Profile of infective microorganisms causing ventilator-associated pneumonia: A clinical study from resource limited intensive care unit

Abstract

Background:Ventilator-associated pneumonia (VAP) is the most common cause of hospital acquired infection and death among patients admitted in ICU. Microorganisms responsible for VAP vary from place to place. Gram-negative bacteria (GNB) have emerged as a major group of pathogen causing VAP and over the years carbapenem group of antibiotics has emerged as one of the important antibiotics used in the critically ill patients. There have been reports of increased occurrence of infection by carbapenem-resistant bacteria in health care settings in recent times.Aim:The aim of the study was to assess the incidence of VAP, their microbiological profile with reference to carbapenemase producing GNB in the intensive care unit of a tertiary care hospital, their relation to initial emperical antibiotic therapy, sensitivity patterns, and outcome.Materials and Methods:This prospective study was carried out over the period of 1 year (July 2010-June 2011) on 100 randomly selected patients above the age of 18 years admitted in the emergency/ICU and requiring intubation and mechanical ventilation for more than 72 hours. The diagnosis of VAP was established on the basis of clinical and radiological parameters as per Centre of Disease Centres (CDC) guidelines. A baseline sample was obtained after initial endotracheal intubation. Thereafter, the culture sent on the first day of occurrence of clinical sign of VAP. Culture was done on blood agar and MacConkey agar. All imipenem-resistant strains were further confirmed by Modified Hodge test and combined disc for confirmation of respective carbapenemase.Results:Incidence of VAP was found to be 51%. GNB mainly Citrobacter 28 (52.83%) and Klebsiella pneumoniae 7 (13.21%), were the most commonly isolated pathogens. The prevalence of carbapenemase-producing GNB was alarmingly high 24/50 (48%). The entire carbapenemase producers showed high degree of cross resistance to antibiotics with some sensitivity to Polymyxin B (94 %) and Tigecycline (96%)Conclusion:High incidence of VAP and the potential carbapenemase-producing GNB are real threat in our ICU. The emergence of microorganisms known for its inherent resistance among most of the common first-line antibiotics calls for a alarm in all upcoming tertiary care hospitals.

Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

“…The National Healthcare Surveillance Network in the United States in 2014 found the following higher rates of MDR in patients with VAP: 37% of Methicillin-resistant S. aureus (MRSA); 31.1% CR- P. aeruginosa , and 14% CR- Klebsiella pneumoniae . A study performed to assess the microbiological profile and MDR Gram-negative bacteria in the ICU during 2010-2011, showed Citrobacter and K. pneumoniae as the most common isolated pathogens, with a high prevalence of carbapenemase- producing bacteria (48%)[ 15 ], considerably higher than the results found in our study.…”

Bacteriological profile and antibiogram analysis from a tertiary care centre in eastern India: Time to Act / ReAct

“…This commensurate with the findings of other published studies from India. 23,24 A very high degree of resistance was observed in Gram negative bacterial infections to almost all classes of antibiotics as depicted in Table 3. For E.coli more than 90% resistance was observed for Ampicillin, Beta lactam combination agents resistance ranged from 48%-88%, 3 r d generation Cephalosporins also showed high resistance with upto 80% of the isolates resistant to the more frequently prescribed cephalosporinsviz; Ceftriaxone/Cefotaxim, Cefepime & Ceftazidime, Fluoroquinolones (Ciprofloxacin & Ofloxacin) were resistant in almost 90% of isolates.…”

Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): literature Review and World Consensus (Part Seven)

“…Delegate Vote: Agree: 76%, Disagree: 8%, Abstain: 16% (Strong Consensus) Justification: There is an increasing awareness of the threat posed by K. pneumoniae strains with decreased susceptibility to carbapenems worldwide (30). This resistance is conferred by K. pneumo carbapemenase (KPC), which is a β-lactamase that also confers resistance to broadspectrum cephalosporins, as well as commercially available β-lactam/ β-lactamase inhibitor combinations (31).…”

“…Some isolates are susceptible to amikacin and gentamicin and most are susceptible to colistin and tigecycline (30,(33)(34)(35).…”