Title: Emerging Issues Regarding Management of MDR Non-Fermenting Gram Negative Ventilator Associated Pneumonia in A Rural Catering Tertiary Care Hospital

Authors: Barnali Kakati, Sonika Agarwal, Shalini Gupta

 DOI:  https://dx.doi.org/10.18535/jmscr/v4i10.69

Abstract

Introduction: Nosocomial infections due to Non-fermenting gram negative bacilli (NFGNB), especially multidrug resistant, are emerging as a great concern to the clinicians worldwide. NFGNB, normally a saprophyte cause serious infections in patients who are immune compromised or are hospitalized especially in ICU. The changing pattern of their susceptibility towards commonly used antibiotics specially carbapenems has necessitate to investigate the prevalent NFGNB circulating in a particular setting and their susceptibility in order to implicate appropriate empirical treatment. In this study we determined the antibiotic sensitivity pattern of the NFGNBs isolated from respiratory secretions of the patients in our ICU.

Design: Observatinal cross-sectional study.

Setting: Intensive care unit of a rural catering tertiary care hospital.

Material and Methods: A total of 523 respiratory tract samples were obtained from patients admitted to ICU during a period of 6 months from September 2015 to March 2016.The samples were processed as per CLSI guidelines on blood agar and macconkey agar. Bacterial growth was identified up to species level and antimicrobial susceptibility testing was determined by Vitek 2 compact (BioMérieux, France).

Result: Out of 150 patients with Ventilator associated pneumonia due to non-fermenting gram negative bacilli 63% were male and maximum age effected is 45-75 yrs with medical disease and multiple co-.morbidities. Acinetobacter baumanii was most common isolate (54.66 %) followed by Pseudomonas aeruginosa(28.66%), Elizabethkingia meningoseptica(8.66%) and Strenotrophomonas maltophilia(8%). Antibiotic resistance among non-fermenting gram negative bacilli appears to be high.

Conclusion: Surveillance of nonfermenting gram negative bacilli infections in ICU appears to be important as organism causing infection and their sensitivity profile changes from hospital to hospital and over the period of time.

Keywords: NFGNB, ICU, VAP,VITEK2.

References

1.      Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries. Am J Infect Cont. 2008; 34:S939.

2.      Barbier F, Andremont A, Wolff M, Bouadma L. Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med. 2013;19:21628.

3.      Sopena N, Heras E, Casas I, Bechini J, Guasch I, Pedro-Botet ML, et al. Risk factors for hospital-acquired pneumonia outside the intensive care unit: a casecontrol study. Am J Infect Control. 2014;42:3842.

4.      In: Winn W Jr, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, et al., editors. Nonfermenting Gram negative bacilli. In: Koneman's color Atlas and textbook of Diagnostic Microbiology.th ed. USA: Lippincott Williams and Wilkins Company; 2006. p. 305-91.

5.      MunozPrice LS, Weinstein RA. Acinetobacter infection. N Engl J Med  2008;358:127181.

6.      Wayne, Pa: Clinical and Laboratory Standards Institute; 2011. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing;21th Informational Supplement (M100-S21

7.      Goossens H. Susceptibility of multi-drug-resistant Pseudomonas aeruginosa in intensive care units: results from the European MYSTIC study group. Clin Microbiol Infec. 2003;9:980-3.

8.      Gales AC, Jones RN, Forward KR et al. Emerging importance of multidrug-resista-nt Acinetobacter species and Stenotropho-monas maltophilia as pathogens in ill patients: geographic patterns,features, and trends in the SENTRY Antimicrobial Surveillance Program (1997–1999). Clin Infect Dis 2001; 32 Suppl 2:S104–13

9.      Ridhima wadhwa1, yash sharma1, renuka pandey upadhyay2, kumud bala1* nosocomial infection by non-fermenting gram negative bacilli in tertiary care hospital: screening and cure international journal of pharmacy and pharmaceutical sciences issn- 0975-1491 vol 8, iss3, 2016

10.  Sarika kombade1,Gopal N. Agrawal2 study of multidrug resistant nonfermenting gram-negative bacilli in intensive care unit, nagpur .Indian j microbiol R es2015;2(2):120-125

11.  Kalidas Rit, Falguni Nag, Hirak Jyoti Raj†, PK Maity‡Prevalence and Susceptibility Profiles of Nonfermentative Gram-negative Bacilli Infection ina Tertiary Care Hospital of Eastern India. Indian Journal of Clinical Practice, Vol. 24, No. 5, October 2013

12.  Deepak Juyal, Rajat Prakash, Shamanth A. Shanakarnarayan, Munesh Sharma, Vikrant Negi, Neelam SharmaPrevalence of nonfermenting gram negative bacilli and their in vitro susceptibility pattern in a tertiary care hospital of Uttarakhand: A study from foothills of Himalayas.Saudi Journal for Health Sciences - Vol 2, Issue 2, May-Aug 2013.

13.  Aoife Howard, † Michael O’ Donog-hue, † AudreyP. Feeney, and Roy D. SleatorAcinetobacter baumannii An emerging opportunistic pathogen. Virulence.  2012 May 1; 3(3): 243–2

14.  Oliveira MS, Prado GV, Costa SF, Grinbaum RS, Levin AS. Ampicillin/ sulbactam compared with polymyxins for the treatment of infections caused by carbapenemresistant Acinetobacter spp. J Antimicrob Chemother 2008;61:136975.

15.  Gilardi GL. Antimicrobial susceptibility as a diagnostic aid in the identification of nonfermenting gram negative bacteria. Appl Microbiol 1971;22(5):821-3.

16.  Li ZhangXian-Zhi Li, and Keith Poole* Multiple Antibiotic Resistance in  Stenotrophomonas maltophilia:               Involvement of a Multidrug Efflux System. Antimicrob Agents Chemother. 2000 Feb; 44(2): 287–293.

17.  Jones RN. 2010. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumo-nia.  Clin. Infect. Dis. 51:S81–S87

18.  M. S. Ratnamani and Ratna Rao Elizabeth-kingia meningoseptica: Emerging nosoco-mial pathogen in bedside hemodialysis patientsIndian J Crit Care Med. 2013 Sep-Oct; 17(5): 304–3078.

19.  Jean SS1, Lee WS2, Chen FL2, Ou TY2, HsuehP R3. Elizabethking-ia meningoseptica: an important emerging pathogen causing healthcare-associated infections. J Hosp Infect. 2014 Apr;86 (4):244-9.

20.  Balm MN1, Salmon SJureen RTeo CMahdi RSeetoh TTeo JTLin RTFisher DA.Bad design, bad practices, bad bugs: frustrations in controlling an outbreak  of Elizabethkingiameningosep-ticain intensive care units.J Hosp Infect. 2013 Oct;85(2):134-40.

Corresponding Author

Sonika Agarwal

Deptt. of Critical Care Medicine, Himalyan Institute of Medical Sciences, SRHU

Swami Ram Nagar, Jolly Grant Dehradun 248016

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