RESUMEN
Background: Intensive care units (ICUs) are burdened with a high frequency of nosocomial infections often caused by multi resistant nosocomial pathogens. Objectives: To determine the common pathogens in medical intensive care unit of Lady Ridgeway Hospital for Children (MICU-LRH) and to look for the pattern of antibiotic resistance of these pathogens. Design & Setting: This retrospective study was performed by tracing all the culture reports of MICU-LRH done at microbiology laboratory of LRH in the year 2006. Results: Total number of blood cultures done in 2006 was 659. Of them 123(18.7%) became positive. Out of positive blood cultures 38.2% were for spores and 24% for coliforms. Staphylococcus aureus (10.6%), streptococcus spp. (4.1%), pseudomonas spp. (4.1%) and candida spp. (4.9%) were the other pathogens in blood cultures. Out of 457 tracheal cultures done in 2006, 251(56%) were positive. Contamination with spores was 3.1%. Majority (43%) of tracheal cultures were positive for coliforms. Other common pathogens were pseudomonas spp. (19.5%) and candida spp. (9.8%) Resistance pattern of coliforms varied in blood cultures and tracheal cultures. There was significant resistance to aminoglycosides. Imipenem & meropenem resistant isolates were not found in blood cultures but in tracheal cultures 44% of isolates were resistant to imipenem & 42% were resistant to meropenem. Resistance pattern of pseudomonas to amikacin was around 34% in both blood & tracheal cultures. 25% of isolates in blood cultures and 50% of isolates in tracheal cultures were resistant to ceftazidime. Although, there was no resistance to ticarcillin in blood cultures, 51% pseudomonas isolated in tracheal cultures showed resistance. Resistance rate to ciprofloxacin was 50% in blood cultures and 34% in tracheal cultures. Eighty three percent of staphylococcus spp. in both blood & tracheal cultures were resistant to cloxacillin. More than 70% were resistant to gentamicin. Around 33% isolates in blood cultures & 22% in tracheal cultures were resistant to fusidic acid. However, all staphylococcus spp. were sensitive to Vancomycin. Conclusions: There were more positive tracheal cultures than blood cultures. Majority of septicaemia were due to coliforms. Coliforms and pseudomonas were major pathogens in tracheal cultures. There was significant colonization of candida spp. in respiratory tract of patients at MICU-LRH in contrast to candida septicaemia. Emergence of antibiotic resistance to broad spectrum antibiotics is a significant problem.