Antimicrobial use, incidence, etiology and resistance patterns in bacteria causing ventilator-associated pneumonia in a clinical-surgical intensive care unit

Abstract

Introduction: Antimicrobial resistance is an increasing threat in hospitalized patients, and inappropriate empirical antimicrobial therapy is known to adversely affect outcomes in ventilator-associated pneumonia (VAP). The aim of this study was to evaluate antimicrobial usage, incidence, etiology, and antimicrobial resistance trends for prominent nosocomial pathogens causing ventilatorassociated pneumonia in a clinical-surgical intensive care unit (ICU). Methods: Gram-negative bacilli and Staphylococcus aureus causing VAP, as well as their antimicrobial resistance patterns and data on consumption (defined daily dose [DDD] per 1,000 patient days) of glycopeptides, extended-spectrum cephalosporins, and carbapenems in the unit were evaluated in two different periods (A and B). Results: Antimicrobial use was high, mainly of broad-spectrum cephalosporins, with a significant increase in the consumption of glycopeptides (p < 0.0001) and carbapenems (p < 0.007) in period B. For Acinetobacter baumannii and members of the Enterobacteriaceae family, 5.27-and 3.06-fold increases in VAPs, respectively, were noted, and a significant increase in resistance rates was found for imipenem-resistant A. baumannii (p = 0.003) and third-generation cephalosporinsresistant Enterobacteriaceae (p = 0.01) isolates in this same period. Conclusions: Our results suggest that there is a link between antibiotics usage at institutional levels and resistant bacteria. The use of carbapenems was related to the high rate of resistance in A. baumannii and therefore a high consumption of imipenem/meropenem could play a major role in selective pressure exerted by antibiotics in A. baumannii strains.

A Comparative Analysis of Nosocomial Infections between Internal and Surgical Intensive Care Units of a University Hospital in Birjand, Iran from 2015 to 2016: A Retrospective Study

“…In terms of mortality, 62.5% of the patients in the internal ICU had positive culture and 48.4% had no infection, and in the ICU surgery 39.7% of the patients had positive culture and 14.3% had no infection, which was a signi cant difference (p-value < 0.001). In a preview studies showed that, NIs rate with increasing of infection (positive-culture) in internal ICU had a signi cant difference [22][23][24][25][26] Therefore, we should be undertaken to monitor and reduce the affecting factors of the patients in ICUs, who are known as the group with the high risk of NI.…”

Molecular epidemiological survey of bacteremia by multidrug resistant Pseudomonas aeruginosa: the relevance of intrinsic resistance mechanisms

“…Today, high levels of resistance to several antimicrobial agents in P . aeruginosa clinical isolates have been reported as a worldwide problem [3–5]; however, this problem is more significant in Brazil due to a very high frequency of antibiotic use, particularly carbapenems and fluoroquinolones [6,7]. …”

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

“…In Brazil this problem is hih5ghly significant and some studies show a very high density of antibiotic use, especially of carbapenems and fluoroquinolones (Moreira et al, 2013;Porto et al, 2013). The resistance of P. aeruginosa to carbapenems is higher than 60 % in some Brazilian hospitals (Baumgart et al, 2010;Sader et al, 2005) and the production of metallo-b-lactamase (MBL) encoded by several genes, including bla SPM-1 , bla VIM and bla IMP , is considered the main mechanism of resistance to these antibiotics (Sader et al, 2005).…”