September 23, 2025Open Access

Silent crisis in the intensive care unit: Current antimicrobial resistance landscape in an Indian hospital

Key Points

The study found that 28.3% of samples cultured positive for bacterial pathogens, indicating significant infection rates in ICUs.
Klebsiella pneumoniae was the most prevalent organism at 34.4%, with an alarming carbapenem resistance rate of 88.4%.
Continuous surveillance is essential to optimize empirical treatment strategies and combat rising antimicrobial resistance levels.
Robust antimicrobial stewardship and stringent infection control are urgently needed to mitigate multidrug-resistant organism prevalence.

Abstract

ABSTRACT Introduction: Antimicrobial resistance (AMR) is a growing concern, particularly in critical care, where patients are more susceptible to infections by multidrug-resistant organisms. Understanding local resistance trends is essential for guiding effective empirical therapy. This study aimed to assess the prevalence and resistance profile of bacterial pathogens isolated from patients admitted in intensive care units (ICUs) in a tertiary care hospital located in northwestern India. Materials and Methods: This was a retrospective observational study conducted for 1 year from January 2024 to December 2024 in the Department of Microbiology at a tertiary care teaching hospital in northwestern India. All clinical specimens (blood, urine, pus, respiratory secretions, etc.) from patients admitted in ICU were processed using standard microbiological protocols. Organism identification and antimicrobial susceptibility testing were performed using a VITEK-2 Compact system and interpreted using Clinical Laboratory Standard Institute guidelines. Results: Out of 8858 samples received, 2507 (28.3%) were culture-positive. Gram-negative bacteria constituted 60.4% of isolates, predominated by Klebsiella pneumoniae (34.4%), 88.4% being carbapenem resistant. Among nonfermenters, Acinetobacter baumannii (23.6%) was most common with carbapenem resistance around 98.4%. For Gram-positive, Enterococcus spp 245 (44.6%) predominated, followed by Coagulase-negative Staphylococcus (39.9%). The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) was 58% and 39.7%, respectively. Conclusions: Our ICU ecosystem harbors a substantial burden of multidrug-resistant organisms, including alarming levels of carbapenem-resistance, MRSA, and VRE. These data underscore the urgent need for robust antimicrobial stewardship and stringent infection control practices. Continuous surveillance is vital to optimize empirical treatment strategies in critical care settings.

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