Abstract
Background: Respiratory infections in critically ill patients are associated with high morbidity and mortality. Patients who are mechanically ventilated are at high risk of acquiring respiratory tract infections due to a complex interplay between the endotracheal tube, host immunity, and virulence of invading bacteria. To initiate empiric antimicrobial therapy knowledge of local antimicrobial resistance patterns are essential.
Aim: The aim of our study was to identify the bacterial pathogens and their antibiotic susceptibility of endotracheal aspirate samples collected from the patients on mechanical ventilation for more than 48 hours.
Materials and Methods: This prospective study was done at Saveetha Medical College and Hospital, Chennai. One hundred and seven samples were collected, bacteriological identification and antibiotic susceptibility were tested for pathogen grown in endotracheal cultures received.
Results: Culture was positive in sixty-one out of one hundred and seven samples (i.e., 57% of all the samples) out of which gram-negative bacteria accounted for (59 out of 61) 96.72% cases and rest 2 cases were Candida spp. Pseudomonas spp 37% (22 out of 61) was the commonest organism isolated followed by Klebsiella spp 33% (20 out of 61), Acinetobacter spp 20% (12 out of 61), Escherichia coli 3.3% (2 out of 61), Enterobacter spp 3.3% (2 out of 61) and Proteus spp 1.6% (1 out of 61). ESBL rate was highest among Acinetobacter spp (100%) followed by Klebsiella spp (40%) and Pseudomonas spp (27%). Most of the Acinetobacter spp 83% (10 out of 12) were Multidrug-resistant whereas five isolates of each of Klebsiella spp (25%) and Pseudomonas spp (23%) were found to be MDR and sensitive to only colistin and tigecycline. Fungal isolates consisted of one case of Candida albicans and Candida non-albicans each.
Conclusion: Gram-negative bacteria especially Pseudomonas spp, Klebsiella spp, Acinetobacter spp are most commonly encountered pathogens isolated in endotracheal samples of ventilator-associated pneumonia patients. Among these pathogens, Acinetobacter spp. shows very high ESBL positivity, while these characteristics are moderately expressed in Klebsiella spp and less commonly in Pseudomonas spp. Multidrug resistance also followed the same trail among these common pathogens.
Keyword: Bronchoalveolar lavage, Endotracheal aspirates, Extended Spectrum Beta-Lactamase (ESBL), Multidrug-resistant.
References
- D. Rosenthal et al., “Device-associated nosocomial infections in 55 intensive care units of 8 developing countries”, Ann. Intern. Med., vol 145, no 8, bll 582–591, 2006.
- Mehta et al., “Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the International Nosocomial Infection Control Consortium (INICC)”, J. Hosp. Infect., vol 67, no 2, bll 168–174, 2007.
- T. Society en I. D. S. of America, “Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia”, Am. J. Respir. Crit. Care Med., vol 171, no 4, bl 388, 2005.
- A. Dudeck et al., “National Healthcare Safety Network report, data summary for 2011, device-associated module”, Am. J. Infect. Control, vol 41, no 4, bll 286–300, 2013.
- M. Joseph, S. Sistla, T. K. Dutta, A. S. Badhe, en S. C. Parija, “Ventilator-associated pneumonia in a tertiary care hospital in India: incidence and risk factors”, J Infect Dev Ctries, 2009.
- D. Hunter, “Ventilator associated pneumonia”, Bmj, vol 344, no e3325, bl e3225, 2012.
- Afshari, L. Pagani, en S. Harbarth, “Year in review 2011: Critical Care–infection”, Crit. Care, vol 16, no 6, bl 242, 2012.
- S. Zolfaghari en D. L. A. Wyncoll, “The tracheal tube: gateway to ventilator-associated pneumonia”, Crit. Care, vol 15, no 5, bl 310, 2011.
- A. Kalanuria, W. Zai, en M. Mirski, “Ventilator-associated pneumonia in the ICU”, Crit. care, vol 18, no 2, bl 208, 2014.
- R. Tillotson en M. Finland, “Bacterial colonization and clinical superinfection of the respiratory tract complicating antibiotic treatment of pneumonia”, J. Infect. Dis., vol 119, no 6, bll 597–624, 1969.
- H. Choudhuri, “Ventilator-Associated Pneumonia: When to hold the breath?”, Int. J. Crit. Illn. Inj. Sci., vol 3, no 3, bl 169, 2013.
- Clinical and Laboratory Standards Institute, Performance Standards For Antimicrobial Susceptibility Testing, 28th ed. CLSI, 2018.
- Mackie & McCartney, Practical Medical Microbiology, 14th Ed. Churchill Livingstone, 2014.
- H. Afify, E. A. Shaheen, S. S. El-Dahdouh, en H. M. El-Feky, “Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP”, Egypt. J. Chest Dis. Tuberc., 2015.
- S. Morehead en S. J. Pinto, “Ventilator-associated pneumonia”, Arch. Intern. Med., vol 160, no 13, bll 1926–1936, 2000.
- Fagon et al., “Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques”, Am. Rev. Respir. Dis., vol 139, no 4, bll 877–884, 1989.
- Şimşek et al., “Ventilator-associated pneumonias in a cardiothoracic surgery centre postoperative intensive care unit”, J. Hosp. Infect., vol 47, no 4, bll 321–324, 2001.
- Mulla Summaiya, “Assessment of biofilm formation by the causative organisms of ventilator associated pneumonia at intensive care unit of a tertiary care hospital”, Natl. J. Med. Res., vol 2, no 1, bll 15–18, 2012.
- Patil, “THE STUDY OF THE ORGANISMS COLONIZING TRACHEA IN MECHANICALLY VENTILATED PATIENTS ADMITTED IN THE INTENSIVE CARE UNIT (ICU)”, Med. Educ., vol 1, no 1, bl 39, 2014.
- Panda et al., “Organisms isolated from endotracheal aspirate and their sensitivity pattern in patients suspected of ventilator associated pneumonia in a tertiary care hospital”, vol 6, no 1, bll 284–288, 2018.
- George en A. Sequiera, “Antimicrobial sensitivity pattern among organisms which were isolated from the endotracheal aspirates of patients with ventilator associated pneumonia”, J Clin Diag Res, vol 4, bll 3397–3401, 2010.
- Chatterjee en S. Dam, “Epidemiological study of acinetobacter baumannii and its resistance pattern in clinical isolates from a private hospital in Kolkata, Eastern India”, Int. J. Curr. Res. Life Sci., vol 7, no 05, bll 2001–2003, 2018.
Corresponding Author
Dr Debjita Debnath
Department of Microbiology, Saveetha Medical College & Hospital, Thandalam, Chennai, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i10.231
