Infection Dynamics in Post-transplant ICU Patients: Spectrum, Resistance Patterns, and Clinical Outcomes at A Tertiary Care Center in North India
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Infections are a major cause of morbidity and mortality in post-transplant patients, especially those requiring intensive care unit (ICU) admission.(2) The immunosuppressive regimens essential for graft survival render these patients particularly vulnerable to a broad spectrum of bacterial, fungal, and viral pathogens. The situation is further compounded by the increasing prevalence of multidrug-resistant (MDR) organisms, which challenge effective treatment and contribute to prolonged hospital stays and higher mortality rates.(1) This study focuses on understanding the microbial spectrum, antimicrobial resistance patterns, and clinical outcomes in post-transplant patients admitted to a tertiary care ICU in North India. OBJECTIVES: The primary objective of this study was to assess the spectrum of infections, including bacterial, fungal, and viral pathogens, in post-transplant ICU patients. Secondary objectives included determining the antimicrobial susceptibility patterns of isolated pathogens and correlating infection profiles with clinical outcomes, such as ICU length of stay and mortality. METHODOLOGY: This prospective observational study was conducted at Indraprastha Apollo Hospitals, New Delhi, from July 1, 2022, to March 31, 2024. The study included 81 post-transplant patients admitted to the ICU with suspected infections. Data collection involved demographic details, clinical parameters, and microbiological analyses of samples, including blood, respiratory secretions, urine, CSF, and tissue biopsies. Antimicrobial susceptibility testing was performed for all isolates. Statistical analyses, including chi-square tests and regression models, were used to explore correlations between infection types, APACHE II scores, ICU length of stay, and mortality rates. RESULTS: Bacterial infections were the most common, with Klebsiella pneumoniae (39.5%), Acinetobacter baumannii (25.9%), and Escherichia coli (22.2%) as the leading pathogens. Among fungal pathogens, Candida auris (18.5%) and Aspergillus species (12.3%) were predominant, while Cytomegalovirus (14.8%) was the most common viral pathogen. Bloodstream infections accounted for 45.3% of cases, followed by respiratory tract infections (23.9%) and urinary tract infections (17.4%). Antimicrobial resistance was significant, with Klebsiella pneumoniae showing 70% susceptibility to meropenem and 45% to ciprofloxacin, and Acinetobacter baumannii exhibiting 85% susceptibility to colistin. Fungal pathogens displayed resistance to azoles, with Candida auris requiring echinocandins or amphotericin B for treatment. High APACHE II scores correlated with increased ICU length of stay and mortality. Mortality rates were highest for Mucormycosis (100%), Aspergillus species (75%), and Pseudomonas aeruginosa (60%). Prolonged ICU stays were observed for infections caused by Candida auris and Acinetobacter baumannii. CONCLUSION: This study highlights the significant burden of infections in post-transplant ICU patients, driven by MDR bacterial pathogens, invasive fungal infections, and immunosuppressive therapy. The findings underscore the importance of tailored antimicrobial stewardship programs, early diagnostic tools, and stringent infection control measures to mitigate adverse outcomes. Addressing these challenges requires a multidisciplinary approach, synergy testing, balancing effective infection management with the preservation of graft function and overall patient well-being.
Language: English
Topic: Nosocomial Infections in ICU
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4410920436