economical for patients.

Acinetobacter species, many times linked to ventilator-associated pneumonia, showed high resistance and persistence. ICU patients with comorbidities were particularly vulnerable.

The results show the growing threat of AMR, limited antibiotic efficacy, and the need for improved infection control, stewardship, and awareness.

Conclusion: The rise of MDROs and P-XDROs, especially in E. coli and K. pneumoniae, demands the urgent need for stronger antibiotic stewardship, infection control, and public awareness to address the growing threat of antimicrobial resistance.