Hospital acquired infections in Intensive Care Unit: A study on incidence, antibiotic resistance profile and outcome of the patients in a tertiary care unit in Eastern India

Mandira Chakraborty; Sayani Sardar; Debasish Ghosh; Biyanka Sau; Maria Teresa Mascellino; Arkit Ghoshal; Aniket Rout; Silpak Biswas; Anita Nandi Mitra; Mandira Chakraborty; Sayani Sardar; Debasish Ghosh; Biyanka Sau; Maria Teresa Mascellino; Arkit Ghoshal; Aniket Rout; Silpak Biswas; Anita Nandi Mitra

doi:10.3934/microbiol.2025025

AIMS Microbiology

2025, Volume 11, Issue 3: 588-601. doi: 10.3934/microbiol.2025025

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Research article

Hospital acquired infections in Intensive Care Unit: A study on incidence, antibiotic resistance profile and outcome of the patients in a tertiary care unit in Eastern India

1.
Department of Microbiology, Calcutta Medical College and Hospital, Kolkata, India
2.
Critical Care Unit In-charge, Department of Anesthesiology, Calcutta Medical College, Kolkata, India
3.
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
4.
Department of Microbiology, School of Tropical Medicine, Kolkata, India
These three authors contributed equally.

Received: 22 November 2024 Revised: 18 June 2025 Accepted: 08 July 2025 Published: 21 July 2025

Hospital acquired infections (HAI) are the most common cause of mortality among critically ill patients because of various predisposing factors such as co-morbidities (medical or surgical), invasive devices, a long-term stay in the Intensive Care Unit (ICU), and the use of broad-spectrum empirical antibiotics. HAI in ICUs include mainly four types of infections: Catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), catheter-related urinary tract infection (CAUTI), and surgical site infections (SSI). In this study, we aimed to characterise the bacteriological andantibiotic resistance profiles of all types of HAI along with their outcomes in the ICU of a tertiary care hospital in Eastern India. Patients included in this study were all critically ill patients aged above 12 years who had one or more devices inserted and were admitted in the ICU due to some medical or surgical complication for more than 48 hours. This was a prospective study for a period of three months. Appropriate specimens were collected from admitted patients suspected of having infections for identification and antibiotic susceptibility testing. The outcomes were determined based on either the discharge of the patient, a transfer to a separate ward, or death within the hospital. A total of 169 patients were included in the study, of which 65 patients (38%) acquired an HAI in the ICU. Thirteen patients were diagnosed with multiple types of infections. There were 72 device related infections, of which CRBSI made up 36%, VAP made up 23%, CAUTI made up 20%, and SSI made up 21% of the total patients. The most isolated organism in the ICU setup was Klebsiella spp. (35%), followed by Enterococcus spp. (22%). We found that 92% of the Klebsiella spp. was resistant to Carbapenem and 30% were Vancomycin-Resistant Enterococcus (VRE). The highest mortality was found associated with VAP (73%), followed by CRBSI (52%), SSI (40%), and CAUTI (31%) in the ICU setting. The findings of this study are of great clinical importance and will help in preventing and controlling the spread of HAIs in the ICU.
Citation: Mandira Chakraborty, Sayani Sardar, Debasish Ghosh, Biyanka Sau, Maria Teresa Mascellino, Arkit Ghoshal, Aniket Rout, Silpak Biswas, Anita Nandi Mitra. Hospital acquired infections in Intensive Care Unit: A study on incidence, antibiotic resistance profile and outcome of the patients in a tertiary care unit in Eastern India[J]. AIMS Microbiology, 2025, 11(3): 588-601. doi: 10.3934/microbiol.2025025

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Abstract

Hospital acquired infections (HAI) are the most common cause of mortality among critically ill patients because of various predisposing factors such as co-morbidities (medical or surgical), invasive devices, a long-term stay in the Intensive Care Unit (ICU), and the use of broad-spectrum empirical antibiotics. HAI in ICUs include mainly four types of infections: Catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), catheter-related urinary tract infection (CAUTI), and surgical site infections (SSI). In this study, we aimed to characterise the bacteriological andantibiotic resistance profiles of all types of HAI along with their outcomes in the ICU of a tertiary care hospital in Eastern India. Patients included in this study were all critically ill patients aged above 12 years who had one or more devices inserted and were admitted in the ICU due to some medical or surgical complication for more than 48 hours. This was a prospective study for a period of three months. Appropriate specimens were collected from admitted patients suspected of having infections for identification and antibiotic susceptibility testing. The outcomes were determined based on either the discharge of the patient, a transfer to a separate ward, or death within the hospital. A total of 169 patients were included in the study, of which 65 patients (38%) acquired an HAI in the ICU. Thirteen patients were diagnosed with multiple types of infections. There were 72 device related infections, of which CRBSI made up 36%, VAP made up 23%, CAUTI made up 20%, and SSI made up 21% of the total patients. The most isolated organism in the ICU setup was Klebsiella spp. (35%), followed by Enterococcus spp. (22%). We found that 92% of the Klebsiella spp. was resistant to Carbapenem and 30% were Vancomycin-Resistant Enterococcus (VRE). The highest mortality was found associated with VAP (73%), followed by CRBSI (52%), SSI (40%), and CAUTI (31%) in the ICU setting. The findings of this study are of great clinical importance and will help in preventing and controlling the spread of HAIs in the ICU.

