title: Antimicrobial Resistance Surveillance among Intensive Care Units of a Tertiary Care Hospital in Southern India.
abstract: BACKGROUND
  Hospital Acquired Infections (HAIs) are the rising threat in the health care facilities across the globe. As most Intesive Care Unit (ICU) patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs.
  
  
  OBJECTIVE
  To study the occurrence of different types of HAIs in patients admitted to various ICUs of JIPMER and the AMR pattern of the bacterial pathogens isolated from them.
  
  
  METHODS
  The record based retrospective data of culture reports of the patients admitted to all the ICUs of JIPMER during the period from April 2015 to March 2016 were collected. A total of 3,090 isolates were obtained from the clinical specimens of 1,244 patients. Data on various factors like demographic characters, type of ICU, infecting organism, site of infection, type of HAI's and AMR including co-resistance were collected and analysed using Microsoft Excel.
  
  
  RESULTS
  Most common culture positive clinical specimen received was tracheal aspirate (29.9%) followed by exudate (22.7%).Acinetobacterspp from tracheal aspirate andPseudomonasspp from blood specimens were the most common organisms isolated; whereasEscherichia coliwas the predominant organism found in urine, exudate and sterile fluid specimens. About 22.2% infections were HAIs, out of which pneumonia (6.24%) was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli (GNB) was Multi Drug Resistant (MDR) i.e., resistant to three or more class of antibiotics such as cephalosporins, carbapenems, aminoglycosides, tetracyclines and fluoroquinolones. The prevalence of Methicillin- resistantStaphylococcus aureus(MRSA) and Vancomycin- resistantEnterococci(VRE) were found to be 40.6% and 11.9% respectively.
  
  
  CONCLUSIONS
  The increasing trend AMR among the hospital acquired pathogens such as MDR-GNBs, MRSA and VRE pose a great threat to HCWs as well as to the other critically ill patients of the ICUs. Study on AMR surveillance is the need of the hour as it helps the centers to generate local antibiogram which further helps in formulating the national data. It also guides the clinicians to choose appropriate empirical therapy and assist escalation and de-escalation wherever possible. Hence, such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial use.
authors.affiliation: Student, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: Kailash
authors.initials: K
authors.lastname: Moolchandani
authors.affiliation: Assistant Professor, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: Apurba Sankar
authors.initials: AS
authors.lastname: Sastry
authors.affiliation: Senior Resident, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: R
authors.initials: R
authors.lastname: Deepashree
authors.affiliation: Professor, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: Sujatha
authors.initials: S
authors.lastname: Sistla
authors.affiliation: Professor, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: B N
authors.initials: BN
authors.lastname: Harish
authors.affiliation: Associate Professor, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: Jharna
authors.initials: J
authors.lastname: Mandal
keywords: Gram negative bacteria; Hospital acquired infection; Multidrug resistance