AMEI's Current Trends in Diagnosis & Treatment

Register      Login

VOLUME 2 , ISSUE 1 ( January-June, 2018 ) > List of Articles


Antimicrobial Resistance Profile in ICUs of Tertiary Care Hospital—A Worrisome State of Affairs

Navreet Kaur, Poonam Sharma, Sarabjit Sharma

Keywords : Intensive care units (ICUs), Nosocomial infections, Multi drug resistance organisms (MDROs).

Citation Information : Kaur N, Sharma P, Sharma S. Antimicrobial Resistance Profile in ICUs of Tertiary Care Hospital—A Worrisome State of Affairs. Curr Trends Diagn Treat 2018; 2 (1):1-3.

DOI: 10.5005/jp-journals-10055-0028

License: NA

Published Online: 01-06-2018

Copyright Statement:  NA


Background and objectives: Nosocomial infections/Hospitalacquired infections (HAI) constitute an important problem worldwide accounting for high morbidity and mortality as well as longer hospital cost and stay. An intensive care unit (ICU) is often the epicenter of infection, due to its extremely vulnerable population. Consequently, ICUs have highest occurrence rates of nosocomial infections causing an enormous impact on health and often survival. This study was therefore aimed to know the prevalence and antibiotic susceptibility profile of various organisms causing HAI in ICUs of a Tertiary Care Hospital and Medical College. Materials and methods: A total of 847 consecutive samples mostly respiratory secretions, blood, and urine were collected from patients admitted in 6 ICUs of a tertiary care hospital and medical college from January 2017 to December 2017 and processed as per Clinical and Laboratory Standards Institute (CLSI) guidelines in the Microbiology department. Final identification and antimicrobial susceptibility testing of isolates were done by the automated Vitek 2 system. Results: Among the 847 samples processed 513 (60.5%) were positive for growth. Gram-negative organisms 366/513 (71.34%) were more commonly isolated than 147/513 (28.65%) Gram-positive organisms. Multidrug-resistant (MDR), Klebsiellapneumoniae, Acinetobacterbaumannii complex and Pseudomonasaeruginosa along with Extended-spectrum betalactamases (ESBL) producing Escherichia coli among Gramnegative organisms and methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) among Gram-positive were the most conspicuous findings. Conclusion: Our results showed higher resistance among all microorganisms in the ICUs compared to the rest of the hospital, the fact that highlights that ICUs should act as a critical point in the control of nosocomial infections.

