A Study on Microbiological Profile of Blood Stream Infections in patients admitted in Intensive Care Unit in a Tertiary Care Hospital.

INTRODUCTION : Blood stream infections (BSI) are the major cause of morbidity and Mortality among patients admitted in Intensive care unit and surveillance of Etiological agents in these infections are important for their prevention & Treatment. Blood stream infection is the infection that required one or more Cultures positive for a bacteria or a fungus of blood samples obtained in the Presence of fever(>380C) not attributable to other causes. Community acquired Bacteremia (CAP) was defined if the first Positive blood culture was obtained before or within 48 hours of Hospitalization. Blood stream infections are considered to be nosocomial if Signs & symptoms of these infections became evident after 48 hours Following hospital admission and/or if the patient had been hospitalized During the 2 weeks before the current admission. The invasion of microorganisms in the circulating blood pose a major threat to every organ in the body leading to serious consequences including shock, multiple Organ failure, DIC & Death. Blood stream infections with primary diseases admitted in ICU are Infective Endocarditis, CAP (community acquired pneumonia), Uro-sepsis & Meningitis. BSI with Secondary Bacteremia are infections resulting from health care interventions such as Vascular catheter insertion, infection following Urinary catheter related sepsis, infection of Surgical sites & infection arising out of hospital acquiredor ventilator associated pneumonia.Vascular access devices are inserted in critically ill patients for the maintenance of fluid Electrolyte Balance, administration of Drugs, maintaining nutritional requirements, monitoring vital parameters, promoting vital organ support & doing essential investigation. AIMS & OBJECTIVES : 1. To isolate the pathogen causing infection in intensive care unit. 2. To identify the possible source of infection. 3. To determine the antimicrobial susceptibility pattern of the isolates. 4. To study the resistance pattern of the common isolates. MATERIALS AND METHODS : This study was reviewed and approved by Institutional ethical committee Madras Medical College and RGGGH, Chennai. Informed written consent was obtained from the study population or their guardians after providing full explanation of the study. All patients satisfying the inclusion criteria were documented and interviewed by structured questionnaire. Statistical analysis were carried out using statistical package for social science (SPSS) and Epi-Info software by a statistician. The proportionaldate of thiscross sectional study were tested using pearson’schi square analysis test and Binomial proportion test. Inclusion Criteria: 1. Patients above 15 yrs of age group. 2. Patients with known Sepsis or strong clinical suspicion of sepsis 3. Signs of SIRS. 4. Dysfunction of atleast one organ system. SIRS criteria: SIRS criteria and proven (or) suspected infection is called sepsis. The criteria includes, (i). Temperature > 38°C or 90/min (iii) RR >20/min (iv). WBC count > 12,000/cu.mm or < 4000cells /cu.mm or 10% immature (band) neutrophil forms. All patients satisfying the inclusion criteria were only documented and were assigned serial numbers. Patients were interviewed by structured questionnaire and their hospital records were used to know about their past medical conditions. They were followed up prospectively until discharged or after admission. Exclusion Criteria: 1. No clinical suspicion of sepsis. 2. Prior antibiotic administration. CONCLUSION : A prospective study was undertaken over a period of one year in 150 patients. To determine the bacterial and fungal isolates causing septicaemia in patients admitted to IMCU (Intensive Medical Care Unit). Fever (10%) and Respiratory distress (19.45%) were the most common presenting symptoms. The culture positivity is 42%. The Spectrum of bacterial isolates were 38.09% GPC (Gram Positive cocci), 55.55% GNB (Gram Negative Bacilli). Fungi contributed to remaining 6.34%. The common Organisms isolated were CONS (Coagulase negative staphylococci) 19.04% and Pseudomonas aeruginosa 17.46%. The Epidemology of BSI in IMCU in the study was nosocomial acquired contributing to 55.6% of cases. All GPC showed 100% sensitivity for Vancomycin except Enterococcus faecilis, 80% sensitivity to Amikacin, 77% sensitivity to Ciprofloxacin and 60% sensitivity to Erythromycin. All GNB except Pseudomonas aeruginosa showed 100% for Imipenam, 90% sensitivity to gentamycin 80% sensitivity to Amikacin, 70% sensitivity to Ciprofloxacin and 60% sensitivity to Erythromycin. Among the Staphylococcus aureus 70% were methicillin resistant and 30% were methicillin sensitive. Staphylococcus epidermidis 66% were methicillin resistant and Staphylococcus schleiferi subsp.schleiferi 66.7% were methicillin resistant