Epidemiology and Clinical Outcome of Common Multi-drug Resistant Gram-negative Bacterial Infections in a Network of Hospitals in India (IMPRES): A Multicenter Intensive Care Unit-based Prospective Clinical Study
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<h5 class="section-title" id="d902396e562">Background and aims</h5>
<p dir="auto" id="d902396e564">India witnessed the exponential rise of antibiotic resistance due to the high burden
of communicable disease. The Indian Council of Medical Research reported
<i>Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii</i>, and
<i>Klebsiella pneumoniae</i> (PEAK organisms) as the most common gram-negative isolates, constituting 65.5% of
total isolates. The present study aimed to observe the demographics and clinical outcomes
of patients infected with these four common gram-negative bacteria in ICUs across
India.
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<h5 class="section-title" id="d902396e573">Patients and methods</h5>
<p dir="auto" id="d902396e575">This prospective multicentric observational study was conducted in ICUs of 19 hospitals
across India. The data collected for each patient included: demography, diagnosis,
disease severity score, site of infection, PEAK organism, risk factors for multidrug
resistance, antibiotic sensitivity, resistance pattern, total ventilator days, and
28-day mortality. Subgroup analysis of 28-day mortality was done for community-acquired
vs hospital-acquired infection, appropriate empirical antibiotic, Carbapenem- and
Colistin-resistant infections.
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<h5 class="section-title" id="d902396e578">Results</h5>
<p dir="auto" id="d902396e580">A total of 936 patients were included in the analysis. Resistance to Cephalosporin,
Fluroquinolones, Piperacillin Tazobactam, Carbapenem, Aminoglycosides, and Colistin
was observed in 84, 68, 55, 47, 37, and 4.2% of patients, respectively. The 28-day
crude mortality rate was 23.5%, which was higher in the subgroup with isolates resistant
to empiric antibiotics compared to those with sensitive isolates (29.6 vs 21.4%,
<i>p</i> > 0.05). Moreover, 32 and 27% mortality rates were observed in patients who were
infected with Carbapenem-resistant and Colistin-resistant PEAK organisms, respectively.
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<h5 class="section-title" id="d902396e586">Conclusion</h5>
<p dir="auto" id="d902396e588">The present study observed a high prevalence of antibiotic resistance in Indian ICUs,
contributing to a crude mortality rate of 23.5%. Patients with Carbapenem and Colistin
resistance may exhibit higher 28-day crude mortality.
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<h5 class="section-title" id="d902396e591">How to cite this article</h5>
<p dir="auto" id="d902396e593">Das SK, Joshi Z, Govil D, Shah MS, Jakaraddi GN, Sinha S,
<i>et al</i>. Epidemiology and Clinical Outcome of Common Multi-drug Resistant Gram-negative Bacterial
Infections in a Network of Hospitals in India (IMPRES): A Multicenter Intensive Care
Unit-based Prospective Clinical Study. Indian J Crit Care Med 2025;29(6):504–509.
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<p dir="auto" id="d902396e598">CTRI identifier: CTRI/2023/01/049121.</p>
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