Acknowledgments

The authors wish to acknowledge the medical laboratory technologists of Medical College and Hospital, Kolkata for their help in collecting data.

Conflicts of interest

Maria Teresa Mascellino is an editorial board member for AIMS Microbiology and was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

Author contributions

M. C., S. S., D. G., S. B., A. N. M.: Conceptualization, Methodology, Investigation and Writing Original Draft, Data curation, Formal Analysis, Writing Review and Editing; B. S., A. G., A.R.: Data curation and Formal Analysis; M. T. M.: Validation, Writing Review and Editing; M. C., A. N. M.: Supervision, Project Administration, Validation.

Ethics approval of research

This research has received ethical approval by the Ethics Commission of the Medical College, Kolkata. For this study, the data was collected from laboratory records; therefore, informed consent was not required.

References

[1]	Word Health OrganizationReport on the Burden of Endemic Health Care-associated Infection Worldwide-Clean Care is Safer Care (2011).
[2]	Word Health OrganizationPrevention of hospital-acquired infections-A practical guid (2012).
[3]	Myny D, Depuydt P, Colardyn F, et al. (2005) Ventilator-associated pneumonia in a tertiary care ICU: Analysis of risk factors for acquisition and mortality. Acta Clin Belg 60: 114-121. https://doi.org/10.1179/acb.2005.022
[4]	Depuydt P, Benoit D, Vogelaers D, et al. (2006) Outcome in bacteremia associated with nosocomial pneumonia and the impact of pathogen prediction by tracheal surveillance cultures. Intensive Care Med 32: 1773-1781. https://doi.org/10.1007/s00134-006-0354-8
[5]	Depuydt PO, Blot SI, Benoit DD, et al. (2006) Antimicrobial resistance in nosocomial bloodstream infection associated with pneumonia and the value of systematic surveillance cultures in an adult intensive care unit. Crit Care Med 34: 653-659. https://doi.org/10.1097/01.CCM.0000201405.16525.34
[6]	Guzmán-Herrador B, Molina CD, Allam MF, et al. (2016) Independent risk factors associated with hospital-acquired pneumonia in an adult ICU: 4-year prospective cohort study in a university reference hospital. J Public Health 38: 378-383. https://doi.org/10.1093/pubmed/fdv042
[7]	Blot K, Hammami N, Blot S, Vogelaers D, et al. (2021) Seasonal variation of hospital-acquired bloodstream infections: A national cohort study. Infection Control & Hospital Epidemiology . Cambridge: Cambridge University Press 1-7. https://doi.org/10.1017/ice.2021.85
[8]	Blot S (2021) Antiseptic mouthwash, the nitrate-nitrite-nitric oxide pathway, and hospital mortality: A hypothesis generating review. Intensive Care Med 47: 28-38. https://doi.org/10.1007/s00134-020-06276-z
[9]	Blot S, Ruppé E, Harbarth S, et al. (2022) Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs 70: 103227. https://doi.org/10.1016/j.iccn.2022.103227
[10]	Tajeddin E, Marjan R, Maryam R, et al. (2016) The role of the intensive care unit environment and health-care workers in the transmission of bacteria associated with hospital acquired infections. J Infect Publ Health 9: 13-23. https://doi.org/10.1016/j.jiph.2015.05.010
[11]	Siegel JD, Rhinehart E, Jackson M, et al. (2007) 2007 Guideline for isolation precautions: Preventing transmission of infectious agents in health care settings. Am J Infect Control 35: S65-S164. https://doi.org/10.1016/j.ajic.2007.10.007
[12]	Hatachi T, Tachibana K, Takeuchi M (2015) Incidences and influences of device-associated healthcare-associated infections in a pediatric intensive care unit in Japan: A retrospective surveillance study. J Intensive Care 3. https://doi.org/10.1186/s40560-015-0111-6
[13]	American Thoracic Society, Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med (2005) 171: 388-416. https://doi.org/10.1164/rccm.200405-644ST
[14]	Reignier J, Mercier E, Le Gouge A, et al. (2013) Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: A randomized controlled trial. JAMA 309: 249-256. https://doi.org/10.1001/jama.2012.196377
