Abstract

Background: Antimicrobial resistance (AMR) poses a major threat to global public health, particularly in developing nations with high infection burdens and widespread antibiotic misuse. Intensive Care Units (ICUs) are critical sites for the emergence and transmission of multidrug-resistant (MDR) organisms, with critically ill patients at increased risk due to invasive procedures and compromised immunity. ESKAPE pathogens and other Gram-negative bacteria are frequently implicated in ICU infections, complicating empirical treatment and contributing to adverse outcomes. Despite this, there is limited surveillance data on resistance trends in ICUs, especially in low and middle-income countries like India. Materials and Methods: A hospital based cross-sectional observational study was conducted over six months (October 2023-March 2024) in the Department of Microbiology, Sharda Hospital, Greater Noida. Clinical samples from ICU patients including blood, urine, respiratory secretions, and pus were processed using standard microbiological techniques. Bacterial identification involved Gram staining, colony morphology, and biochemical testing. Antimicrobial susceptibility testing (AST) was carried out using the Kirby-Bauer disc diffusion method, interpreted as per CLSI 2023 guidelines. Results: A total of 2,125 ICU samples were analyzed, including blood (46%), urine (30%), respiratory samples (20%), and pus (4%). From these, 285 clinical isolates were recovered: respiratory samples yielded the highest proportion (46%), followed by blood (23%), urine (20%), and pus (11%). The most common isolates included Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, and Enterococcus spp., consistent with the global ESKAPE pathogen profile. Conclusion: The study highlights a predominance of Gram-negative organisms in ICU infections, with significant antimicrobial resistance, emphasizing the need for regular surveillance and updated antibiograms. Tailored empirical therapy based on local resistance patterns is crucial to improve patient outcomes and support antimicrobial stewardship efforts in resource-limited settings.

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