Major articles Intensive care unit-acquired infections in a tertiary care hospital: An epidemiologic survey and influence on patient outcomes Sanwar M. Mitharwal MD a , Sandhya Yaddanapudi MD a, *, Neerja Bhardwaj MD a , Vikas Gautam MD, PhD b , Manisha Biswal MD b , Lakshminarayana Yaddanapudi MD, DA a a Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India b Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Key Words: Antibiotic Laboratory-confirmed bloodstream infection Microorgansims Nosocomial infection Ventilator-associated pneumonia Background and objective: Nosocomial infections are common in intensive care units (ICUs), but the pattern of infections and the distribution of microorganisms vary. We studied the ICU-acquired infections and their effect on patient outcomes in our ICU. Methods: Patients admitted to our ICU for >48 hours were studied prospectively over a year. Infections were diagnosed based on Centers for Disease Control and Prevention guidelines. Antibiotics were ad- ministered based on culture and sensitivity. Univariate and multivariate logistic regressions were carried out to determine the factors associated with infection. Results: One hundred ninety-eight patients were studied. The crude infection rate was 50% with ventilator- associated pneumonia (40%) and bloodstream infection (21%) being the most common. Acinetobacter calcoaceticus-baumannii complex, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most common microorganisms. More than 90% of patients received antibiotics, the most common being β lactam-β lactamase inhibitors, aminoglycosides, fluoroquinolones, and carbapenems. Thirty-five percent of staph- ylococci were methicillin-resistant, 50% of Enterococcus strains were vancomycin-resistant, and 68% of Acinetobacter calcoaceticus-baumannii complex, 47% of Pseudomonas strains, and 35% of Klebsiella strains were multidrug-resistant. A longer duration of ventilation was associated with infection. The overall ICU mortality rate was 24% and was similar in patients with or without infection. Conclusions: The incidence of infection and the multidrug resistance in the ICU was high. Infection was associated with duration of ventilation but not mortality. © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. The incidence of hospital-acquired infections is 2-5 times greater in intensive care units (ICUs) than in the general inpatient popu- lation of hospitals. 1 The antimicrobial resistance rates are also much higher in ICUs than in general ward settings. 2 ICU-acquired infections (IAIs) affect patient morbidity and mor- tality. The mortality due to infections in an ICU can be effectively reduced by timely and appropriate empiric antimicrobial therapy. The empiric treatment of infections in ICU settings requires knowl- edge of the epidemiology of infections as well as the antimicrobial resistance patterns of the local microbiologic flora. 3 The rates and types of hospital-acquired infections, the distribution of predom- inant organisms, and the pattern of antimicrobial resistance vary across geographic regions, among different hospitals, and among different ICUs of the same hospital. We conducted an epidemiologic study to determine the inci- dence of ICU-acquired infections and their influence on patient outcome in the main ICU of our hospital. MATERIALS AND METHODS A prospective, observational study was conducted from July 2010- June 2011 in the 12-bed main ICU of our hospital (CTRI/2014/08/ 004879). The main ICU is a mixed ICU that caters to both medical and surgical patients. It is managed by anesthesiologists with anesthesia-specialty resident physicians being present around the clock and has a nurse to patient ratio of 1:2. The standard infec- tion prevention protocols followed in our ICU include hand hygiene * Address correspondence to Sandhya Yaddanapudi, MD, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India. E-mail address: sandhya.yaddanapudi@gmail.com (S. Yaddanapudi). Conflicts of Interest: None to report. ARTICLE IN PRESS 0196-6553/© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2016.01.021 American Journal of Infection Control ■■ (2016) ■■-■■ Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control