Distribution and antibiotic susceptibility of pathogens isolated from adults with hospital-acquired and ventilator-associated pneumonia in intensive care unit

Abstract

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are the most common hospital infections with the highest prevalence in intensive care units (ICU). The aim of this study was to investigate prevalence of bacterial pathogens isolated from ICU patients with HAP/VAP and reveal their susceptibility rates in order to establish a basis for empirical antibiotic therapy. Prospective cohort study was conducted in central ICU of Clinical Centre Kragujevac, Serbia, from January 2009 to December 2015, enrolling 620 patients with documented HAP (38.2%) or VAP (61.8%). Gram-negative agents were isolated in 95.2%. Generally, the most common pathogens were Acinetobacter spp. and Pseudomonas aeruginosa, accounting for over 60% of isolates. The isolates of Acinetobacter spp. in HAP and VAP had low susceptibility to the 3rd generation cephalosporins, aminoglycosides, fluoroquinolones (0-10%). The rate of susceptibility to piperacillin-tazobactam was below 15%, whereas for carbapenems and 4th generation cephalosporins it was about 15-20%. Isolates of P. aeruginosa from HAP and VAP showed low susceptibility to ciprofloxacin and gentamicin (below 10%), followed by amikacin (25%), while the rate of susceptibility to carbapenems and 4th generation cephalosporin was 30-35%. Furthermore, 86% of isolates of P. aeruginosa non-susceptible to carbapenems were also non-susceptible to ciprofloxacin. The highest level of susceptibility from both groups was retained toward piperacilin-tazobactam. In ICU within our settings, with predominance and high resistance rates of Gram-negative pathogens, patients with HAP or VAP should be initially treated with combination of carbapenem or piperacillin-tazobactam with an anti-pseudomonal fluoroquinolone or aminoglycoside. Colistin should be used instead if Acinetobacter spp. is suspected. Vancomycin, teicoplanin or linezolide should be added only in patients with risk factors for MRSA infections.

Microbiological profile of ventilator-associated pneumonia among intensive care unit patients in tertiary Egyptian hospitals

“…This observation might indicate that males are more susceptible to VAP acquisition than females. Other studies showed also the majority of males among VAP-suspected patients [13,17,18,19]. In this study, the reason for admission of the majority of VAP cases was medical problems like other previous studies [4,20].…”

Is ventilated hospital-acquired pneumonia a worse entity than ventilator-associated pneumonia?

“…However, a recent small retrospective study by FENG et al [50] of the microbial aetiology of HAP and VAP reported that the leading pathogens were similar in both entities, with a predominance of Acinetobacter baumannii and P. aeruginosa in VAP, and Klebsiella pneumoniae and S. aureus in HAP. Moreover, the authors demonstrated an increase in the MDR bacteria in VAP, with a lower susceptibility of P. aeruginosa in VAP compared to HAP, as reported in previous studies [51,52]. The results of FENG et al [50] are in line with those of a less recent prospective observational study by ESPERATTI et al [13] about ICU-acquired nosocomial pneumonia, where the proportion of relevant pathogens in patients with an isolated organism was similar, suggesting that the cause and the outcome depend on the underlying conditions of the patients rather than previous intubation.…”

Epidemiology, antimicrobial resistance, and incremental medical costs of hospital-acquired infections in the Intensive Care Unit: 2-year experience from Serbia

“…The antimicrobial resistance patterns and the percentage of MDR strains observed reiterates the concerning results from other Serbian studies [12,22]. Overall resistance rates of 88% for cephalosporins, 85% and 75% for gentamycin and amikacin, 92% for ciprofloxacin, and 56% for carbapenems are higher compared to most European countries [19].…”