Determination of Antibiotic Resistance Pattern of Organisms Isolated from Endotracheal Tube Cultures of Patients Admitted to Intensive Care Unit

Abstract

Background: It is widely accepted that increased prevalence of antibiotic resistance of pathogens grown in the respiratory system in intensive care unit (ICU) patients is a very serious problem causing expansion of mortality. The most important strategy to prevent the occurrence and appropriate solution to control the antibiotic resistance is to thoroughly investigate the pattern of resistance in the studied ward. Therefore, the purpose of this study was to determine the antibiotic resistance pattern of organisms isolated from endotracheal tube secretions of patients admitted to ICU of Khatam-Al-Anbia Hospital at Zahedan in Iran.
 Methods: In the present retrospective and descriptive cross-sectional study, the medical records of patients hospitalized during 2013-2018 were included by census method and then selected based on inclusion criteria (n=1387). The required data, including age, gender, type of microorganism isolated from endotracheal tube cultures, antibiotic resistance and sensitivity, duration of intubation and cause of hospitalization, were recorded for each patient. Finally, the data were analyzed by descriptive statistics using SPSS 16 software.
 Results: Mean age of patients was 44.66 ± 21.39 years and mean duration of intubation was 17.96 ± 10.99 days. Stroke was the most common cause of hospitalization with a prevalence of 553 patients (49%). The prevalence of positive culture of endotracheal tube secretions was 1128 (81.3%) of which 71.5% were male (n=807) and 28.5% were female (n=321). The cultures of endotracheal tube secretions resulted in 933 (82.7%) gram-negative bacteria, 191 (16.9%) grampositive bacteria and 4 (0.4%) mixed isolates. The most prevalent gram-negative bacterium was Acinetobacter baumannii (37.2%) with the highest and lowest antibiotic resistance to Meropenem (95.1% resistance) and colistin (99.5% sensitivity), respectively. In addition, the most prevalent gram-positive bacterium was Staphylococcus epidermidis (50.3%) with the highest and lowest antibiotic resistance to Meropenem (85.7% resistance) and Vancomycin (92.2% sensitivity).
 Conclusion: The findings of the present study illustrate that there was widespread bacterial resistance to respiratory tract infections in our ICU patients. Due to the high sensitivity of gram-negative bacteria to colistin, the use of antibiotic combination with colistin in the control of pulmonary infections caused by these organisms can be a good choice. In addition, in the case of gram-positive bacteria, the highest sensitivity was to vancomycin; therefore, it can be the selective antibiotic to control infections caused by these bacteria.

Oropharyngeal Decontamination for Prevention of VAP in PatientsAdmitted to Intensive Care Units: A Systematic Review

“…16 However, the best substance for oropharyngeal decontamination to prevent VAP with a good effect on pathogenic organisms is controversial, and numerous studies have shown that different organisms cause VAP in a critical care environment and have different patterns of resistance and sensitivity to similar organisms in other environments. [17][18][19] Therefore, it is necessary to conduct a systematic review that not only determines the effects of antiseptic agents or topical antibiotics on the rate of VAP but also show the type of growing organisms so that health care providers could make decisions based on the type of common organisms in their environment and their pattern of antibiotic resistance or sensitivity. The antiseptic agent types should be identified for use in oral hygiene.…”

Bacteriological Profile and antibiogram of isolates from tracheal secretions of patients in an intensive care unit

“…According to Sarkar Mohammad et al, 16 Vimal Shiram Rathod et al, 24 Khayyam et al 12 with an isolation rate of 7.0%, 12.3%,15% respectively. But according to Masoum et al 25 Staphylococcus epidermidis was the predominant Gram positive cocci isolated (50.3%) followed by Staphylococcus aureus (47.1%)…”

“…In the present study Gram positives including MRSA, MSSA, Streptococcus spp showed 100% susceptibility to vancomycin & linezolid which correlates with the findings of Hassan Ahmad et al 23 and Vimal Shiram Rathod et al 24 followed by Tetracycline, co-trimoxazole (64.3%), clindamycin (42.85%), gentamicin (35.71%), oxacillin, amoxyclav, ceftriaxone, cephalothin (28.6%), erythromycin, ciprofloxacin (21.43%) and the least susceptibility is seen with penicillin (14.3%). But according to Masoum et al, 25 the susceptibility rate for vancomycin was 89.65 and for Streptococcus spp, it was shown to be 66.7%. In the present study, Escherichia coli isolates showed 100% susceptibility to polymyxin B correlating with findings of Deepti et al 1 100% and 92.3% by Masoum et al 25 followed by meropenem showing susceptibility rate (66.67%) and 66.66% by Deepti et al, 1 73.1% by Masoum et al 25 followed by Gentamicin & Co-trimoxazole (75%), Imipenem & Amikacin (66.67%), Amoxyclav (50%), Cefaperazone sulbactam, Ciprofloxacin (41.67%), Piperacillin tazobactam, ceftriaxone, Cephalothin (25%).…”

“…24 Neha Samal et al had a culture positive rate of 85.7% 17 and Masoum Khoshfetrat et al had a culture positive rate of 81.3%. 25 In the present study 26/102 (25.49%) showed polymicrobial growth and 62/102 (60.78%) showed monomicrobial growth which correlates with a study reported by Vamsi C k et al 26 where Gram negative bacilli were the most predominant isolates in our study (84.2%) followed by Gram positive cocci (15.8%) correlating with studies by Neha Samal et al, 17 Chidambaram et al, 7 Khayyam et al 12 and Masoum et al 25 In the present study Klebsiella pneumoniae [ 35/96 (36.46%)] was the predominant Gram negative organism isolated followed by Acinetobacter spp [24/ 27 Malik et al, 28 Deepti C et al, 1 Vimal Shiram Rathod 24 in which Klebsiella pneumoniae was the predominant isolate. But in a study done by Neha Samal et al 17 Acinetobacter baumannii (46%) was the predominant isolate followed by Pseudomonas aeruginosa (17%) and Klebsiella pneumoniae (17%) and Khayyam et al 12 also reported that Acinetobacter spp was the predominant isolate (23.75%) followed by Pseudomonas aeruginosa (21.25%) and Klebsiella pneumoniae (16.25%).…”

Photophysical and Antibacterial Properties of Porphyrins Encapsulated inside Acetylated Lignin Nanoparticles

“…Antimicrobial resistance (AMR) is one of major threats to our current way of life, with enduring humanitarian and economic consequences if not addressed assertively [ 1 ]. For instance, concerns on the negative influence of the concurrent COVID-19 pandemic over AMR, are arising [ 2 , 3 ], particularly from the extensive use and misuse of mechanical ventilation [ 4 , 5 ]. Moreover, conventional antibiotics’ bacterial resistance advocates exploring less resistance-prone therapeutic approaches [ 6 ], where photodynamic antimicrobial chemotherapy (PACT) [ 7 ] has proved as an efficient alternative in the inactivation of several bacterial strains [ 8 , 9 , 10 , 11 , 12 , 13 ].…”