Prevalence And Impact Of Nosocomial Infections In The ICU Of A Tertiary Care Hospital In Central India

Abstract

Background: Nosocomial infections, or hospital-acquired infections (HAIs), are a major concern in healthcare, especially in critical care units where patients are highly vulnerable due to invasive procedures and prolonged hospital stays. These infections contribute significantly to morbidity, mortality, and healthcare costs. This study aimed to investigate the prevalence, etiological factors, and antibiotic resistance patterns of nosocomial infections in the intensive care unit (ICU) of a tertiary care hospital in Central India.

Methods: A prospective observational study was conducted over 18 months, from May 2022 to October 2023, in a 32-bed ICU at a tertiary care hospital in Central India. Data were collected from all ICU admissions using specific infection surveillance forms, excluding pre-existing infections through baseline cultures. Antibiotic susceptibility testing was performed according to Clinical Laboratory Standards Institute (CLSI) guidelines using the Kirby-Bauer disk diffusion method. Nosocomial infection rates were calculated based on CDC guidelines.

Results: Out of 679 patients admitted during the study period, 166 (24.44%) developed device-associated infections. The infections included 73 cases of catheter-associated urinary tract infections (CAUTI) (10.75%), 86 cases of central-line-associated bloodstream infections (CLABSI) (13.50%), and 39 cases of ventilator-associated pneumonia (VAP) (6.15%). The most common pathogens were Pseudomonas aeruginosa, Acinetobacter species, and Klebsiella pneumoniae. High levels of antibiotic resistance were observed, particularly against cefotaxime, ceftazidime, and ciprofloxacin. Risk factors such as diabetes, chronic obstructive pulmonary disease (COPD), and prolonged ICU stays were significantly associated with the development of infections. The mortality rate was higher among patients with device-associated infections (48.7%) compared to those without (31.5%).

Discussion: The prevalence and patterns of nosocomial infections observed in this study are comparable to those reported in other similar settings. The study underscores the critical need for stringent infection control practices and antimicrobial stewardship to combat the high rates of antibiotic resistance and improve patient outcomes in ICU settings. By comparing our findings with current literature, we identify areas for targeted intervention and highlight the importance of continuous monitoring and research to refine infection prevention strategies.

Conclusion: This study provides a comprehensive understanding of the nosocomial infection landscape in an ICU setting in Central India, highlighting the prevalence, common pathogens, and antibiotic resistance patterns. The findings emphasize the necessity of robust infection control measures and ongoing healthcare worker training to reduce infection rates and enhance patient care in critical care environments.