Emerging trends of nosocomial pneumonia in intensive care unit of a tertiary care public teaching hospital in Western India

Abstract

Background:Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU.Materials and Methods:It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months. We studied clinical profile and outcome of 120 adult patients who developed VAP/HAP during the study period. We also analyzed the causative organisms, antibiotic sensitivity, and resistance pattern in these patients.Results:Out of 120 patients, 29 patients were HAP and 91 patients were VAP. Mortality was 60% (72), and development of VAP and requirement of mechanical ventilation showed significant association with mortality (P < 0.00001). Most common organism causing HAP was Staphylococcus aureus (43.4%) and VAP was Klebsiella pneumoniae (49%). Maximum antibiotic sensitivity was found to piperacillin + tazobactam (58.8%), followed by imipenem (49.5%) and meropenem (41.8%), whereas maximum antibiotic resistance was found to cefepime (95.1%), followed by ceftazidime and amoxicillin (91.2%).Conclusion:Nosocomial pneumonia showed high incidence (17.44%) and mortality (60%). Common organisms identified were S. aureus and K. pneumoniae. Resistance was high for commonly used antibiotics and high antibiotic sensitivity for piperacillin + tazobactam and carbapenem.

Elevated Blood Urea Nitrogen-to-Serum Albumin Ratio as a Factor That Negatively Affects the Mortality of Patients with Hospital-Acquired Pneumonia

“…HAP is a common hospital-acquired infection with a prolonged hospital length of stay and high patient mortality [1]. HAP is associated with a mortality rate ranging from 20% to 60%, especially in the ICU [7–9]. The attributable mortality is probably higher in some specific populations such as patients with chronic obstructive pulmonary disease (COPD) [10] and psychiatric diseases [11].…”

Acute interface infectious keratitis with multidrug resistant Klebsiella and Escherichia Coli following deep anterior lamellar keratoplasty

“…Klebsiella and E. Coli are common nosocomial pathogens both worldwide and in India, and are often MDR. [ 9 10 ] Hospital-acquired Klebsiella can be harbored in the conjunctiva and sometimes cause serious ocular infection in patients during the hospital stay. [ 11 ] The Klebsiella and E. Coli isolate in this case was extended drug resistant and sensitive only to colistin.…”

“…These organisms are notorious for being multi-drug resistant (MDR). [ 9 10 ] Since the exudates are trapped in the potential space between the donor cornea and host Descemet membrane (DM), surgical management in the form of therapeutic penetrating keratoplasty (TPK) is often required. [ 5 ]…”

Spectrum of microbial growth and antimicrobial usage in an intensive-care unit of a tertiary-care hospital in Trinidad, West Indies

“…[18] Studies from ICUs in Egypt and India found Klebsiella to be the most common organisms associated with ventilator-associated pneumonia (VAP). [19,20] The ICU where the present study was conducted does not formally adhere to any 'ventilator care bundle' , and VAP rates might have been underestimated. However, endotracheal-tube colonisation by Pseudomonas is a well-established phenomenon; a recent study investigating the microbiome of endotracheal tubes showed that the presence of Pseudomonas in the endotracheal tube showed a strong correlation with the poor prognosis of ICU patients.…”