Satheesh Chandra Sugatha Rao1, Shara Beena2
BACKGROUND
Lower respiratory tract infections are the most common bacterial infections in
neurosurgery intensive care units (NSICU), resulting in high overall mortality. The
emergence of antibiotic resistant pathogens poses a challenge to their empiric
treatment. Regular surveillance of the prevalent strains and their susceptibility
pattern, helps to revise the antibiotic policies and aids in better management of
the patient.
METHODS
A cross sectional study was conducted in the Department of Neurosurgery and
Microbiology, Government Medical College, Thrissur, over a period of 1 year, using
lower respiratory tract specimens of 190 patients with acute respiratory symptoms
admitted in neurosurgery intensive care unit. The specimens collected aseptically
were processed immediately. Following culture, the bacterial isolates were
identified using standard methods and antibiotic susceptibility was done by Kirby
Bauer disc diffusion method. The data obtained was coded and entered in
Microsoft Excel and expressed as percentage.
RESULTS
Bacterial isolates were obtained from 74 % samples. 82 % isolates were
monomicrobial and 18 % were polymicrobial. Majority of the isolates were gram
negative bacteria (94 %) followed by gram positive bacteria (6 %). The common
gram-negative isolates were K. pneumoniae (36 %), A. baumannii (29 %), P.
aeruginosa (20 %). Methicillin-resistant staph (MRSA) (3 %) and methicillinsusceptible
staph (MSSA) (3 %) accounted for the gram positive cocci. 61 %
isolates were multi drug resistant (MDR). Most common MDR organism was A.
baumannii. It was observed that 26 % isolates were extended spectrum betalactamase
(ESBL) producers. A high rate of resistance to cephalosporins, beta
lactams, fluoroquinolones, aminoglycosides, and cotrimoxazole was observed. An
emerging resistance to carbapenems was observed.
CONCLUSIONS
Proper microbiological work up and antibiotic stewardship programmes can limit
spread of resistant organisms, thereby reducing the medical and economic burden
of the patient.