[15]	Seguin P, Laviolle B, Dahyot-Fizelier C, et al. (2014) Effect of oropharyngeal povidone-iodine preventive oral care on ventilator-associated pneumonia in severely brain-injured or cerebral hemorrhage patients: A multicenter, randomized controlled trial. Crit Care Med 42: 1-8. https://doi.org/10.1097/CCM.0b013e3182a2770f
[16]	Thimmaiah G, Navin P, Shankar P, et al. (2024) Ventilator-associated pneumonia–What price does the public health system pay?. Lung India 41: 278-283. https://doi.org/10.4103/lungindia.lungindia_597_23
[17]	Nicolle LE (2014) Catheter associated urinary tract infections. Antimicrob Resist Infect Control 3: 23. https://doi.org/10.1186/2047-2994-3-23
[18]	Burton DC, Edwards JR, Srinivasal A, et al. (2011) Trends in catheter-associated urinary tract infections in adult intensive care units–the United States, 1990–2007. Infect Control Hosp Epidemiol 32: 748-756. https://doi.org/10.1086/660872
[19]	Leblebicioglu H, Ersoz G, Rosenthal VD, et al. (2013) Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: International Nosocomial Infection Control Consortium findings (INICC). Am J Infect Control 41: 885-891. https://doi.org/10.1016/j.ajic.2013.01.028
[20]	Kumar A, Sharma RM, Jaideep CN, et al. (2014) Diagnosis of central venous catheter-related bloodstream infection without catheter removal: A prospective observational study. Med J Armed Forces India 70: 17-21. https://doi.org/10.1016/j.mjafi.2013.08.001
[21]	Patil HV, Patil VC, Ramteerthkar MN, et al. (2011) Central venous catheter related bloodstream infections in the intensive care unit. Indian J Crit Care Med 15: 213-223. https://doi.org/10.4103/0972-5229.92074
[22]	Singh S, Chaturvedi R, Garg SM, et al. (2013) Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital. Med J Armed Forces India 69: 124-129. https://doi.org/10.1016/j.mjafi.2012.08.028
[23]	Wattal C, Oberoi JK (2012) Infections in pediatric intensive care units (PICU). Indian J Pediatr 79: 647-649. https://doi.org/10.1007/s12098-012-0696-x
[24]	Atici S, Soysal A, Kadayifci EK, et al. (2016) Healthcare-associated infections in a newly opened pediatric intensive care unit in Turkey: Results of four year surveillance. J Infect Dev Ctries 10: 254-259. https://doi.org/10.3855/jidc.7517
[25]	Patricia MT (2021) Bailey & Scott's Diagnostic Microbiology. Amsterdam, The Netherlands: Elsevier.
[26]	Kouchak F, Askarian M (2012) Nosocomial infections: The definition criteria. Iran J Med Sci 37: 72-73.
[27]	(2020) CLSIPerformance Standards for Antimicrobial Susceptibility Testing. Wayne: Clinical and Laboratory Standards Institute.
[28]	Dasgupta S, Das S, Chawan NS, et al. (2015) Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian J Crit Care Med 19: 14-20. https://doi.org/10.4103/0972-5229.148633
[29]	Zolfaghari PS, Wyncoll DL (2011) The tracheal tube: Gateway to ventilator-associated pneumonia. Crit Care 15: 310-317. https://doi.org/10.1186/cc10352
[30]	Grgurich PE, Hudcova J, Lei Y, et al. (2013) Diagnosis of ventilator-associated pneumonia: Controversies and working toward a gold standard. Curr Opin Infect Dis 26: 140-150. https://doi.org/10.1097/QCO.0b013e32835ebbd0
[31]	Mietto C, Pinciroli R, Patel N, et al. (2013) Ventilator associated pneumonia: Evolving definitions and preventive strategies. Respir Care 58: 990-1007. https://doi.org/10.4187/respcare.02380
[32]	Haddadin Y, Annamaraju P, Regunath H (2024) Central Line–Associated Blood Stream Infections. Florida: StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430891
[33]	Werneburg GT (2022) Catheter-associated urinary tract infections: Current challenges and future prospects. Res Rep Urol 14: 109-133. https://doi.org/10.2147/RRU.S273663
[34]	Zabaglo M, Leslie SW, Sharman T (2024) Postoperative Wound Infections. Florida: StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560533/
[35]	Gunasekaran S, Mahadevaiah S (2020) Healthcare-associated infection in intensive care units: Overall analysis of patient criticality by acute physiology and chronic health evaluation IV scoring and pathogenic characteristics. Indian J Crit Care Med 24: 252-257. https://doi.org/10.5005/jp-journals-10071-23384
