https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/194 Thu, 20 Apr 2017 10:41:39 +0000 Critically ill patients admitted in intensive care units (ICU) are always at a higher risk of developing infections with various antibiotic resistant organisms. The objective of this study was to know the antibiotic resistance pattern of the common isolates from blood, urine, respiratory secretions and pus/wound swab of patients admitted in ICU at BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder) hospital, during a one year period from March 2006 to February 2007. A total of 1660 samples were analyzed. Growth was obtained in 34% of the samples yielding 632 organisms. The major organism isolated were Pseudomonas sp. (29.1%), Acinetobacter sp. (27.5%), Candida sp. (12.8%), Escherichia coli (10.3%) and Klebsiella sp. (9.7%). Staphylococcus aureus, Enterobacter sp, Citrobacter sp, Enterococcus sp, Providencia sp and Serratia sp accounted for 10.6% of the isolates. All the isolates were highly resistant (>80%) to cephalosporins and fluoroquinolones. The frequency of third generation cephalosporin resistant E. coli, Klebsiella and imipenem resistant Pseudomonas and Acinetobacter were >50%. Acinetobacter was remarkably resistant to most antibiotics including imipenem (>70% resistant), but most of the members of the Enterobacteriacae group showed maximum sensitivity to imipenem (50%-94%). The findings of this study might help clinicians to formulate their first line empirical antibiotic treatment regimens for the patients admitted in ICUs. Address for Correspondence:Dr. Lovely Barai, Assistant Professor, Department of Microbiology, BIRDEM, 122 Kazi Nazrul Islam Avenue, Dhaka 1000. e-mail: barai_lovely@yahoo.com   Critically ill patients admitted in intensive care units (ICU) are always at a higher risk of developing nosocomial infections with resistant strains.1 Patients admitted in ICUs have an increased susceptibility to infection because of decreased mobility and increased use of invasive devices.2 A knowledge of the antibiotic susceptibility of the organisms isolated in the ICU helps to formulate an antibiotic policy for the ICU. This also avoids unnecessary use of broad spectrum antibiotics and prevents emergence of drug resistant bacterial strains.7 The data on the changing antibiotic susceptibility trends is important for infection control activities in ICU settings. Presently, data on pattern of organisms and their antibiotic susceptibility in ICUs of large hospitals of our country are lacking. Therefore, the present study was undertaken to determine the pattern of organisms causing infection in ICU with their antibiotic sensitivity patterns over a one year period in a 600 bed tertiary care hospital of Dhaka city. This data may be useful to plan antibiotic guidelines as well as antibiotic cycling in ICU settings. Material and Methods   A total of 1660 samples were analyzed which included blood (811), urine (372), respiratory secretions (448) and pus or wound swab (29). Out of 1660 samples, organisms were isolated from 564 samples (Table 1). Table 1: Sample profile and rate of positive culture from different samples       Major organisms isolated from blood were Pseudomonas sp. (51.7%) and Acinetobacter sp. (18.4%) while from urine it was Candida sp (43.3%) and E. coli (19.3%). The most frequently isolated organisms from both respiratory secretions and pus were Acinetobacter sp. (40.9% and 27% respectively) and Pseudomonas sp. (32.9% and 27% respectively).     About 77 % of isolated S. aureus were methicillin resistant (MRSA). Discussion In this study, about 55.7% of the organisms were isolated from respiratory secretions (sputum and tracheal aspirate) which probably were due to the fact that most patients either had prior respiratory problems or were in ventilators. Reduction in antimicrobial resistance in the ICUs has been a goal for all intensive care units as it improves the outcome and reduces total expenses as well as duration of ICU stay. The extreme antibiotic use results in the emergence of multi-resistant microorganisms in the ICU environment. The present study revealed high prevalence of antibiotic resistant organisms in our ICU. More than 75% Pseudomonas sp. showed resistance to third generation cephalosporins and fluoroquinolons. In 2005, a study conducted in the same ICU reported 82% of Pseudomonas as resistant to third generation cephalosporins.11 But it has been observed that the frequency of fluoroquinolon and imipenem resistant Pseudomonas (79.1% and 58.9%) has increased in the present study compared to that of 2005 (48% and 36% respectively). Candida species was the third frequently isolated organism in our ICU. Both C. albican and non- albican Candida species were found. Most were isolated from urine. High number isolation of Candida might be due to the presence of underlying conditions like poor nutritional status, diabetes mellitus and the use of steroids and broad spectrum antibiotics.   1.   Singh AK, Sen MR, Anupurba S, Bhattacharya P. Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU. Journal of Communicable Diseases 2002; 34: 257-263. 3.   Kaul S, Bahmadathan KN, Jagannati M, Sudarsanam TD, Pitchamuthe K, Abraham OC et al. One year trends in the gram negative bacterial antibiotic susceptibility patterns in a medical intensive care unit in South India. Indian J Med Microbiology 2007; 25: 230-5. 5.   Patwardhan RB, Dhakephalkar PK, Niphadkar KB, Chopade BA. A study on nosocomial pathogens in ICU with special reference to multiresistant Acinetobacter baumannii harbouring multiple plasmids. Indian J Med Res 2008; 128: 178-187. 7.   Tullu MS, Deshmukh CT, Baveja SM. Bacterial profile and antimicrobial susceptibility pattern in catheter related nosocomial infections. J Postgraduate Med 1998; 44: 7-13. 9.   Bauer AW, Kirby WMM, Sherris JC, Tierch M. Antibiotic susceptibility testing by a standardized sigle disc method. Am J Clin Pathol 1966; 45: 493-9. 11.Basunia MRA, Rahman MR, Faruq MO, Huq F, Ahsan A, Hasan R, Ahmed B. Microbial pathogens and antibiotic sensitivity at intensive care unit of BIRDEM: A retrospective study. Bangladesh J Medicine 2005; 16: 14-20. 2026 Ibrahim Medical College. 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