Clinical outcomes of multidrug-resistant organism infections in a tertiary care hospital in India

Abstract

BACKGROUND

Multidrug-resistant organisms (MDROs) pose a major threat to hospital care, with antimicrobial resistance contributing to an estimated 4.95 million deaths globally in 2019 (including 1.27 million directly attributable deaths). India carries a particularly high burden.

AIM

To evaluate clinical outcomes associated with MDRO isolation in a tertiary-care center and identifies actionable signals to strengthen infection prevention and targeted antimicrobial stewardship.

METHODS

We conducted a cross-sectional analysis of culture-confirmed MDRO infections treated as pathogens at All India Institute of Medical Sciences Rishikesh from May 2021 to November 2024 using E-Hospital records. Incomplete datasets were excluded. Associations between isolation practices and clinical outcomes-including mortality, length of stay (LOS), and intensive care unit (ICU) utilization-were assessed using χ² tests and Mann-Whitney U tests (P < 0.05).

RESULTS

A total of 1598 MDRO infected patients were included (mean age 42.8 years; 58.5% male). Overall mortality was 20.8%. ICU care was required in 439 patients (27.5%), and 29.2% had at least one comorbidity. Among ICU patients, 143 (32.6%) were isolated and 296 (67.4%) were not. Mortality did not differ significantly between isolated (46%) and non-isolated (54%) groups (χ² = 2.4; P = 0.12). However, isolated ICU patients had significantly longer ICU LOS (20.5 ± 18.4 days vs 16.4 ± 14.4 days; U = 244157.5; P < 0.001) and hospital LOS (33.7 ± 22.8 days vs 26.9 ± 21.8 days; U = 238460.5; P < 0.001). Most MDRO cases originated from internal medicine (16.3%), general surgery (14.7%), and trauma surgery (13.8%). Duration of antibiotic therapy varied significantly across departments (F = 5.03; P < 0.001). Quarterly trends demonstrated significant fluctuations in MDRO prevalence, hospital LOS (χ² = 200; P < 0.001), and antibiotic utilization (χ² = 252; P < 0.001).

CONCLUSION

MDRO infections are associated with substantial mortality and prolonged ICU and hospital stays. Marked interdepartmental variability in antibiotic use highlights the need for strengthened infection-prevention practices and targeted antimicrobial stewardship, including de-escalation, intravenous-to-oral switching, and optimized treatment durations to reduce selection pressure. Limited culture availability during 2022 was a key constraint. The associations observed between isolation status and clinical outcomes further highlight the importance of reinforcing infection-control strategies and stewardship efforts in high-risk departments.

Keywords: Antibiotic utilization; Antimicrobial resistance; Antimicrobial stewardship; Isolation; Hospital stay; Mortality

Core Tip: Multidrug-resistant organisms (MDROs) pose a significant threat to hospital care, particularly in high-burden settings such as India, contributing substantially to antimicrobial resistance-related morbidity and mortality. This study aimed to evaluate clinical outcomes associated with MDRO isolation in a tertiary-care hospital and to identify actionable gaps to strengthen infection prevention and targeted antimicrobial stewardship. A key finding was that while isolation did not significantly reduce mortality among Intensive care unit (ICU) patients, it was associated with significantly longer ICU and hospital length of stay.