BACTERIOLOGICAL STUDY OF VENTILATOR-ASSOCIATED PNEUMONIA AND ANTIBIOTIC SUSCEPTIBILITY OF ISOLATES

VIJAYA KUMAR KANIPAKAM; HIMABINDU THOTI; YAMINI SHARABU; ANITHA LAVANYA VALLURI; RAJYALAKSHMI GUNTI

doi:10.22159/ijcpr.2024v16i2.4049

Authors

VIJAYA KUMAR KANIPAKAM Department of Microbiology, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh -605102, India
HIMABINDU THOTI Department of Microbiology, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh -605102, India
YAMINI SHARABU Department of Microbiology, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh -605102, India
ANITHA LAVANYA VALLURI Department of Microbiology, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh -605102, India
RAJYALAKSHMI GUNTI Department of Microbiology, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh -605102, India

DOI:

https://doi.org/10.22159/ijcpr.2024v16i2.4049

Keywords:

Ventilator associated pneumonia, Multi-drug resistant organisms, Hospital-acquired infections, ESBLs, Amp C, Metallo--lactamase

Abstract

Objective: The present study determined the prevalence of various aerobic bacteria causing ventilator-associated pneumonia in adult patients. Initially the bacteria causing ventilator-associated pneumonia was isolated from ET samples and studied the antimicrobial susceptibility pattern of bacterial isolates.

Methods: Total 250 endotracheal aspiration (ET) samples were collected from patients admitted in Medical, Respiratory and Surgical ICUs for 1 y period. ET aspirates were collected under aseptic precautions and processed as per standard operating procedure for the identification of microorganisms. The antibiotic susceptibility test was performed by using Kirby-Bauer disk diffusion method as per CLSI guidelines.

Results: Out of the 250 samples processed, culture-positive were 34.8% (n=87) and culture-negative were 65.2% (n=163). Out of 87 culture-positive samples, polymicrobial growth was observed in 9.19% (n=8) and monomicrobial growth was observed in 90.8% (n=79). Gram negative bacilli 95.7% (n=91), and gram-positive cocci isolates are 4.2% (n=4). Among Gram-negative organisms isolated, A. baumannii is the most common isolate 33 (34.7%), followed by P. aeruginosa 28 (29.5%) and K. pneumoniae 20 (21.0%) E. coli 8 (8.4%) and E. cloacae 2 (2.1%). Out of 4 Gram-positive organisms isolated, 3 (3.1%) were MSSA, and 1(1.1%) was MRSA.

Conclusion: VAP is increasingly associated with multidrug-resistant (MDR) pathogens due to the production of ESBL, Amp C b-lactamase, Metallo-b-lactamase. It is important to carry out aggressive surveillance to determine the prevalence of MDR organisms and to generate a local antibiogram periodically. Early and appropriate antibiotics in right doses followed by de-escalation based on microbiological culture results are essential to curtail the VAP rate. VAP bundle care shall be implemented correctly.

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References

Ventilator-associated pneumonia (VAP) | HAI. CDC. Available from: https://www.cdc.gov/hai/vap/vap.html.

McEachern R, Campbell GD. Hospital-acquired pneumonia: epidemiology, etiology, and treatment. Infect Dis Clin North Am. 1998;12(3):761-79. doi: 10.1016/s0891-5520(05)70209-9, PMID 9779389.

Akca O, Koltka K, Uzel S, Cakar N, Pembeci K, Sayan MA. Risk factors for early-onset, ventilator-associated pneumonia in critical care patients: selected multiresistant versus nonresistant bacteria. Anesthesiology. 2000 Sep;93(3):638-45. doi: 10.1097/00000542-200009000-00011, PMID 10969295.

Porzecanski I, Bowton DL. Diagnosis and treatment of ventilator-associated pneumonia. Chest. 2006;130(2):597-604. doi: 10.1378/chest.130.2.597, PMID 16899866.

