Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens

Abstract

Background: Ventilator-Associated Pneumonia (VAP) is the most frequent intensive-care-unit (ICU)-acquired infection. The aetiology of VAP varies with different patient populations and types of ICUs. Methodology: A prospective study was performed over a period of 15 months in a tertiary care hospital to determine the various aetiological agents causing VAP and the prevalence of multidrug resistant (MDR) pathogens. Combination disk method, Modified Hodge test, EDTA disk synergy (EDS) test and AmpC disk test were performed for the detection of extended spectrum beta-lactamases (ESBL), carbapenemases, metallo-beta-lactamases (MBL) and AmpC β-lactamases respectively. Results: Enterobacteriaceae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Candida spp. were more common in early-onset VAP, while non-fermenters (Pseudomonas spp. and Acinetobacter spp.) were significantly associated with late-onset VAP (P value 0.0267, Chi-square value 4.91). Thirty-seven (78.7%) of the 47 VAP pathogens were multidrug resistant. ESBL was produced by 50% and 67% of Escherichia coli and Klebsiella pneumoniae respectively. MBL was produced by 20% of P. aeruginosa. AmpC beta-lactamases were produced by 33.3% and 60.7% of the Enterobacteriaceae and non-fermenters respectively. Of the S. aureus isolates, 43% were methicillin resistant. Prior antibiotic therapy and hospitalization of five days or more were independent risk factors for VAP by MDR pathogens. Conclusions: VAP is increasingly associated with MDR pathogens. Production of ESBL, AmpC beta-lactamases and metallo beta-lactamases were responsible for the multi-drug resistance of these pathogens. Increasing prevalence of MDR pathogens in patients with late-onset VAP indicate that appropriate broad-spectrum antibiotics should be used to treat them.

Bacteriological Profile of Ventilator Associated Pneumonia in a Tertiary Care Hospital of South India with Special Reference to Multi Drug Resistant Pathogens

“…ESBLs are most commonly produced by Klebsiella spp and E. coli but may also occur in other Gramnegative bacteria as documented by Joseph et al, (2010). Among the isolates obtained in the present study, 60% of K. pneumoniae, 50% of E. coli, 100% of Enterobacter spp and C. koseri were found to be ESBL producers.…”

“…It is commonly classified as either early onset (occurring within 96 hours of start of mechanical ventilation) or late onset (>96 hours after start of mechanical ventilation) (Joseph et al, 2010). VAP may be caused by a wide spectrum of bacterial pathogens.…”

Antibiotic Susceptibility Pattern of Bacteria Isolated from Adult Patients with Ventilator Associated Pneumonia (VAP) in Intensive Care Units in a Tertiary Care Hospital

“…56.9% Present study 2014 60% [7] 20.0 30.0 23.3 26.7 Rakshit et al [8] 5.9 32.0 20.0 17.6 Joseph et al [13] 29. 8 21.3 6.4 14.9 Goel et al [16] 23.6…”

Gram-negative bacilli causing infections in an intensive care unit of a tertiary care hospital in Istanbul, Turkey

“…The spectrum of pathogens in ICUs may change from country to country with time and by hospital, type of ICU, and specific patient population [15][16][17][18][19][20].…”