PDF Share
  1. Finkelstein R, Rabina G, Kasis I. and Mahamid E. Deviceassociated, device-day infection rates in an Israeli adult general intensive care unit. J Hosp Infect. 2000;44:200-205.
  2. Luna CM, Rodriguez-Noriega E, Bavestrello L, Guzmán-Blanco M. Gram-Negative Infections in Adult Intensive Care Units of Latin America and the Caribbean. Critical Care Research and Practice [Internet]. Hindawi Limited; 2014;2014:1-12.
  3. Arnold HM, Micek ST, Skrupky LP, Kollef MH. Antibiotic stewardship in the intensive care unit. Semin Respir Crit Care unit Med. 2011;32:215-227.
  4. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N et al. Antibiotic resistance- the need for global solutions. Lancet Infect Dis. 2013;13:1057-1098.
  5. Leuthner KD. Doern GV. Antimicrobial stewardship programs. J ClinMicrobiol. 2013;51(12) : 3916-3920.
  6. Bergmans DC, Bonten MJ, Gaillard CA, Tirl FH, Geest S, Stobberingh EE et al. Indications for antibiotic use in ICU patients: a one-year prospective surveillance. J AntimicrobChemother. 1997;39:527-535.
  7. Roberts JA, Paul SK, Akova M, Bassetti M, De Waele JJ, Dimopoulos G et al. DALI: defining antibiotic levels in intensive care unit patients: are current beta-lactam antibiotic doses sufficient for critically ill patients?.Clin Infect Dis. 2014; 58:1072-1083.
  8. Kollef MH. Optimizing antibiotic therapy in the intensive care unit setting. Crit Care 2001;5:189-195.
  9. Akalin H, Kahveci F, Ozakin C, HelvaciS, Gedikoglu S, Kutlay O, et al. Influences of alternate therapy protocol and continuous infectious disease consultation on antibiotic susceptibility in ICU. Intensive Care 1999;25:1010-1012.
  10. Küçükates E, Kocazeybek B. High resistance rate against 15 different antibiotics in aerobic gram-negative bacteria isolates of cardiology intensive care unit patients. Indian J Med Microbiol. 2002;20(4):208-210.
  11. Verbist L. Epidemiology and sensitivity of 8625 ICU and hematology/oncology bacterial isolates in Europe. International Study Group. Scand J Infect Dis Suppl. 1993;91:14-24.
  12. Aksaray S, Dokuzouz B, Guvener E, et al. Surveillance of antimicrobial resistance among gram negative isolates from intensive care units in eight hospitals in Turkey. J Antimicrob- Chemother. 2000;45:695-699.
  13. Shah PM, Asanger R, Kahan FM. Incidence of multi-resistance in Gram-negative aerobes from intensive care units of 10 German hospitals. Scand J Infect Dis Suppl. 1991;78 : 22-34.
  14. Snydman DR. Clinical implications of multi-drug resistance in the intensive care unit. Scandinavian J Infect Dis Suppl. 1991;78:54-63.
  15. Whittington BR, Durward CS. Survey of anomalies in primary teeth and their correlation with the permanent dentition. N Z Dent J 1996 Mar;92(407):4-8.
  16. Kramer PF, Feldens CA, Ferreira SH, Spiguel MH, Feldens EG. Dental anomalies and associated factors in 2- to 5-year old Brazilian children. Int J Paediatr Dent 2008 Nov;18(6):434-440.
  17. Chen YH, Cheng NC, Wang YB, Yang CY. Prevalence of congenital dental anomalies in the primary dentition in Taiwan. Pediatr Dent 2010 Nov-Dec;32(7):525-529.
  18. Yonezu T, Hayashi Y, Sasaki J, Machida Y. Prevalence of congenital dental anomalies of the deciduous dentition in Japanese children. Bull Tokyo Dent Coll 1997 Feb;38(1): 27-32.
  19. Mukhopadhyay S, Mitra S. Anomalies in primary dentition: their distribution and correlation with permanent dentition. J Nat Sci Biol Med 2014 Jan;5(1):139-143.
  20. Daugaard-Jensen J, Nodal M, Kjær I. Pattern of agenesis in the primary dentition: a radiographic study of 193 cases. Int J Paediatr Dent 1997 Mar;7(1):3-7.
  21. Nagaveni NB, Bajaj M, Muthusamy K, Poornima P, Pai SM, Subba Reddy VV. Concomittent mandibular hypo-hyperdontia: report of two rarest cases with the literature review. Int J Contemp Dent Med Rev 2014;6:1-6.
  22. Kapdan A, Kustarci A, Buldur B, Arslan D, Kapdan A. Dental anomalies in the primary dentition of Turkish children. Eur J Dent 2012 Apr;6(2):178-183.
  23. Gaur A, Mallikarjuna RM, Sujan SG. Multiple congenital missing primary teeth: a case report. J Int Oral Health 2011 Aug;3(4):29-32.
  24. Pinho T, Tavares P, Maciel P, Pollmann C. Developmental absence of maxillary lateral incisors in the Portuguese population. Eur J Orthod 2005 Oct;27(5):443-449.
  25. Poornima P, Shruthi AS, Nagaveni NB, Roopa KB. A case report: nonsyndromic familial oligodontia. Int J Infor Res Rev 2015 Jul;2(7):853-855.
  26. Dhanrajani PJ. Hypodontia: etiology, clinical features and management. Quintessence Int 2002 Apr;33(4):294-302.
  27. Ephraim R, Rajamani T, Feroz TM, Abraham S. Agenesis of multiple primary and permanent teeth unilaterally and its possible management. J Int Oral Health 2015 May;7(5): 68-70.
  28. Endo T, Ozoe R, Kojima K, Shimooka S. Congenitally missing mandibular incisors and mandibular symphysis morphology. Angle Orthod 2007 Nov;77(6):1079-1084.
  29. Daugaard-Jensen J, Nodal M, Skovgaard LT, Kjær I. Comparison of the pattern of agenesis in the primary and permanent dentitions in a population characterized by agenesis in the primary dentition. Int J Paediatr Dent 1997 Sep;7(3):143-148.
  30. Ooshima T, Sugiyama K, Sobue S. Oligodontia in the primary dentition with permanent successors: report of case. ASDC J Dent Child 1988 Jan-Feb;55(1):75-77.
  31. Cho SY, Lee CK. Congenitally missing maxillary primary canines: report of three cases. Int J Paediatr Dent 2006 Nov;16(6):444-447.
