Emergence of Multidrug-Resistant Pathogens in a Tertiary Care Hospital in Northern India: A Comparative Study Between Critical Care Units and Wards

Background and aim Multidrug-resistant organisms (MDROs) represent a major global public health concern, largely driven by inappropriate antibiotic use, over-the-counter availability of antimicrobials, and the absence of effective prescription audit systems. MDROs are microorganisms, most commonly bacteria, that exhibit resistance to one or more classes of antimicrobial agents. The burden of multidrug-resistant infections has increased worldwide, with marked rises in both healthcare-associated and community-acquired infections, particularly in regions with high levels of antibiotic misuse. This study aimed to characterize the spectrum of MDROs circulating in a tertiary care center, identify associated risk factors, and describe their antibiotic susceptibility patterns. Methods A prospective observational study was conducted over a period of one month, involving 1,223 clinical specimens from predefined areas. Specimens were processed for culture, identification, and antibiotic susceptibility testing. For all samples, patient demographic details, clinical information, and risk factors were documented and assessed. Infection prevention and control-related information was also documented. Data were analyzed using IBM SPSS Statistics for Windows, version 22.0 (released 2013; IBM Corp., Armonk, NY, USA), with the incorporation of the chi-square test for comparison between categorical variables, and a p-value of < 0.05 was considered statistically significant. Results Of the 1223 specimens, 1020 specimens were culture positive, with 240 (23.52%) yielding MDROs, with the highest proportions isolated from peritoneal fluid, CSF, and pus. Escherichia coli was the most common MDRO, with 73 (30.4%) isolates, followed by 37 (15.4%) isolates of Klebsiella spp., 29 (12.1%) isolates of Pseudomonas spp., and 19 (7.9%) isolates of Acinetobacter spp. The majority of MDROs were isolated from general wards, with 112 (46.7%) MDROs rather than 47 (19.6%) MDROs from the critical care unit. Conclusions This study highlights the significant burden of MDROs in a tertiary care center, with a high proportion of resistance to last-line agents. The findings emphasize the need for regular surveillance, strict adherence to infection control practices, and effective antimicrobial stewardship programs to mitigate the growing MDRO burden. Future recommendations include establishing robust antimicrobial stewardship programs, conducting periodic hospital-specific antibiogram reviews, and promoting research on emerging resistance mechanisms.