# Evolving Aerobic Bacterial Skin Flora and Healthcare-Associated Infections Among Intensive Care Unit Patients at a Tertiary Care Hospital: A Therapeutic Concern

## TL;DR

This study shows that ICU patients develop more drug-resistant bacteria on their skin over time, increasing the risk of healthcare-associated infections.

## Contribution

The study tracks the evolution of aerobic bacterial flora in ICU patients and links it to rising healthcare-associated infections.

## Key findings

- WHO priority pathogens and potentially pathogenic bacteria were found in 63.4% of skin swabs.
- Fingertips and webs had the highest pathogenic burden, with ESBL-producing Enterobacteriaceae being most prevalent.
- Multidrug-resistant organism colonization increased significantly from day 1 to day 7 in ICU patients.

## Abstract

This study aimed to assess the evolution of aerobic bacterial flora among ICU patients and its association with healthcare-associated infections in a tertiary care hospital. A total of 52 patients were selected from the medical, surgical, and burn and plastic surgery ICUs. A total of 764 skin swabs were collected from four sites, namely the fingertips and webs, dorsum of the hand, axilla, and anterior nares on days 1, 2, 3, 4, and 7.

Of the total swabs collected, 484 (63.4%) were identified to have WHO priority pathogens and potentially pathogenic bacteria. A total of 650 isolated microorganisms were isolated from the 484 swabs, comprising both WHO priority pathogens and potentially pathogenic bacteria. Fingertips and webs were found to have the highest pathogenic burden of these 650 microorganisms (27.7%, n=180), with WHO priority pathogens comprising 20.5% (n=37) and extended-spectrum beta-lactamase (ESBL)-producing carbapenem-resistant (CRP-R) Enterobacteriaceae being the most prevalent (9.4%, n=17). Other potentially pathogenic bacteria accounted for 79.4% (n=143), led by vancomycin-sensitive methicillin-resistant Staphylococcus aureus (MRSA) (26.7%, n=48).

On day 1 of hospitalization, the total culture count was 208, and on day 7, it was 100. The critical WHO priority pathogen colonization on day 1 increased significantly from 6.7% (n=14) to 27% (n=27) by day 7 (p<0.05). The burn and plastic surgery ICU (total n of swabs collected=152) had the highest microbial load, with Pseudomonas aeruginosa (30.2%, n=47) and carbapenem-resistant strains being predominant. This study reveals that colonization of multidrug-resistant organisms increases with prolonged hospitalization in ICUs, highlighting the need for strict infection control protocols. Regular monitoring and effective hygiene practices can reduce the spread of hospital-acquired infections (HAIs) and improve patient outcomes.