title: Antibiogram of Medical Intensive Care Unit at Tertiary Care Hospital Setting of Pakistan.
abstract: OBJECTIVE
  To determine the frequency of micro-organisms causing sepsis as well as to determine the antibiotic susceptibility and resistance of microorganisms isolated in a medical intensive care unit.
  
  
  METHODS
  This is a cross-sectional analysis of 802 patients from a medical intensive care unit (ICU) of Shifa International Hospital, Islamabad, Pakistan over a one-year period from August 2015 to August 2016. Specimens collected were from blood, urine, endotracheal secretions, catheter tips, tissue, pus swabs, cerebrospinal fluid, ascites, bronchoalveolar lavage (BAL), and pleural fluid. All bacteria were identified by standard microbiological methods, and antibiotic sensitivity/resistance was performed using the disk diffusion technique, according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data was collected using a critical care unit electronic database and data analysis was done by using  the Statistical Package for Social Sciences (SPSS), version 20 (IBM SPSS Statistics, Armonk, NY).
  
  
  RESULTS
  Gram-negative bacteria were more frequent as compared to gram-positive bacteria. Most common bacterial isolates were Acinetobacter (15.3%), Escherichia coli (15.3%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (10.2%), whereas Enterococcus (7%) and methicillin-resistant staphylococcus aureus (MRSA) (6.2%) were the two most common gram-positive bacteria. For Acinetobacter, colistin was the most effective antibiotic (3% resistance). For E.coli, colistin (0%), tigecycline (0%), amikacin (7%), and carbapenems (10%) showed low resistance. Pseudomonas aeruginosa showed low resistance to colistin (7%). For Klebsiella pneumoniae, low resistance was seen for tigecycline (0%) and minocycline (16%). Overall, ICU mortality was 31.3%, including miscellaneous cases.
  
  
  CONCLUSIONS
  Gram-negative infections, especially by multidrug-resistant organisms, are on the rise in ICUs. Empirical antibiotics should be used according to the local unit specific data. Constant evaluation of current practice on basis of trends in multidrug resistance and antibiotic consumption patterns are essential.
authors: Department of Pulmonology & Critical Care Medicine, Shifa International Hospital, Islamabad, Pakistan.
authors: Aayesha
authors: A
authors: Qadeer
authors: Department of Pulmonology & Critical Care Medicine, Shifa International Hospital, Islamabad, Pakistan.
authors: Aftab
authors: A
authors: Akhtar
authors: Medical Officer, Shifa International Hospital, Islamabad, Pakistan.
authors: Qurat Ul
authors: QU
authors: Ain
authors: Nephrology, Shifa International Hospital, Islamabad, Pakistan.
authors: Shoab
authors: S
authors: Saadat
authors: Department of Neurology, Shifa International Hospital, Islamabad, Pakistan.
authors: Salman
authors: S
authors: Mansoor
authors: Department of Neurology & Neurosurgery, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
authors: Salman
authors: S
authors: Assad
authors: Department of Pulmonology & Critical Care Medicine, Shifa International Hospital, Islamabad, Pakistan.
authors: Wasib
authors: W
authors: Ishtiaq
authors: Department of Pulmonology & Critical Care Medicine, Shifa International Hospital, Islamabad, Pakistan.
authors: Abid
authors: A
authors: Ilyas
authors: Department of Internal Medicine & Infectious Diseases, Shifa International Hospital, Islamabad, Pakistan.
authors: Ali Y
authors: AY
authors: Khan
authors: Shifa International Hospital, Islamabad, Pakistan.
authors: Yousaf
authors: Y
authors: Ajam
keywords: antibiogram; bacteria; resistance