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Bulletin, Postgraduate Institute of Medical Education and Research, Chandigarh 43: 77-84 (2009)
Epidemiological survey of nosocomial infections in patients admitted to medical high dependency unit from the emergency department
S Kumar , A Bhalla , V Suri , N Sharma , A Sharma , S Varma
Background: Nosocomial infections (NI) occur worldwide and affect both developed and resource-poor countries leading to increased morbidity and mortality with important economic consequences. There are few prospective studies on NI from Indian subcontinent. Aims: To study the epidemiology, hospital course and outcome of NI in patients admitted to medical high dependency unit (MHDU) from the emergency department (ED). Settings and Design: A prospective observational study in a tertiary care referral hospital. Material and Methods: All patients admitted from October 2006 to January 2007 to the MHDU from ED for more than 48 hours were included in this study. Demographic data such as age, gender and clinical status at admission to MHDU was noted. The type of infection at the presentation was noted. Antibiotics received from outside center and its appropriateness was also documented. Spectrum of NI developing in patients including duration after hospital admission and antibiotics given were also documented. Types of micro-organisms isolated from various body fluids were also noted. Results: One hundred two patients admitted over a period of four months (October 2006 to January 2007) and with a MHDU stay of more than 48 hours were studied. Sixty six were male and 36 were female patients. Mean age of the group was 46+/-13.7 years. Sixty seven patients had evidence of infection at the time of presentation. Twenty four patients developed hospital acquired infection. Fourteen patients developed pneumonia, seven had urinary tract infection, two patients had features of sepsis of unknown origin and one patient developed secondary peritonitis. Microbiological results were positive in eight patients. Three patients grew klebsiella -pneumoniae and methicillin resistant staphylococcus aureus (MRSA) was grown in two patients. Out of 24 patients who had acquired hospital infection, 12 improved while other 12 died. Conclusions: Nosocomial infection is an important contributor to morbidity and mortality in MHDU. The predominant pathogens are resistant gram negative entrobactereciae and MRSA This calls for placement of strict antibiotic prescription policy based on local hospital flora and institution of simple hand washing techniques and other measures of asepsis.