Determinants of nosocomial infections and emerging antibiotic resistance in the Intensive Care Unit: A prospective evidence-based study

Abstract

Objective： To determine the incidence, risk factors, antibiotic resistance patterns, and outcomes of various nosocomial infections in Intensive Care Unit (ICU) patients.

Methods: The present prospective observational study was conducted in the multidisciplinary ICU of a tertiary care hospital for 6 months. Incidence, risk factors, and outcome parameters were calculated using Mann Whitney U test, Chi-square test, and stepwise univariate and multivariate logistic regression analysis.

Results： The overall incidence of nosocomial infections was 23.5% (74/314). Ventilator-associated pneumonia was the most common infection (54.1%, 52/96), followed by catheter-related bloodstream infections (22.9%, 22/96). Stress ulcer prophylaxis (aOR 7.691, 95% CI 2.202-26.860, P=0.001), endotracheal intubation (aOR 3.251, 95% CI 1.251-8.420, P=0.015), Foley’s catheter (aOR 11.917, 95% CI 1.335-106.410, P=0.027), and ICU stay > 7 days (aOR 30.915, 95% CI 10.062-94.980, P=0.001) were statistically significant risk factors associated with nosocomial infection in ICU patients. Gramnegative bacteria showed a high degree of resistance to most of antibiotics except colistin and tigecycline. Infected group's mortality was significantly greater than the uninfected group (21.62% vs. 5.83% P<0.001) and had considerably longer ICU length of stay [21 (12) vs. 7 (4) days, P<0.001)] and duration of mechanical ventilation [20 (11) days vs. 0 (5) days, P<0.001].

Conclusions： This study highlights the high incidence rate of ventilator-associated pneumonia, with extensive drug resistance in ICU patients, highlighting the need for an optimized antimicrobial stewardship program to develop effective strategies for the management of nosocomial infections. Multifaceted interventions targeting modifiable risk factors are essential to reduce the occurences of these nosocomial infections in ICU patients.

Keywords

Nosocomial infections / Extensively drug-resistant Acinetobacter baumannii / Mortality / Intensive Care Unit

Conflict of interest statement

We declare that we have no conflict of interest

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions

ALR contributed to the concept and design of the study, drafting the manuscript, data curation, interpretation, critical revision of the article, final approval of the version to be published, writing- original draft, writing-review and editing, supervision and project administration. APM contributed in data analysis, interpretation of results, drafting sections of the manuscripts, writing-review and editing. JNS contributed to data identification, clinical diagnosis and assessment, data visualization and supervision. PDP involved in data collection, data curation, data analysis, interpretation, drafting the manuscript, critical revision of the article, writing-original draft and editing.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Acknowledgements

We extend our sincere thanks to Dr. Shivkumar Iyer HOD, Department of Critical Care Medicine, Infectious diseases, and Infection Control for allowing us to conduct our research in their facilities.

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