# P-67. Bacteremia in the Intensive Care Unit: Pathogen Profiles and Antimicrobial Resistance Trends from January 2022 to June 2024

## TL;DR

This study examines rising antibiotic resistance in ICU blood infections in India, highlighting the urgent need for new treatments and better infection control.

## Contribution

The study provides updated resistance trends of ICU blood pathogens in India, emphasizing the growing threat of multidrug-resistant Gram-negative bacteria.

## Key findings

- Gram-negative bacteria dominated ICU blood infections, with high carbapenem resistance in Klebsiella pneumoniae and others.
- Antimicrobial resistance rates increased over time, particularly for carbapenems, fluoroquinolones, and beta-lactam/beta-lactamase inhibitors.
- Gram-positive bacteria remained susceptible to linezolid and vancomycin, offering limited treatment options compared to resistant Gram-negatives.

## Abstract

Bacteremia is a major concern in ICUs due to high morbidity and mortality, particularly with multidrug-resistant organisms. Rising antimicrobial resistance further complicates management, limiting therapeutic options, prolonging ICU stays, increasing costs, and elevating mortality rates. Monitoring pathogen profiles and resistance trends is crucial for optimising antibiotic stewardship and guiding empirical therapy. This study analyses resistance patterns and pathogen prevalence in bacteremia in an ICU setting in India over a 30-month period.

A retrospective analysis was conducted in a tertiary care ICU in India. Blood culture reports of ICU patients (Jan 2022–June 2024) were collected. Pathogen identification and antimicrobial susceptibility testing followed standard microbiological procedures.

Among 958 blood isolates, Gram-negative bacteria constituted 71.5%, with Klebsiella pneumoniae (21.5%), Pseudomonas aeruginosa (20%), Acinetobacter baumannii (12%), and Escherichia coli (11%) as the predominant pathogens. Gram-positive bacteria made up 22%, mainly Staphylococcus spp. (13%) and Enterococcus faecium (5%). Fungal infections, primarily Candida spp., accounted for 6%.

Antimicrobial resistance among Gram-negative bacteria was notably high and increasing. Carbapenem resistance reached 79% in Klebsiella pneumoniae, 72% in Pseudomonas aeruginosa, and 100% in Acinetobacter baumannii and Escherichia coli by 2024. Other antibiotic classes, including fluoroquinolones and beta-lactam/beta-lactamase inhibitors, also showed increasing resistance over time, limiting treatment options. Gram-positive bacteria retained susceptibility to linezolid and vancomycin.

The study highlights a concerning rise in antimicrobial resistance, particularly among Gram-negative organisms in an Indian ICU, complicating treatment strategies. The escalating resistance rates, especially to carbapenems, call for exploration of alternative therapeutic options and the development of novel antimicrobials to improve patient outcomes in critical care settings. The findings underscore the urgent need for targeted antimicrobial stewardship and stringent infection control measures.

All Authors: No reported disclosures