title: Healthcare Associated Infections in a Resource Limited Setting.
abstract: BACKGROUND
  Health Care associated Infections (HAI) are the most common complications affecting the hospitalized patients. HAI are more common in developing and under developed countries. However, there are no systematic surveillance programs in these countries.
  
  
  OBJECTIVE
  To find out the burden, predisposing factors and multidrug resistant organisms causing HAI in a resource limited setting.
  
  
  METHODS
  This prospective observational study was done at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Patients aged 13 years or more with stay of more than 48 hours in a 16 bedded Medical Intensive Care Unit (MICU) between November 2011 and April 2013 were included in the study. Patients were prospectively followed up till discharge or death for the development of HAI. Device associated HAI like Ventilator Associated Pneumonia (VAP), Catheter Related-Blood Stream Infection (CR-BSI) and Catheter Associated-Urinary Tract Infections (CA-UTI) were studied. Standard laboratory methods were used for identification of microorganisms causing HAI and to test their antibiotic sensitivity.
  
  
  RESULTS
  A total of 346 patients were included in the study with median age of 38 years. Common indications for admission to Medical Intensive Care Unit (MICU) were poisoning (31.5%); neurological illness (23.4%) like Guillian-Barre syndrome, tetanus, meningitis, encephalitis; respiratory illness (14.5%) like pneumonia, acute respiratory distress syndrome and tropical infections (7.2%) like malaria, scrub typhus, leptospirosis. Fifty percent (174/346) patients developed one or more HAI with VAP being the most common. The rates of HAI per 1000 device days for VAP, CR-BSI, CA-UTI were 72.56, 3.98 and 12.4, respectively.Acinetobacter baumanniiwas the most common organism associated with HAI. Multidrug resistance was seen in 74% of the isolates.
  
  
  CONCLUSIONS
  The burden of HAI, especially with MDR organisms, in resource constrained setting like ours is alarming. There is urgent need for infection control and monitoring system to reduce HAI.
authors.affiliation: Associate Professor, Department of Medicine, JIPMER , Puducherry, India .
authors.forename: Chanaveerappa
authors.initials: C
authors.lastname: Bammigatti
authors.affiliation: Junior Resident, Department of Medicine, JIPMER , Puducherry, India .
authors.forename: Saikumar
authors.initials: S
authors.lastname: Doradla
authors.affiliation: Professor, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: Harish Narasimha
authors.initials: HN
authors.lastname: Belgode
authors.affiliation: Assistant Professor, Department of Biostatistics, JIPMER , Puducherry, India .
authors.forename: Harichandra
authors.initials: H
authors.lastname: Kumar
authors.affiliation: Professor, Department of Medicine, JIPMER , Puducherry, India .
authors.forename: Rathinam Palamalai
authors.initials: RP
authors.lastname: Swaminathan
keywords: Cross infections; Hospital infections; Nosocomial infections