Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

Qureshi, Sadia; Agrawal, Chaturbhuj; Madan, Molly; Pandey, ArunR; Chauhan, H. S.

doi:10.4103/0255-0857.153566

Cited by 11 publications

(5 citation statements)

References 8 publications

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“…During the flushing process, the patient's condition should be carefully observed. When an abnormality occurs, the nursing staff should immediately stop the flushing and accurately find the cause to ensure that the incoming flushing fluid dosage is the same as the outgoing flushing solution [21]. At the same time, during the operation, the nursing staff must be gentle to prevent damage to the patient's oral mucosa and strictly follow the relevant operating procedures to ensure that the intubation does not shift or other problems [22].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Improved Oral Care Methods on the Oral Health of Patients Undergoing Transoral Mechanical Ventilation

Shen¹,

Dai

Zhu³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. To explore the effects of improved oral care on the number of oropharyngeal bacteria and the incidence of ventilatorassociated pneumonia in patients undergoing mechanical ventilation through oral endotracheal intubation by improving conventional oral care methods and operating procedures and to evaluate the quality of improved oral care and effect. Methods. A total of 100 cases of mechanically ventilated patients with oral endotracheal intubation who met the inclusion criteria were randomly divided into the observation group and control group with 50 cases each. The control group took routine oral care, that is, scrubbing 3 times per day, and the oral care solution was selected as physiological brine. The observation group improved the conventional oral care method, namely, oral scrubbing before intubation, brushing and washing after intubation, 3 times per day, and 0.1% povidone-iodine in oral care solution. Analysis and comparison of the oral bacterial flora, oral cleanliness, and incidence of ventilator-associated pneumonia, mechanical ventilation time, ICU hospitalization time, and mortality rate of the two groups of patients were analyzed and compared. The relevant data were collected and processed for statistical processing. Results. The oral bacterial flora of the two groups of patients before oral care after mechanical ventilation after oral tracheal intubation was compared, and there was no significant statistical difference (P > 0:05). After nursing, the oral bacterial flora of the observation group at 8 h, 16 h, and 24 h after intubation was significantly lower than that of the control group. Statistics showed that the difference was statistically significant (P < 0:05). After nursing, the number of patients with oral cleanliness in the observation group was significantly higher than that of the control group, while the incidence of ventilator-associated pneumonia in the observation group was 8% significantly lower than that of the control group 14%. Statistics show that this difference is statistically significant (P < 0:05). After nursing, the observation group's oral cleanliness score, mechanical ventilation time, ICU hospitalization time, and GCS score were better than those of the control group. Statistics showed that the difference was statistically significant (P < 0:05). The mortality of the observation group was significantly lower than that of the control group, which was not statistically significant (P > 0:05). Conclusion. Oral care can effectively reduce the number of oropharyngeal bacteria in patients who are mechanically ventilated through orotracheal intubation and significantly reduce the incidence of ventilator-associated pneumonia.

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Section: Discussionmentioning

confidence: 99%

The Impact of Improved Oral Care Methods on the Oral Health of Patients Undergoing Transoral Mechanical Ventilation

Shen¹,

Dai

Zhu³

et al. 2022

Computational and Mathematical Methods in Medicine

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“…However, with such increasing trend of ceftriaxone resistance, carbapenem use is likely to occur. In the face of lack of new molecules from pharmaceutical companies in the last three decades, we risk reverting to a pre-antibiotic era after running out of therapeutic options [4,29]. To reverse this trend, we need to practice a judicial use of antibiotics by promoting hospital antimicrobial stewardship programs [30][31][32].…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Resistance in Aerobic Bacterial Isolates From Infected Diabetic Foot Ulcers in North Eastern Tanzania: An Urgent Call to Establish A Hospital Antimicrobial Stewardship Committee

