Prevalence of nosocomial infections by multidrug resistant organisms in patients admitted to the critical care area of the Regional cancer center, Gujarat, India

Introduction: Nosocomial infection is a main cause of mortality and morbidity among patients admitted in different critical areas [post-operative, Intensive Care Units (ICU), and for bone marrow transplantation (BMT)] in a hospital. Availability of a clinical microbiology service for patients admitted to critical areas can significantly improve clinical outcome.

Methods: During the study period (January 2014 to March 2014) 330 patients from different oncology departments were admitted to critical areas of the hospital. Conventional and molecular methods were used to determine resistance mechanisms [methicillin resistance (MRSA), extended spectrum β-lactamase (ESBL), carbapenemases and Amp C) of clinically significant isolates.

Results: Of 330 patients admitted to critical care areas during the study period, 84 (25.4%) were identified as having acquired infection during their stay in the critical areas. Of these 84 patients 16 had dual infections. The mean age of patients was 44.5 yrs. The most common infection in the ICU was wound infection (49%) followed by respiratory infection (19%). The most common isolated organisms from wound infection were Escherichia coli (42.8%) followed by Pseudomonas aeruginosa (14.2%). The majority of bacterial isolates were multidrug resistant (MDR). Using both conventional and molecular methods of 88 isolated Gram negative bacilli (GNB), 45.9% were found to be ESBL producers, 16 % Amp C producers and 4.5% carbapenemase producers. The prevalence of MRSA was 30.7% (4/13) by a conventional method and 23% (3/13) using a molecular method.

Conclusion: From this study, we concluded that cancer patients admitted to critical areas are at a greater risk of acquiring nosocomial infection. However, the increasing prevalence of MDR-GNBs, especially those resistant to cephalosporins and carbapenems, could contribute to both increased morbidity and mortality due to non-response to routinely used first line antibiotics and resultant recourse to colistin