Bacteriological Profile of Ventilator Associated Pneumonia in a Tertiary Care Centre of Dakshina Kannada Dist.

Abstract

BACKGROUNDMechanical ventilation can increase the risk of VAP 7 -21 times and 10% -25% of patients undergoing mechanical ventilation develop pneumonia. The aetiological agents of VAP vary with different patient populations and types of ICUs. Prompt administration of appropriate antibiotics seems to be the only intervention that alters outcome once the diagnosis is established. MATERIALS AND METHODSThis is a descriptive study with seventy-four non-repetitive endotracheal aspirate from patients who were on mechanical ventilation for more than 48 hrs. and in whom ventilator associated pneumonia was suspected using modified CPIS score and quantitative culture was confirmed using modified two-fold dilution scheme. Kirby-Bauer disk diffusion method was adopted for antimicrobial susceptibility testing. RESULTSThe most common isolate was pseudomonas aeruginosa (27%) followed by Acinetobacter spp. (20.3%), Klebsiella spp. (16.2%) and E. coli (12%). Among gram positive bacteria in our study, only Staphylococcus aureus (9.5%) was isolated. Amikacin and levofloxacin were found to be better against non-fermenters; 10% were carbapenemase producers, MDR isolates were observed in enterobacteriaceae members. MRSA was found in 28.6%. CONCLUSIONIn conclusion, the incidence of VAP and the prevalence of multidrug resistant microorganisms were quite high in our ICU setup. A local surveillance program at each centre is essential, as the knowledge of local resistant patterns is vital for selecting the appropriate agents for treating infections. BACKGROUNDVentilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after the initiation of endotracheal intubation and mechanical ventilation (MV) including pneumonia developing even after extubation. 1 Mechanical ventilation can increase the risk of VAP 7 -21 times and 10% -25% of patients undergoing mechanical ventilation develop pneumonia. 2 It results in high mortality and morbidity, prolonged lengths of hospitalisation and also increased cost of hospitalisation. The mortality rates for VAP range from 20% to 75% according to the study population. 3 Accurate data on aetiologic agents and the epidemiology of VAP are limited by the lack of a 'gold standard' for diagnosis. However, regardless of the diagnostic technique used, there have been dramatic variations in the distribution of pathogens and drug resistance patterns. Because early and