Shabhay

Horumpende

Mujuni³

et al. 2021

Preprint

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Background. Diabetic foot ulcers (DFU) is among major health problems which impact the socio economic burden globally. We aimed at assessing the susceptibility pattern of antimicrobials in DFU infections among patients admitted in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC). Methods. This descriptive cross-sectional study was conducted from September 2018 through March 2019. Pus swabs were collected on the first day of admission by deep wound swabbing after irrigation with normal saline solution. Kirby-Bauer method was done according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. Results. Sixty diabetic ulcer patients had 62 bacterial isolates. Majority of the isolates were gram negative 49/62(79.03%). The most common isolate was Escherichia coli 15/62(24.19%) followed by Pseudomonas aeruginosa 14/62(22.58%), Proteus mirabilis 8/62(12.9%) and Staphylococcus aureus 5/62(8.06%). Klebsiella pneumoniae, Coagulase Negative Staphylococcus, Proteus Vulgaris, and Streptococcus pyogenes each contributed 4/62(6.25%) isolates. Of the 49/62(79.3%) gram negative isolates, 8/49(16.33%) were mono resistant, 30/49(61.22%) were multiresistant, and 11/49(22.45%) were susceptible. Of the multi-resistant isolates, E. coli 12/15(80.00%), and P.aeruginosa 7/14(50.00%) were predominant. A total of 39/62(62.90%) isolates in patients contributed to poorer outcomes including loss of body part. Patients with ulcers infected by P. aeruginosa 11/39 (28.21%) had the highest number of surgical removal of body parts followed by E. coli 8/39(20.51%). Gram negative bacteria were highly susceptible to amikacin 91.18%, meropenem 93.33% and imipenem 95.24%. Isolates susceptibility to ceftriaxone was 32%. Conclusions. Amikacin, meropenem and imipenem can be safely used as broad-spectrum antimicrobials in DFU. The Standard of care remains culture and sensitivity of isolated microorganisms in combating diabetic foot ulcers infections.

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“…137 Similarly, in a meta-analysis of 50 publications from China from 2010 to 2014, PA was implicated in 19.4% of cases of VAP. 118 In summary, PA is responsible for 15 to 28% of ICU-acquired pneumonias globally; furthermore, MDR strains have increased dramatically in frequency over the past three decades [144][145][146][147] (discussed in detail later).…”

Section: Incidence Of Pa Infection In Nosocomial Settingsmentioning

confidence: 98%

Pseudomonas aeruginosa Pneumonia: Evolution of Antimicrobial Resistance and Implications for Therapy

Lynch

Zhanel

2022

Semin Respir Crit Care Med

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Pseudomonas aeruginosa (PA), a non–lactose-fermenting gram-negative bacillus, is a common cause of nosocomial infections in critically ill or debilitated patients, particularly ventilator-associated pneumonia (VAP), and infections of urinary tract, intra-abdominal, wounds, skin/soft tissue, and bloodstream. PA rarely affects healthy individuals, but may cause serious infections in patients with chronic structural lung disease, comorbidities, advanced age, impaired immune defenses, or with medical devices (e.g., urinary or intravascular catheters, foreign bodies). Treatment of pseudomonal infections is difficult, as PA is intrinsically resistant to multiple antimicrobials, and may acquire new resistance determinants even while on antimicrobial therapy. Mortality associated with pseudomonal VAP or bacteremias is high (> 35%) and optimal therapy is controversial. Over the past three decades, antimicrobial resistance (AMR) among PA has escalated globally, via dissemination of several international multidrug resistant “epidemic” clones. We discuss the importance of PA as a cause of pneumonia including health care–associated pneumonia, hospital-acquired pneumonia, VAP, the emergence of AMR to this pathogen, and approaches to therapy (both empirical and definitive).

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Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

Cited by 11 publications

References 8 publications

The Impact of Improved Oral Care Methods on the Oral Health of Patients Undergoing Transoral Mechanical Ventilation

The Impact of Improved Oral Care Methods on the Oral Health of Patients Undergoing Transoral Mechanical Ventilation

Antibiotic Resistance in Aerobic Bacterial Isolates From Infected Diabetic Foot Ulcers in North Eastern Tanzania: An Urgent Call to Establish A Hospital Antimicrobial Stewardship Committee

Pseudomonas aeruginosa Pneumonia: Evolution of Antimicrobial Resistance and Implications for Therapy

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