Outcomes of Healthcare-Associated Infections in Respiratory Intensive Care Unit

BACKGROUND: Healthcare-associated infections (HAIs) are the major cause of morbidity and mortality. This study aimed to investigate the prevalence, microbiological profile, resistance patterns, risk factors, and outcomes of HAIs in a respiratory ICU (RICU) of a tertiary care hospital in Nepal. METHODS: A prospective observational study was conducted in RICU. HAIs were diagnosed according to the CDC criteria. Descriptive statistics were reported as mean (SD) and frequencies. Unpaired t-tests, chi-square tests were used for comparisons, and multivariable logistic regression was used to assess the risk factors. RESULTS: Among 121 ICU admissions, 42 patients developed 50 episodes of HAI, yielding a prevalence of 34.7%. Ventilator-associated pneumonia was the most common HAIs. The most frequently isolated organisms were Acinetobacter baumannii in 42.0% and Klebsiella pneumonia in 18.0%. Both were resistance to Ceftriaxone. Resistance to Piperacillin-tazobactam were 85.8% and 77.8% and to carbapenems were 92% and 90% respectively. Tigecycline resistance was seen in 20% of Acinetobacter isolates and none of the Klebsiella isolates. Sensitivity to Polymyxin B was 100%. Mechanical ventilation, urinary catheters and history of prior hospitalization were the strongest predictors of HAI. Patients who developed HAI had a longer ICU stay (9.5 vs. 5.2 days, p=0.001) and higher mortality (28.6% vs. 13.9%, p=0.04). CONCLUSIONS: HAIs, particularly VAP caused by MDR organisms, were common in our ICU and there was a high resistance to beta lactams and carbapenem antibiotics. Low resistance to tigecycline and polymyxin B warrants careful stewardship.