Bacterial Pattern and Antibiogram of Isolates from the Patients Admitted in a Pediatric Intensive Care Unit of Central Gujarat: A Prospective Observational Study

Abstract

Background: The incidence of hospital acquired infection (HAI) is 5-7 folds more in ICU set up. In last two decades, along with antibiotic related adverse effects, HAI has become a special health problem resulting in increased morbidities, mortalities and burden of cost. There is a wide diversity in the incidence of microbial agents and their antimicrobial susceptibility from the various set ups such as indoor wards, Neonatal intensive care units (NICUs), PICUs etc. There is also variation in the proportion and types of infections among different subsets of patients within the same PICU at different season and due to geographical variation of the diseases. Objective: To assess the antimicrobial sensitivity pattern of bacterial isolates from the patients admitted in the PICU of a tertiary care center of central Gujarat. Methodology: This was a prospective observational hospital-based study, carried out at tertiary care center at Kashiben Gordhandas Patel children hospital, Vadodara, Gujarat, India from September 2019 to May 2020. Patients admitted to PICU were assessed for eligibility and enrolled after obtaining parental consent and checking for inclusion criteria. Patients were inquired about the presenting symptoms and were examined thoroughly. Clinical profile and demographical details were taken as per proforma. Basic hematological investigations such as complete blood count and C reactive protein were done in all cases. Various tissue samples were taken from the patients admitted in a PICU with positive septic screen to identify the bacterial isolates and their sensitivity pattern. Results: A total of 691 cases were admitted in PICU. Among the total 90 positive cultures, 61(67.7%) bacterial isolates were Gram negative (GN) bacteria, while 23(25.5%) were Gram-positive (GP) bacteria and 6(6.6%) were mycobacterium tuberculosis. S.typhi was the commonest bacteria found in 27% of the clinical specimens, followed by E.coli found in 22%, P. aeruginosa and Klebsiella pneumoniae in 7% each. Among GP isolates, Staphylococcus aureus was found in 14% of which MRSA was seen in 2%. S.pneumoniae and Enterococcus spp. were detected in 7% and 4% respectively. Conclusion: Common microorganisms found were Salmonella typhi in blood, E coli in urine, S. aureus in pus, pseudomonas and streptococcus pneumonia in CSF culture. Gram-negative bacteria were the predominant pathogens. Most gram-negative bacterial isolates showed resistance to multiple antibiotics but S Typhi still have good sensitivity for ceftriaxone/cefotaxim. Gram positive isolates especially S aureus showed resistance to commonly used antibiotics like penicillin, pipercillin+tazobactum but high sensitivity for newer drugs like linezolid, vancomycin, teicoplanin & tigecycline.