A Comparative study of drug resistance in bacterial isolates from environmental sources and patients with special reference to Critical Care Unit at AIIMS Rishikesh

An ICU has the most seriously ill patients of the hospital. Often the patients are infected with various bacteria. The routine culture sensitivity reporting requires a minimum time interval of 48-72 hours. The patients are so critical that it is not possible to wait for the microbial culture reports and empirical therapy has to be started as early as possible. The microbial population of ICUs is usually different from other areas of the hospital and usually much more resistant as compared to other areas of the hospital. Also many opportunistic pathogens may be present in an ICU Setting. They may be present on equipment being used, other patients, medical and paramedical staff attending them and the surrounding environment of the ICU. Patients in ICU are more susceptible to infections caused by opportunistic pathogens as they have low body resistance due to various underlying diseases, duration of stay in ICU, use of invasive devices like ventilator or catheters etc., immune

suppression or disrupted physiological barriers. These opportunistic bacteria are often resistant to most of the antibiotics due to extreme selective pressure in ICU, making them a highly dangerous source of infection for susceptible patients. Since the susceptibility pattern of bacteria differ from place to place and since the prevalence of predominant microorganisms also varies, the pathogens prevalent in a particular setting along with their susceptibility patterns must be known in order to formulate rationale prescribing of antimicrobials.

Primary Objective – Since drug resistant opportunistic pathogen are present in the environment of the ICU as well as they are carried by the medical and paramedical staff, an attempt will be made to isolate them from the environment and hands of the medical staff and also from infected patients whose cultures are routinely sent and will be maintained as stock culture to see if a correlation exists between the two.

Secondary Objective – Their drug susceptibility pattern will also be studied to find out suitable antibiotic to be started empirically before the culture and sensitivity report is available.