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...

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Background:Antibiotic-resistant Acinetobacter nosocomial infection is a leading problem. It acts as an opportunistic pathogen to cause a wide spectrum of infection including nosocomial pneumonia, meningitis, endocarditis, skin and soft tissue infections, urinary tract infection, conjunctivitis, burn wound infection and bacteremia. Multidrug-resistant Acinetobacter infection creates a great problem in hospital setting.Materials and Methods:The clinical specimens obtained from ICU and different surgical and medical wards were investigated using standard microbiological techniques to know the distribution of and their resistant profile. Antimicrobial resistance was studied using the modified Kirby Bauer disk diffusion technique following the CLSI protocol.Results:Major infections found in different medical wards, surgical wards and ICU were due to Acinetobacter baumannii (74.02%), A. lowfii (14.2%), A. haemolyticus (7.79%), A. junii (3.8%) among Acinetobacter spices. Acinetobacter showed increased resistant against majority of commercially available drugs imipenem (5.2%), meropenem (9.75%), piperacillin-tazobactum (18.2%), netilmicin (16.24%), amikacin (14.29%), ceftazidime (74.1%), gentamicin (70.13%), ofloxacin (42.21%).Conclusion:A. baumannii was found to be associated with UTI, RTI, septicemia, bacteremia, and meningitis and wound infection. A. baumannii displayed higher resistance to more number of antibiotics than other nosocomial pathogens from ICU.

Small colony variants (SCVs) of Staphylococcus aureus often cause persistant and relapsing infections. SCVs are characterized by a strong reduction in growth rate, atypical colony morphology and unusual biochemical characteristics. We here report a case of chronic oesteomyelitis caused by SCV of Staphyloccous aureus in a middle aged male patient.

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INTRODUCTION: Chronic otitis media (COM) is one among the commonest otological diseases encountered in otorhinolaryngological practice and attending ENT OPD especially among the lower socioeconomic strata of society. AIMS: This study was carried out to know about the aerobic bacterial flora causing COM and in-vitro antibiotic susceptibility pattern in order to scientifically guide patient management instead of relying on empirical therapy alone. MATERIALS AND METHODS: This study included 100 patients of community acquired COM attending ENT OPD of a tertiary care level hospital. After proper sample collection by sterile aural swabs, they were immediately sent to the microbiology laboratory for processing by aerobic culture, isolation and identification following standard recommended methods and antibiotic susceptibility tests were done by Kirby-Bauer disc diffusion methods as per Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: Out of 100 cases of COM, microbiological culture yielded 101 bacterial isolates from 90 patients and 4 fungal isolates (3 isolates of Candida albicans and 1 isolate of Aspergillusfumigatus) from 4 patients. Polymicrobial infections were seen in 11.11% patients. In this study Staphylococcus aureus (31.68%) was the commonest isolate followed by Pseudomonas aeruginosa (23.76%). Other common bacterial isolates were E.coli, Klebsiellapneumoniae, coagulase negative Staphylococcus (CONS), Proteus mirabilis in descending order. Piperacillin-tazobactum was the most sensitive drug (85.45%) among the gram-negative bacteria followed by meropenem (81.81%), amikacin (76.36%) and levofloxacin (74.54%). Gram positive bacteria showed 100% sensitivity to vancomycin and 93.47% sensitivity to linezolid. For Methicillin resistant Staphylococcus aureus (MRSA) isolates ciprofloxacin, cotrimoxazole, tetracycline, linezolid and vancomycin were found to have good activity. CONCLUSION: This study suggests that the common etiological agents for community acquired COM were Staphylococcus aureus and Pseudomonas aeruginosa. Also correct choice of anti-bacterial agents by proper microbial sensitivity tests is necessary for effective therapy as the bacterial isolates are gradually becoming resistant to commonly prescribed antibiotics.

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