Study: Most ICU Patients Infected Via Ventilators

Ventilators may be intended to offer life support for critically-ill patients but they can also increase the risk of mortality by being carriers of multi-drug resistant bacteria, shows a study in seven leading tertiary care hospitals spread across the country.

A team of intensive care specialists studied close to 380 patients, of whom 346 had at least one ICU-acquired infection, and 35 had more.

The most common source of the bacteria, researchers found, were ventilators — around 64% of patients had pneumonia acquired from these breathing devices. Worse, between 66%-88% of the pathogen strains found in them couldn’t be battled by multiple drugs. A quarter of these patients died.

The study, published recently in the peer-reviewed Indian Journal of Critical Care Medicine, covered 15 ICUs in government and private hospitals in Chennai, Delhi, Mumbai, Hyderabad, Pune and Rohtak.

The other two common ICU-acquired infections were catheter-related blood stream infections (CRBSI) and catheter associated urinary tract infection (CAUTI). While multi-drug resistant pathogens were found to be lesser in these two devices, the mortality rate was higher among those who had CRBSI.

Co-author, Dr N Ramakrishnan, director, Critical Care Services, Apollo Hospital, said the team chose patients who had been in the ICU for more than two days. The onset of the infection from the time of admission to these units varied from 4 to 8 days.

The term ventilator-acquired pneumonia is misleading, said Dr Ramakrishnan. “The device itself isn’t a source. Sometimes, it serves as a conduit, carrying pathogens in the oral cavity into the lungs, bypassing the body’s natural filter system,” he explained. Likewise, bacteria at the mouth of the urethra can also be pushed in when a catheter is inserted to collect urine. However, Ramakrishnan admitted in many cases it could be because of “poor handling” of the tubes by hospital attendants after nursing other patients.

Multi-drug resistance, doctors found, was most prevalent in two strains –Acinetobacter and Pseudomonas species – which were transmitted by all three lifesaving devices. They were sensitive only to colistin, which doctors call a “last hope” antibiotic.

Critical care experts said most hospitals in India are reluctant to share their ICU and hospital-acquired infection rates unlike institutions in the West. A 2012 report found that one in every eight patients in India die from infections contracted in ICUs, based on their study of 4,209 patients across 17 states.

“ICU-acquired infection is a quality issue and every patient has the right to not get a secondary infection while being treated,” said paediatric intensive care specialist Dr Bala Ramachandran.

Doctors say it is impossible to achieve zero infections in any ICU. “Hospitals that claim ‘zero-infections ICU’ are either not actively detecting infections or not treating enough patients who are really sick,” said Dr Ramesh Venkataraman of Apollo Hospitals in Chennai who led the study. “Human bodies carry their own bacteria. The least we can do is identify these pathogens and take steps to minimize them.”ET Health World