Rello J, Sa-Borges M, Correa H, Leal SR, Baraibar J. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Respir Crit Care Med. 1999;160(2):608-13. doi: 10.1164/ajrccm.160.2.9812034, PMID 10430736.

Mukhopadhyay C, Bhargava A, Ayyagari A. Role of mechanical ventilation and development of multidrug resistant organisms in hospital acquired pneumonia. Indian J Med Res. 2003;118:229-35. PMID 14870795.

Ranjit S, Bhattarai B. Incidence and risk factor for ventilator-associated pneumonia in Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ). 2011;9(33):28-31. doi: 10.3126/kumj.v9i1.6258, PMID 22610805.

Saravu K, Preethi V, Kumar R, Guddattu V, Shastry AB, Mukhopadhyay C. Determinants of ventilator associated pneumonia and its impact on prognosis: a tertiary care experience. Indian J Crit Care Med. 2013;17(6):337-42. doi: 10.4103/0972-5229.123435, PMID 24501484.

Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: a nine months’ prospective study. Ann Thorac Med. 2007;2(2):52-7. doi: 10.4103/1817-1737.32230, PMID 19727346.

Bahrami H. Etiology and drug resistance pattern of ventilator associated pneumonia in an Iranian 1000 bed tertiary care hospital. BMRJ. 2014;4(11):1211-8. doi: 10.9734/BMRJ/2014/7543.

Ranjan N, Chaudhary U, Chaudhry D, Ranjan KP. Ventilator-associated pneumonia in a tertiary care intensive care unit: analysis of incidence, risk factors and mortality. Indian J Crit Care Med. 2014;18(4):200-4. doi: 10.4103/0972-5229.130570, PMID 24872648.

Golia S, KT S, CL V. Microbial profile of early and late onset ventilator associated pneumonia in the intensive care unit of a tertiary care hospital in Bangalore, India. J Clin Diagn Res. 2013;7(11):2462-6. doi: 10.7860/JCDR/2013/6344.3580, PMID 24392373.

Joseph N, Sarath S, Tarun D, Ashok SB. Role of semi-quantitative cultures and quantitative cultures of endotracheal aspirates in the diagnosis of ventilator-associated pneumonia. Australian Medical Journal. 2010;3(10):627-32.

Thakuria B, Singh P, Agrawal S, Asthana V. Profile of infective microorganisms causing ventilator-associated pneumonia: a clinical study from resource limited intensive care unit. J Anaesthesiol Clin Pharmacol. 2013;29(3):361-6. doi: 10.4103/0970-9185.117111, PMID 24106362.

Ahmed NH, Hussain T, Biswal I. Antimicrobial resistance of bacterial isolates from respiratory secretions of ventilated patients in a multi-specialty hospital. Avicenna J Med. 2015;5(3):74-8. doi: 10.4103/2231-0770.160233, PMID 26229758.

Mehndiratta MM, Nayak R, Pandey S, Sharma A, Thakur A. Ventilator associated pneumonia in neurology and neurosurgery intensive care unit: incidence. Risk Factors and Pathogens Neurology. 2014;82:334. doi: 10.1186/s12931-023-02456-9, PMID 37259054.

Dominic SR, Prasanth H, Shenoy S, Shrikala B. A clinic-microbiological study of ventilator-associated pneumonia in a Tertiary Care Hospital. Int J Biol Med Res. 2012;3:1651-4.

Rit K, Saha R, Chakraborty B, Majumder U. Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multidrug resistant pathogens. Int J Med Public Health. 2014;4(1). doi: 10.4103/2230-8598.127125.

Kwa AL, Loh C, Low JG, Kurup A, Tam VH. Nebulized colistin in the treatment of pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Clin Infect Dis. 2005;41(5):754-7. doi: 10.1086/432583, PMID 16080101.

Lesho E. Role of inhaled antibacterials in hospital-acquired and ventilator-associated pneumonia. Expert Rev Anti Infect Ther. 2005;3(3):445-51. doi: 10.1586/14787210.3.3.445, PMID 15954860.