Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multidrug resistant pathogensOriginal Article INTRODUCTIONVentilator associated pneumonia (VAP) is pneumonia that occurs 48 h or more after endotracheal intubation and mechanical ventilation (MV) that was not intubating at the time of admission, also including pneumonia developing after extubation.[1] Pneumonia is the second most common intensive care unit (ICU) acquired infection and 86% of nosocomial pneumonias are VAP.[1] Around 10-20% of patients on MV for longer than 48 h, develops VAP. [2,3] Early onset VAP, which occurs during the fi rst 4 days of MV is usually less severe, associated with a better prognosis and more likely caused by antibiotic sensitive bacteria. Late onset VAP, which develops 5 or more days after initiation of MV, is caused by multidrug resistant (MDR) pathogens and associated with increased mortality and morbidity.[4] The common pathogens causing VAP include aerobic gram negative rods such as Pseudomonas aeruginosa, Acinetobacter species, Klebsiella pneumoniae, and Escherichia coli. [1,5,6] VAP due to methicillin resistant Staphylococcus aureus (MRSA) has been rapidly emerging. [5,6] Treatment of VAP is usually supportive, along with administration of proper antibiotic. The selection of proper antimicrobial agents, active against the VAP pathogens is an important determinant for reducing morbidity and Background: Ventilator associated pneumonia (VAP), a hospital acquired infection (HAI) is seen among critically ill patients on mechanical ventilation (MV) due to various causes, in intensive care units (ICUs). VAP increases morbidity, mortality, as well as the cost of healthcare. Materials and Methods: A prospective study was done over a period of 10 months in a tertiary care hospital in India to determine the incidence, etiological agents, their sensitivity profi les, and risk factors associated with VAP. Combination disc method, ethylenediaminetetraacetic acid (EDTA) disc synergy (EDS) tests, and AmpC disc tests were performed for detection of extendedspectrum beta-lactamases (ESBL), metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: One hundred and forty adult patients, on MV for 48 h and more, were included and 28 (20%) developed VAP. The incidence density rate of VAP was 21.875 per 1,000 ventilator days. Most of the patients had late onset VAP (60.7%) with average number of days for onset around 8 days. Pseudomonas spp. and Acinetobacter spp. were signifi cantly associated with late onset VAP, whereas Enterobacteriaceae, Staphylococcus aureus, Haemophilus infl uenzae, Streptococcus pneumoniae, Burkholderia cepacia, and Candida species were commonly isolated from early onset VAP. Polymicrobial infections occurred in 14 cases, so overall 43 VAP pathogens were isolated. Thirty (69.7%) of them were multidrug resistant (MDR), among which ESBL contributed 23.25%, MBL 30.23%, AmpC beta-lactamases 9.30%, and to methicillin resistant S. aureus (MRSA) c...
Enteric fever, a potentially fatal multisystem disease that is caused by Salmonella enterica serovar Typhi and Paratyphi, poses a significant risk in low- and middle-income countries. A retrospective study to understand the prevalence and evolving patterns of antibiotic resistance in Salmonella Typhi and Paratyphi was undertaken from June 2017 to June 2022. A total of 4051 blood samples were collected from patients attending inpatient and outpatient departments of the School of Tropical Medicine (Kolkata, India) hospital. Blood samples were cultured, and culture positive samples were further processed for identification using conventional and automated systems. Antibiotic susceptibility test was performed using both the Kirby-Bauer disc diffusion method and VITEK2 (bioMerieux). Forty-five (1.1%) Salmonella species were isolated among the number of total (n = 4051) samples that were tested. Out of the 45 Salmonella isolates, 35 were Salmonella Typhi (77.77%) and 10 were Salmonella Paratyphi A (22.23%). We found pronounced fluoroquinolone resistance of 100% in the recent years (2019–2022) in both of the S. Typhi and S. Paratyphi A isolates. We found that 1 Salmonella Typhi and 2 Salmonella Paratyphi A isolates were resistant against multiple antibiotics (cefixime, ceftriaxone, ciprofloxacin and nalidixic acid), and 1 multidrug-resistant (MDR) Salmonella Paratyphi A isolate was found in a recent study year (2020) and it showed resistance against different classes of antibiotics (cephalosporins, fluoroquinolones and carbapenems). There was no resistance that was detected to the 3rd generation cephalosporins in the final years of the study. The emergence of Salmonella isolates that are resistant to multiple antibiotics poses a serious health problem. The antimicrobial resistance patterns that were detected in the study thus warrant further studies to understand the antibiotic susceptibility and resistance pattern of Salmonella against the major classes of antibiotics.
With increasing demand for large numbers of testing during the coronavirus disease 2019 pandemic, alternative protocols were developed with shortened turn-around time. We evaluated the performance of such a protocol wherein 1138 consecutive clinic attendees were enrolled; 584 and 554 respectively from two independent study sites in the cities of Pune and Kolkata. Paired nasopharyngeal and oropharyngeal swabs were tested by using both reference and index methods in a blinded fashion. Prior to conducting real-time polymerase chain reaction, swabs collected in viral transport medium (VTM) were processed for RNA extraction (reference method) and swabs collected in a dry tube without VTM were incubated in Tris–EDTA–proteinase K buffer for 30 min and heat-inactivated at 98 °C for 6 min (index method). Overall sensitivity and specificity of the index method were 78.9% (95% confidence interval (CI) 71–86) and 99% (95% CI 98–99.6), respectively. Agreement between the index and reference method was 96.8% (k = 0.83, s.e. = 0.03). The reference method exhibited an enhanced detection of viral genes (E, N and RNA-dependent RNA polymerase) with lower Ct values compared to the index method. The index method can be used for detecting severe acute respiratory syndrome corona virus-2 infection with an appropriately chosen primer–probe set and heat treatment approach in pressing time; low sensitivity constrains its potential wider use.
In this tertiary care institution of ours, A. baumannii isolates have shown a high frequency of drug resistance, with imipenem being the best sensitive drug. This non-fermenter is the cause of a variety of infections, irrespective of whether the individuals are hospitalized or are outdoor patients.
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