Oct-Dec, 2011 - Indian Journal of Pharmacy Practice

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Indian Journal of Pharmacy PracticeAssociation of Pharmaceutical Teachers of IndiaA Retrospective Study of Nosocomial infections in Patients Admitted in M.I.C.U1 1 2Pratham R* , Manmohan S , Vipin R1School of Pharmaceutical Sciences, Jaipur National University, Jaipur -302025, (Rajasthan.), India2Nariender Mohan Hospital and Heart Center, Ghaziabad, (Uttar Pradesh), IndiaA B S T R A C TSubmitted: 22/10/2011Accepted: 3/11/2011In present study, the current status of nosocomial infection, rate of infection and distribution of infection was analysed in patients admitted inMICU of a multispecialty hospital. Clinical data were collected from patients that presented with symptoms of nosocomial infection in MICU. Weexamined of 128 patients who were admitted in Nariender mohan hospital, Ghaziabad from August 2010 to May 2011. The research approachadopted in the study was a retrospective method. Incidence of nosocomial infections in MICU patients was 10.93% (14/128 patients). Urinarytract infection (42.85%) was the most frequent; followed by Lower respiratory infection (14.28%), surgical site infection (14.28%),Gastroenteritis (14.28%), Blood stream infection and Meningitis (7.14%). The nosocomial infection was seen more in the 40 to 60 year of age.The male was more prone to nosocomial infections than the female. Nosocomial infections are common in geriatric patients in the MICU setting.More studies are needed to be carried out in Indian population to plan long term strategies for prevention and management of nosocomialinfections.INTRODUCTIONInfections acquired during hospital stay are generally callednosocomial infections. Formerly, they were defined as1infections arising after 48 hours of hospital admission .National Nosocomial Infections Surveillance system definesa nosocomial infection as a localized or systemic conditionthat results from adverse reaction to the presence of aninfectious agent(s) or its toxin(s) that was not present or1incubating at the time of admission to the hospital . Asincubation period varies with the type of pathogen andpatients underlying condition, each infection must beassessed individually. As incubation period varies withsituations in which an infection is considered to be1,2nosocomial ;(I) Infection that is acquired in the hospital, but does notbecome evident until hospital discharge.(ii) Infection in a neonate that results from passage throughbirth canal.The elderly have defective host defenses that compromisetheir ability to ward off infectious agents. Factors whichinfluence immune competence are immune senescence,changes in non adaptive immunity, chronic diseases,medications, malnutrition and functional impairments. T-Address for Correspondence:Pratham R, School of Pharmaceutical Sciences, Jaipur National University,Jaipur -302025, (Rajasthan.), IndiaE-mail: prathamsrathore@gmail.comlymphocyte production and proliferation decline with age,which results in decreased cell-mediated immunity anddecreased antibody production to new antigens. Thinning ofskin, enlarged prostate, diminished cough reflex and otheranatomic or physiologic accompaniments of aging arechanges in non adaptive immunity that render the elderlymore vulnerable to infection. Chronic diseases such as cancer,malnutrition, atherosclerosis, diabetes mellitus, and dementia2predispose to certain types of infections .In addition to these, functional impairments (like immobility,incontinence, dysphasia) associated with aging necessitatethe use of urinary catheters, feeding tubes, and other invasive3devices enhancing susceptibility to nosocomial infections .There is an urgent need to focus our attention to problems ofgeriatric patients, specifically infections among MedicalIntensive Care Unit (MICU) admissions. According to4, 5, 6published literature the most prevalent nosocomialinfections among patients in the Intensive Care Unit (ICU) areurinary tract infection, pneumonia, bloodstream infections,skin and soft tissue infections, gastro-enteritis, hepatitis andcentral nervous system infections like meningitis.Billions of dollars are used annually in the developedcountries alone for the control of just these hospital acquiredinfections alone which reflect another aspect of the magnitudeof the problem. The magnitude of the problems of thenosocomial infections in other countries is even more seriousand in a developing country like India, one could one assume(since there is no established recognized statistics) theIndian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 62
