Prevalence of Microorganism in The intensive Care Unit (Icu)Patients and Their Association With Indoor environment

Abstract

A six month cross sectional study was undertaken with an objective to determine theprevalence of microorganisms in the clinical specimens of suspected patients admittedfor more than 48 hours to the Intensive Care Unit (ICU) at the National Institute ofNeurological and Allied Sciences (NINAS) Hospital, Kathmandu, Nepal and to traceout their possible sources of transmission. Microorganisms from 687 clinical specimensand 677 environmental samples (hands and anterior nares of Health Care Workers(HCWs), air, water, fabrics/clothes, equipments and other inanimate objects) wereidentified by conventional microbiological method and antibiogram was performed byKirby-Bauer disc diffusion method and Clinical Laboratory Standard Institute (CLSI)guidelines. Microorganisms isolated from clinical and environmental samples weretested for their relatedness on the basis of their observational microbiological charactersfollowed by statistical analysis. Pseudomonas aeruginosa (61.3%), Klebsiellapneumoniae (24.7%), Acinetobacter spp. (22.7%), Escherichia coli (7.6%) andStaphylococcus aureus(4.9%) were isolated from 404 (58.8%) growth positive clinicalspecimens. 83.0% (n=562) culture positive environmental samples also found to contain38.9% ofP. aeruginosa, 14.5% ofK. pneumoniae, 15.3% ofAcinetobacterspp., 10.3%ofE. coli and 51.6% ofS. aureus. Clinical and environmental isolates ofAcinetobacterspp. demonstrated marked resistance to common antibiotic tested includingCefoperazone/Sulbactam, Piperacillin/Tazobactam and Imipenem except Polymyxin B(100% susceptibility).P. aeruginosa,K. pneumoniaeandE. coli isolates from clinicalspecimens exhibited relatively higher sensitivity (84.6%, 94.0% and 83.8%respectively) to Imipenem while from environment expressed 100% sensitivity. Themost effective antibiotic for all the isolates of S. aureuswas Vancomycin with 100%efficacy. Microbial analysis reflected similarity in occurrence pattern, microbiologicalcharacters and antibiotic sensitivity pattern among the clinical and environmentalisolates. Simultaneous statistical analysis also demonstrated significant associationbetween clinical and environmental isolates (p<0.05) indicating some degree ofrelatedness among them. This signified that environment of ICU may act as potentsource of pathogens. The allocation of environmental sources harboring pathogensaided the hospital to implement the intervention strategies to control the particularsources of pathogens. Key words:ICU, HCWs, fabrics/clothes, inanimate objects, relatedness.