Antibiotic Prescription, Organisms and its Resistance Pattern in Patients Admitted to Respiratory ICU with Respiratory Infection in Mysuru

M Mahendra, B S Jayaraj, K S Lokesh, S K Chaya, Vivek Vardhan Veerapaneni, Sneha Limaye, Raja Dhar, Rajesh Swarnakar, Shrikant Ambalkar, P A Mahesh, M Mahendra, B S Jayaraj, K S Lokesh, S K Chaya, Vivek Vardhan Veerapaneni, Sneha Limaye, Raja Dhar, Rajesh Swarnakar, Shrikant Ambalkar, P A Mahesh

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.

Keywords: Antibiotic resistance; mortality; pneumonia; respiratory infection.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart depicting number of patients screened, included in the study and number of survival and deaths
Figure 2
Figure 2
(a) Common organisms isolated and their resistance pattern of organisms isolated in patients with pneumonia. (b) Common organisms isolated and their resistance pattern of organisms isolated in patients with COPD. (c) Common organisms isolated and their resistance pattern of organisms isolated in patients with empyema
Figure 3
Figure 3
(a) Common organisms isolated and their antibiotic resistance in patients with prior antibiotic use. (b) Common organisms isolated and their antibiotic resistance in patients with no prior antibiotic use
Figure 4
Figure 4
Common organisms and their resistance pattern in patients with normal lung, underlying diseased lung, and ventilator-associated pneumonia
Figure 5
Figure 5
Antibiotic prescription pattern to patients admitted to respiratory Intensive Care Unit with respiratory infection
Figure 6
Figure 6
Comparison of proportion of resistance to Piperacillin-tazobactum in relation to prior antibiotic use

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