Convergence of Minds: For Better Patient Outcome in Intensive Care Unit Infections

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Round Table IntroductIonIn typical health-care settings, Intensive Care Units (ICUs) have 10%-15% of the total hospital beds, but the hospital-acquired infections (HAIs) in ICUs account for 20%-30% of all nosocomial infections.[1] In addition, ICUs are the epicenters of multidrug-resistant organisms (MDROs) which may increase the chances of inadequate empirical antibiotic therapy resulting in excess mortality.[1] With the emergence of carbapenem-resistant Enterobacteriaceae (CRE) along with the recent reports of colistin resistance, [2] ICUs are facing the prospect of a "postantibiotic era."This calls for the urgent and definitive measures to prevent the situation slipping into further abyss.To address the above issues, for the first time in the country, a combined meeting of the Indian Association of Medical Microbiologists -Delhi Chapter and the Indian Society of Critical Care Medicine Delhi and national capital region (NCR) was held on May 7, 2016, with an aim of developing common understanding in treating infections as seen in critical care medicine practice. Need for synergy and convergence of minds• There are increasing reports of difficult-to-treat infections by MDROs in hospital settings.Resistance to the last-line effective antibiotics, carbapenems, has reached alarming proportions (12%-83%) in Gram-negative bacteria (GNB) in Indian ICUs.[3,4] Not only that, there is also an increasing prevalence of fungi in ICUs.[3] Background: There is emergence of resistance to the last-line antibiotics such as carbapenems in Intensive Care Units (ICUs), leaving little effective therapeutic options.Since there are no more newer antibiotics in the armamentarium in the near future, it has become imperative that we harness the interdisciplinary knowledge for the best clinical outcome of the patient.Aims: The aim of the conference was to utilize the synergies between the clinical microbiologists and critical care specialists for better patient care and clinical outcome. Materials and Methods: A combined continuing medical education program (CME) under the aegis of the Indian Association of MedicalMicrobiologists -Delhi Chapter and the Indian Society of Critical Care Medicine, Delhi and national capital region was organized to share their expertise on the various topics covering epidemiology, diagnosis, management, and prevention of hospital-acquired infections in ICUs.Results: It was agreed that synergy between the clinical microbiologists and critical care medicine is required in understanding the scope of laboratory tests, investigative pathway testing, hospital epidemiology, and optimum use of antibiotics.A consensus on the use of rapid diagnostics such as point-of-care tests, matrix-assisted laser desorption ionization-time of flight mass spectrometry, and molecular tests for the early diagnosis of infectious disease was made.It was agreed that stewardship activities along with hospital infection control practices should be further strengthened for better utilization of the antibiotics.Through this CME, we identified the barriers and actionables for appropriate antimicrobial usage in Indian ICUs.Conclusions: A close coordination between clinical microbiology and critical care medicine opens up avenues to improve antimicrobial prescription practices.

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