Nosocomial infections in surgical intensive care unit: A retrospective single-center study.

AIMS: This study aims to study the incidence, microbiological and antibiotic sensitivity and resistance profile and impact on intensive care units (ICUs) stay and mortality of nosocomial infections in patients admitted to surgical ICU of our hospital. METHODS: A retrospective analysis of all patients admitted, over the course of 1 year, in the surgical ICU was undertaken. All patients who developed nosocomial infections were included in the study. Incidence, sites, common organisms of nosocomial infection were identified. The antibiotic sensitivity pattern of the microorganisms which were cultured was identified. This group of patients with nosocomial infections was matched with group of patients without nosocomial infections with respect to age, gender, and clinical diagnosis and the impact of nosocomial infections on ICU stay, and mortality was studied. RESULTS: Of 1051 patients admitted to the ICU during the study, 350 patients developed nosocomial infections and were included in the study group. Of the remaining patients, 350 patients matching the patients in the study group were included in the control group. The prevalence of nosocomial infections in our study was 33.30%. Skin and soft tissue infections (36.30%), including postoperative wound infections were the most common nosocomial infection, followed by respiratory infections (24.46%) and genitourinary infections (23.40%). The most common organisms causing nosocomial infections were Escherichia coli (26.59%) and Acinetobacter species (18.08%). About 40% of all Gram-negative organisms isolated were multidrug resistant. The average length of stay in ICU was 14.4 days for patients with nosocomial infections and 5.4 days (P < 0.05) for matched patients without nosocomial infections. The mortality in patients with nosocomial infections was 25.14% while that in patients without nosocomial infections was 10.57% (P < 0.05). Overall ICU mortality was 14.27%. CONCLUSIONS: Nosocomial infections in surgical ICU patients significantly increase ICU length of stay and mortality.

Exchange Transfusion in Severe Falciparum Malaria.

Malaria is endemic in India with the incidence of P. falciparum Malaria increasing gradually over the last decade. Severe malaria is an acute disease, caused by P. falciparum, but increasingly also by P. vivax with major signs of organ dysfunction and/or high levels of parasitaemia (>10%) in blood smear. Use of exchange transfusion with antimalarial drug therapy as an additional modality of treatment in severe Falciparum malaria is controversial and is unclear. We report a case of severe malaria complicated by multiorgan failure and ARDS. Patient responded well to manual exchange transfusion with standard artesunate-based chemotherapy.