[36]	Kumar A, Chaudhry D, Goel N, et al. (2021) Epidemiology of intensive care unit-acquired infections in a tertiary care hospital of North India. Indian J Crit Care Med 25: 1427-1433. https://doi.org/10.5005/jp-journals-10071-24058
[37]	Elnasser Z, Obeidat H, Amarin Z (2021) Device-related infections in a pediatric intensive care unit: The Jordan university of science and technology experience. Medicine 100: e27651. https://doi.org/10.1097/MD.0000000000027651
[38]	Duszynska W, Rosenthal VD, Szczesny A, et al. (2020) Device associated–health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015–2017). BMC Infect Dis 20: 761. https://doi.org/10.1186/s12879-020-05482-w
[39]	Gunalan A, Sastry AS, Ramanathan V, et al. (2023) Early- vs Late-onset ventilator-associated pneumonia in critically ill adults: Comparison of risk factors, outcome, and microbial profile. Indian J Crit Care Med 27: 411-415. https://doi.org/10.5005/jp-journals-10071-24465
[40]	Ch'ng JH, Chong KKL, Lam LN, et al. (2019) Biofilm-associated infection by enterococci. Nat Rev Microbiol 17: 82-94. https://doi.org/10.1038/s41579-018-0107-z
[41]	Said MS, Tirthani E, Lesho E (2024) Enterococcus Infections. Florida: StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567759/
[42]	García-Solache M, Rice LB (2019) The Enterococcus: A model of adaptability to its environment. Clin Microbiol Rev 32. https://doi.org/10.1128/CMR.00058-18
[43]	Smout E, Palanisamy N, Valappil SP (2023) Prevalence of vancomycin-resistant Enterococci in India between 2000 and 2022: A systematic review and meta-analysis. Antimicrob Resist Infect Control 12: 79. https://doi.org/10.1186/s13756-023-01287-z
[44]	Sivaradjy M, Gunalan A, Priyadarshi K, et al. (2021) Increasing trend of vancomycin-resistant enterococci bacteremia in a tertiary care hospital of South India: A three-year prospective study. Indian J Crit Care Med 25: 881-885. https://doi.org/10.5005/jp-journals-10071-23916
[45]	Chakraborty M, Sardar S, De R, et al. (2023) Current trends in antimicrobial resistance patterns in bacterial pathogens among adult and pediatric patients in the intensive care unit in a tertiary care hospital in Kolkata, India. Antibiotics 12: 459. https://doi.org/10.3390/antibiotics12030459
[46]	Ibrahim ME (2023) Risk factors in acquiring multidrug-resistant Klebsiella pneumoniae infections in a hospital setting in Saudi Arabia. Sci Rep 13: 11626. https://doi.org/10.1038/s41598-023-38871-7
[47]	Moglad E, Alanazi N, Altayb HN (2022) Genomic study of chromosomally and plasmid-mediated multidrug resistance and virulence determinants in Klebsiella pneumoniae isolates obtained from a tertiary hospital in Al-Kharj, KSA. Antibiotics 11: 1564. https://doi.org/10.3390/antibiotics11111564
[48]	Zowawi HM, Balkhy HH, Walsh TR, et al. (2013) β-lactamase production in key gram-negative pathogen isolates from the Arabian Peninsula. Clin Microbiol Rev 26: 361-380. https://doi.org/10.1128/CMR.00096-12
[49]	Xu L, Sun X, Ma X (2017) Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Ann Clin Microbiol Antimicrob 16: 18. https://doi.org/10.1186/s12941-017-0191-3
[50]	Tacconelli E, Carrara E, Savoldi A, et al. (2018) Discovery, research, and development of new ntibiotics: The WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis 18: 318-27. https://doi.org/10.1016/S1473-3099(17)30753-3
[51]	Rosenthal VD, Maki DG, Salomao R, et al. (2006) Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 145: 582-591. https://doi.org/10.7326/0003-4819-145-8-200610170-00007
[52]	Salgado YE, Bovera MM, Rosenthal VD, et al. (2017) Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International nosocomial infection control consortium's findings. World J Biol Chem 8: 95-101. https://doi.org/10.4331/wjbc.v8.i1.95
[53]	Blot S, Ruppé E, Harbarth S, et al. (2022) Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs 70: 103227. https://doi.org/10.1016/j.iccn.2022.103227

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