Critical Care

Critical care medicine encompasses the diagnosis and treatment of a wide variety of clinical problems representing the extreme of human disease. Critical care usually takes place in an intensive care unit (ICU) of hospitals for people who have life-threatening injuries and / or illnesses. A team of specially trained healthcare providers gives 24-hour care. This includes using machines to constantly monitor patient’s vital signs. It also usually involves giving specialized treatments. The care of critically ill patients also raises many complicated ethical and social issues, and the intensivist must be competent in areas such as end-of-life decisions, advance directives, estimating prognosis, and counseling of patients and their families. Diagnosis of infection by healthcare practitioners plays an important role in timely treatment. Nosocomial infections are key concern for such critically ill patients.^1,2

We offer a range of medicines to fight all kinds of infections, be it bacterial or fungal. We make anti-infectives available and accessible to all. We partner with the healthcare professionals to spread awareness about emerging threats, latest guidelines, diagnosis, options, and strategies for treatment of critical patients.^1,2

Hundreds of millions of patients are affected by Nosocomial infection (also referred to as Healthcare Associated Infections, HAIs) around the world every year, leading to significant mortality and huge financial losses. HAIs account for 2 million cases and about 80,000 deaths a year in India. This high burden was attributed to unsafe patient care.

In India, over-crowded hospitals with poor infrastructure, lack of required hygiene, low healthcare professionals to patient ratio, inappropriate usage of invasive devices and antibiotics, and lack of regulation enforcement contribute to nosocomial infections-associated deaths in India.

More than one out of every 6 patients acquire a potential life-threatening Nosocomial infection in a Medical ICU. Also, occurrence of infection was associated with significantly higher treatment cost.

Studies on the costs of NI^$ have used different methods, definitions and degrees of stringency when calculating indirect costs and therefore, still uncertainty prevails over their true economic impact on the community and on the workplace economy. Drug and especially antibiotic acquisition in addition to increased length of stay are the widely and well described parameters. Extra cost of NI^$ include bed, intensive care unit stay, hematological, biochemical, microbiological and radiological tests, antibiotics, other drugs, extra surgical procedures and working hours. In addition to high morbidity and mortality, one of the well described parameters is the extra length of stay in the hospital. High mortality rates and economic expense which NI^$ represents emphasizes the justification for measures of control of NI^$

Drugs’ acquisition cost formed a major part of the extra cost due to nosocomial infections. In the drugs’ acquisition cost, almost half of the share was for Anti-microbial drugs. The usage of anti-microbial drugs was higher in infected patients than in patients in the control group (49% vs. 41%)

Cost of drugs is a major contributor to the costs of HAIs as evidenced by five times higher costs in cases than in controls. In view of this, it is recommended that hospitals should take infection control as a high-priority area. This can be achieved using appropriate prophylaxis at admission especially in ‘‘high-risk’’ and immunocompromised patients, use of aseptic techniques, and complete sterilization of surgical instruments before and during the surgical procedures.

*IFI : Invasive Fungal Infections

NI^$ : Nosocomial Infections

Over the past few decades, incidence of IFIs has been increasing. This is attributed primarily to the overall increase in the number of patients irrespective of severe immunosuppression such as acquired immunodeficiency syndrome (AIDS), hematological malignancies, organ transplantation, etc. or apparent immunocompetent status with diabetes mellitus, chronic obstructive pulmonary disease (COPD), etc. The overall IFI incidence rate varies from 3% to 20%.¹

The most feasible IFI diagnostic modality—fungal culture and pathological examination—is not conducive, as it does not meet the urgent diagnosis requirement and thereby delays treatment, resulting in a high fatality rate. IFI pathogens like Candida, Aspergillus, Mucor and many more being the cases.¹

A key determinant for the outcome of IFIs is early initiation of antifungal therapy. There are established guidelines for the four commonest IFIs—invasive candidiasis (IC), Cryptococcosis, invasive aspergillosis (IA), and mucormycosis—from the Infectious Diseases Society of America (IDSA), the European Society for Clinical Microbiology and Infectious Diseases, and the European Confederation of Medical Mycology (ESCMID/ECMM). However, uncertainty lingers about the interpretation of antifungal susceptibility testing (AST) and the significance of minimal inhibitory concentration (MIC) in predicting outcome. Regardless, IFIs are a major cause of morbidity and mortality. Careful consideration of local fungal epidemiology describing clinical characteristics, prognostic factors, use of diagnostic algorithms and antifungal susceptibility patterns can prove useful for overcoming these shortcomings. However, there are a limited number of studies from India, which renders many aspects of IFI poorly understood. To address this lacuna, Dabas T et al conducted a study aimed at analyzing clinical, microbiological, susceptibility, and outcome data of IFIs to support clinicians when deciding on prophylactic or empirical antifungal therapy.²