  32. Venkataraghavan K, Anantharaj A, Prasanna P, Sudhir R. Oligodontia in the primary dentition: report of a case. J Dent Child (Chic) 2007 May-Aug;74(2):154-156.
  33. Shilpa, Thomas AM, Joshi JL. Idiopathic oligodontia in primary dentition: case report and review of literature. J Clin Pediatr Dent 2007 Fall;32(1):65-67.
  34. Shilpa, Mohapatra A, Reddy CP, Sivakumar N. Congenital absence of multiple primary teeth. J Indian Soc Pedod Prev Dent 2010 Oct-Dec;28(4):319-321.
  35. Selva Kumar H, Swaminathan K, Thomas E, Varghese JS. Congenitally missing primary lateral incisors along with permanent successors: a case report. Int J Dent Case Rep 2012;2(1):47-49.
  36. Goswami M, Chaitra TR, Singh S, Kulkarni AU. Congenitally missing primary mandibular lateral incisors: a case of rare occurrence. BMJ Case Rep 2012 Aug;2012:006472.
  37. Nirmala SV, Gokhale N, Sivakumar N, Quadar MA. Agenesis of multiple primary teeth and its rehabilitation: a case report. Int J Clin Pediatr Dent 2013 Jan-Mar;6(1):55-57.
  38. Birnboim-Blau G, Spierer S, Keinan D. Congenital bilateral missing primary mandibular canines while their successors exist: a case report. Dentistry 2014 Mar;4:224.
  39. Kokich V Jr. Early management of congenitally missing teeth. Semin Orthod 2005 Sep;11(3):146-151.
  40. Nagaveni NB, Radhika NB, Satisha TS. Concomitant occurrence of canine transmigration and symmetrical agenesis of mandibular incisors. A case report. Bangladesh J Med Sci 2011 Apr;10(2):132-136.
  41. Schwartz-Arad D, Herzberg R, Dolev E. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol 2004 Apr;75(4):511-516.
  42. Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus. J Oral Maxillofac Surg 2006 Feb;64(2):277-282.
  43. Berengo M, Sivolella S, Majzoub Z, Cardioli G. Endoscopic evaluation of the bone-added osteotome sinus floor elevation procedure. Int J Oral Maxillofac Surg 2004 Mar;33(2):189-194.
  44. van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing DB. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000 Jun;11(3):256-265.
  45. Aimetti M, Massei G, Morra M, Cardesi E, Romano F. Correlation between gingival phenotype and Schneiderian membrane thickness. Int J Oral Maxillofac Implants 2008 Nov-Dec;23(6):1128-1132.
  46. Tissot RJ, Sullivan HC. Evaluation of survival of partial thickness and full thickness flaps. J Dent Res 1971;50:170.
  47. Mormann W, Schaer F, Firestone AR. The relationship between success of free gingival grafts and transplant thickness. Revascularization and shrinkage—a one year clinical study. J Periodontol 1981 Feb;52(2):74-80.
  48. McFall WT Jr. The laterally repositioned flap—criteria for success. Periodontics 1967 Mar-Apr;5(2):89-92.
  49. Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, Cortellini P. Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol 1999 Sep;70(9): 1077-1084.
  50. Cho KH, Yu SK, Lee MH, Lee DS, Kim HJ. Histological assessment of the palatal mucosa and greater palatine artery with reference to subepithelial connective tissue grafting. Anat Cell Biol 2013 Sep;46(3):171-176.
  51. Ahmad I. Anterior dental aesthetics: dental perspective. Br Dent J 2005 Aug;199(3):135-141.
  52. Atwood DA. Post extraction changes in the adult mandible as illustrated by microradiographs and mid-sagittal section and serial cephalometric roentgenographs. J Prosthet Dent 1963;13:810-816.
  53. Uchida H, Kobayashi K, Nagao M. Measurement in vivo of masticatory mucosal thickness with 20 MHz B-mode ultrasonic diagnostic equipment. J Dent Res 1989 Feb;68(2):95-100.
  54. Hermann JS, Buser D, Schenk RK, Schoolfield JD, Cochran DL. Biologic width around one- and two-piece titanium implants. Clin Oral Implants Res 2001 Dec;12(6):559-571.
  55. Cardaropoli G, Lekholm U, Wennstrom JL. Tissue alterations at implant-supported single-tooth replacements: a 1-year prospective clinical study. Clin Oral Implants Res 2006 Apr; 17(2):165-171.
  56. Berglundh T, Lindhe J. Dimension of the peri implant mucosa. Biological width revisited. J Clin Periodontol 1996 Oct;23(10):971-973.
  57. Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 2005 Oct;76(10):1729-1734.
  58. Abrahamsson I, Berglundh T, Wennstrom J, Lindhe J. The peri implant hard and soft tissues at different implant systems. A comparative study in the dog. Clin Oral Implants Res 1996 Sep;7(3):212-219.
  59. Goodacre CJ, Kan JY, Rungcharassaeng K. Clinical complications of osseointegrated implants. J Prosthet Dent 1999 May;81(5):537-552.
  60. Kois JC. Predictable single-tooth peri-implant esthetics: five diagnostic keys. Compend Contin Educ Dent 2004 Nov;25(11):895-900.
  61. Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res 2008 Jan;19(1):73-80.
  62. Romeo E, Lops D, Rossi A, Storelli S, Rozza R, Chiapasco M. Surgical and prosthetic management of interproximal region with single-implant restorations: 1-year prospective study. J Periodontol 2008 Jun;79(6):1048-1055.
  63. Nagaraj KR, Savadi CR, Savadi AR, Prashanth Reddy GT, Srilakshmi J, Dayalan M, John J. Gingival biotype— prosthodontic perspective. J Indian Prosthodont Soc 2010 Mar;10(1):27-30.
  64. Jung RE, Sailer I, Hämmerle CH, Attin T, Schmidlin P. In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent 2007 Jun;27(3): 251-257.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.