Multidrug Resistant Acinetobacter Infection in Surgical Intensive Care Unit in a Tertiary Care Center in North India

Introduction: Acinetobacter is nowadays a common threat in hospital, acquired especially in critically ill patients admitted to intensive care unit. This study was done to determine the presence of MDR Acinetobacter species in patients admitted in surgical intensive care unit in our hospital, so that timely steps are taken to prevent their spread, protect patients from inappropriate therapy and ensure proper infection control measures. Material and Methods: Prospective study was designed in the Department of Microbiology and surgical intensive care unit, Sher I Kashmir Institue of Medical Sciences,Soura J&K, between December 2015 to March 2016. The samples were inoculated on 5% sheep blood agar and MacConkey agar and incubated overnight aerobically at 37οC. After the isolation of typical colonies, the identification was done as per standard microbiological techniques. Antibiotic susceptibility was performed according to CLSI recommendations. Results: A total of 77 non duplicate samples were received from surgical ICU. Out of these 77 samples, 48 were positive and 29 samples were sterile. Out of 48 positive samples, 30 isolates of Acinetobacter spp were isolated. Maximum 23.3% were from the 60-70 year age group and maximum were obtained from tracheal aspirate 96.6%. Twenty five patients had prolonged hospital stay i.e; ≥ 7 days where as only 5 of the patients were in the hospital for ≤ 7 days before the Acinetobacter was isolated from their samples. Twenty eight were on ventilator support. Twenty nine (96.6%) isolates were resistant to Amikacin, and Tobramycin each. Higher resistance was also seen for Tetracycline, Tigecycline, Gentamicin, Levofloxacin and Cefotaxime (93.3% each). Twenty seven (90%) of isolates were resistant to Cefepime, 86.6% of isolates were resistant to Meropenem and Imipenem each. All the Acinetobacter isolated (100%) were sensitive to Polymyxin B. Nineteen isolates (63.3%) were sensitive to Pipercillin+tazobactum. Conclusion: Risk factors in ICU patients like advanced age, ventilator support, prolonged hospital stay should raise suspicion of MDR Acinetobacter infection and the antibiotic should be given only after susceptibility test.