Pratham R - A Retrospective Study of Nosocomial infections in Patients Admitted in M.I.C.Upathetic picture in terms of morbidity, mortality as well as theinvisible but very valuable economic loss. The otherfrustrating fact regarding the natural history of Nosocomial orHospital Acquired Infections is that they can not be eradicatedentirely; but many of them can be prevented by proper controlmeasures. In places where control programmes can beimplemented, there had been a proven reduction of morbidityand mortality. Furthermore, the money that can be saved byreduction of nosocomial infections is much more used forinfection control.MATERIAL AND METHODSThe study was a retrospective analytical study. Themethodology involved collection of data ofnosocomial infections from patient records, analysis ofinfections, their causes and distribution pattern of pathogens.To carry out this work, a total of 128 records of patientsadmitted to multidisciplinary MICU during December 2010to May 2011 at Nareiender mohan Hospital, Ghaziabad wereconsidered and out of these 14 belonged to medical [nonsurgical] cases. Detailed history and physical examination7notes were reviewed in all patients. A diagnostic criterion fornosocomial infection is given in table 1.7Table 1: Diagnostic criteria for nosocomial infectionsNosocomial Clinical features Laboratory featuresInfectionUrinary tractinfectionPneumoniaBlood streamInfections.Skin and softtissueInfections1. Fever2. Lower abdominalpain Change in urinecharacteristics1. Fever2. Pleuritic chest pain3. Decreased intensityof breath sounds4. Presence orincrease in ralesUnexplained fever withchills and rigor Pain,tenderness or purulentdrainage at the site ofinsertion of IV accessor CVP Catheter1. Pain, swelling,tenderness orinflammation andwarmth of skin2. Purulent drainagefrom skin3. Fever1. Leukocytosis2. Positive urine culture5(10 CFU of a singleorganism per ml ofurine)1. Leukocytosis2. Sputum for Gramstain3. Positive sputumculture4. Positive chest x-ray1. Leukocytosis2. Positive bloodculture3. Positive CVPcatheter culture(after catheterremoval)1. Smear for Gramstain2. Positive swabculture3. LeukocytosisNosocomial Clinical features Laboratory featuresInfectionGastroenteritisMeningitisRESULT1. Increased frequencyof stools2. Change inconsistency of stools3. Fever4. Dehydration1. Fever2. Altered sensorium3. Headache4. Neck stiffness5. Vomiting .1. Leukocytosis2. Positive stool culture1. Leukocytosis2. CSF- cell count, celltype, culture, sugar,proteinThe present study was conducted on 128 patients admitted inhospital MICU. Fourteen of 128 patients (10.93%) admittedto the MICU suffered from nosocomial infection, there were11 males and 3 females. The mean duration of stay of thepatients in the hospital was 14.4 days. Table 2 gives thedistribution of the nosocomial infections in these patients.Table 2: Distribution of nosocomial infectionsAmong Nosocomial Positive PatientsNosocomial infections No. of patients PercentageUrinary tract infection 6 42.85%Pneumonia 2 14.28%Soft tissue infections 2 14.28%Gastroenteritis 2 14.28%Blood stream infections 1 7.14%Meningitis 1 7.14%In our study, we observed that the distribution of nosocomialinfections in MICU patients were UTI (42.85%), LRTI(14.28%), SSI (14.28%), GI (14.28%), BSI(7.14%) andmeningitis (7.14%).The distribution of pathogens in nosocomial infection wasdescribed in table 3. According to study the commonpathogens for nosocomial infection was PseudomonasAeruginosa (urinary tract infection), E.coli (urinary tract andgastroenteritis), Staphylococcus Aureus (urinary tract andblood stream infection) and staphylococcus epidermidis(surgical site infection).Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 63
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