Characterisation of aerobic bacteria isolated from endotracheal aspirate in adult patients suspected ventilator associated pneumonia in a tertiary care center in Mangalore

Abstract

Background and Objectives:Despite advances in antimicrobial therapy, better supportive care modalities and use of a wide range of preventive measures, ventilator-associated pneumonia (VAP) continues to be an important cause of morbidity and mortality in intensive care unit (ICU). VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, to prevent mortality and morbidity. Inappropriate and inadequate antibiotic treatment causes emergence of drug resistance in pathogens and poor prognosis in patients. Early detection of pathogens causing VAP helps to control their spread by administration of suitable antibiotics and proper infection control measures. The study was conducted to know the pathogens causing VAP in Fr. Muller Medical College Hospital, Mangalore, and their susceptibility pattern.Methods:A total of 100 patients, on mechanical ventilation for more than 48 h, who were suspected to have VAP were included in the study between December 2008 and November 2009. Their endotracheal aspirates (ETAs) were collected and processed. From 100 ETA, 138 isolates of count > 105 CFU/ mL were characterized and antibiogram was determined using standard antibiotics regime.Results:Incidence of VAP was found to be 44.2% among the mechanically ventilated patients. Klebsiella pneumoniae (34%) was the most common pathogen isolated, followed by Pseudomonas aeruginosa (20%). Among them, most of the K. pneumoniae and P. aeruginosa isolates were resistant to penicillins, cephalosporins, fluoroquinolones was observed but were sensitive to piperacillin/tazobactum, cefaperazone/sulbactum, and carbapenems. All isolates were sensitive to amikacin.Interpretation and Conclusion:The present study shows prevalence of multidrug-resistant organisms in the study region. Klebsiella species was the most common pathogen isolated in ETA. Acinetobacter species were the most resistant pathogens prevailing in our ICU setup, leading to the increased mortality in the ventilated patients. Patients with chronic obstructive pulmonary disease is the most common predisposing factor for VAP in the study group.

Microbial Profile of Early and Late Onset Ventilator Associated Pneumonia in The Intensive Care Unit of A Tertiary Care Hospital in Bangalore, India

“…Our study shows that patients in the age group of 46-60 years were more prone to VAP as the number of patients exposed to mechanical ventilation (>48hours) were also more in this age group and this was found in accordance with earlier studies [4]. The incidence of VAP was more in males (39.53%) compared to females (29.03%) which was similar to studies conducted by Sharma et al, [20].…”

“…Meropenem resistance was high in this study as 40% of the Pseudomonas and 37.5 % of Acinetobacter species showed multi-drug resistance (MDR), even to carbapenems, which is in concordance with other studies [19,26]. Whereas certain studies reported a lower incidence of meropenem resistance [4,20]. 85.71% of Staphylococcus aureus strains were MRSA.…”

“…Despite the advancements in antimicrobial regimes, VAP continues to be an important cause of morbidity and mortality. VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, as there is adverse effect of inadequate antibiotic treatment on patient's prognosis Microbiology Section and the emergence of multidrug-resistant (MDR) pathogen [4]. Inadequate antimicrobial therapy, such as inappropriate antimicrobial coverage, or delayed initiation of antimicrobials has been associated with higher hospital mortality in subjects with hospital acquired pneumonia (HAP) or VAP [5].…”

Bacterial Isolates from Tracheal Aspirates and their Anti-microbial Susceptibility in Mechanically-Ventilated Children with Pneumonia Admitted to an Urban Critical Care Ward

“…The instrument monitors the fluorescence of the vial sensor that is activated when CO 2 is produced or O 2 is utilized. Analysis of the rate and amount of CO 2 produced or O 2 utilized enables the instrument to determine if the vial is positive; i.e., the presumptive presence of viable organisms [18].…”

Identification of Bacterial Isolates from Endotracheal Aspirate of Patients in Intensive Care Unit and Their Antimicrobial Susceptibility Pattern

“…9 After vortexing specimens were centrifuged at 2000 g for 10 minutes. Two mL supernatant was discarded using a sterile pipet and the deposit was further mixed by vortexing.…”