Incidence of ventilator associated events among intubated patients in neurosurgery ICU of a tertiary health centre in India (original) (raw)
Related papers
2018
Background: Ventilator-associated pneumonia (VAP) is a major cause of higher morbidity and mortality among hospitalized patients especially in the intensive care unit (ICU) despite of recent advances in diagnosis and treatment. VAP is usually complicated by infection with multidrug-resistant (MDR) difficult-to-treat microorganisms. This study was conducted to evaluate the microbial agents, their antimicrobial characteristics, presence of MDR biomarkers such as ESBL, CRE and MRSA in VAP related infections. Methods: This study reviewed the records of admitted patients in the ICU of Square Hospital Ltd (SHL) who developed VAP between January 2015 and 30 June 2017. Evaluation included microbial isolates, their resistant pattern and the biomarkers detected in Microbiology laboratory following standard methods and analyzed information on VAP associated morbidity and mortality. Results: Of 2758 patients, 16% (442 of 2758) patients died. Among deaths, 50% (222 of 442) developed ventilator-associated pneumonia, more in males over 60 years. With regard to microbial isolates, Acinatobacter species (29%) was the most frequently isolated gram-negative pathogens followed by Klebsiella pneumoniae (26%), Pseudomonas (10%) and E. coli (5%). Acinatobacter had 86% resistance to meropenem, 17% resistance to collistin, but Klebsiella still 100% sensitive to both collistin and polymyxin B. Of gram-positive isolates, Staphylococcus aureus (9%) predominated over coagulase-negative Staphylococcus species (6%). Antimicrobials such as Amikacin, Meropenem, Collistin and Polymyxin B were more sensitive against gram-negative bacteria; while Linezolid and Vancomycin were the drugs of choice for other Staphylococcal species. Candia was associated 4.5% cases. Of MDR biomarkers, ESBL producer E. coli and Klebsiella were associated in VAP cases by 45% and 16% respectively; CRE producing Klebsiella and Acinatobacter in 61% and 86% cases; while MRSA producer S. aureus was in 55% cases. Thus for VAP patients, collistin, polymyxin B and minocycline are the treatment option for CRE, meropenem for ESBL and vancomycin for MRSA cases. Conclusion: Ventilator-associated pneumonia complicates the prognosis of patients receiving mechanical ventilation. Challenges remain with ESBL, CRE, MRSA and emerging collistin resistant Acinatobacter cases. Higher prevalence of VAP with MDR infections in ICU warrant early management plan using appropriate antibiotics followed by de-escalation based on culture-sensitivity and clinical response of the patient.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Ventilator Associated Pneumonia (VAP) is an important infection most often encountered in mechanical ventilation (MV) patients in intensive care units in hospital. VAP occurs in approximately 9-27% of patients who are intubated. The morbidity and mortality associated with VAP is more inspite of recent advances in diagnosis and accurate management. Emergence of multidrug resistance among the pathogens causing VAP is also contributing to the outcome. We wanted to isolate the bacterial pathogens, study the antibiotic susceptibility pattern of the isolates and detect the presence of drug resistance in various pathogens. METHODS This is a retrospective, cross sectional study done on samples received between 2016 to 2018 among patients on MV for >/= 48 hours. Endotracheal aspirates were collected from 85 patients with assumed VAP, clinical pulmonary infection score (CPIS) was noted and aerobic quantitative cultures were performed on all samples. VAP was diagnosed by count of pathogenic organisms isolated >/= 10 5 cfu/mL. Identification and antibiotic susceptibility of the isolates were done as per the standard laboratory procedures. Patients with characteristic features i.e. clinical and radiological signs of pneumonia on admission were excluded from the study. RESULTS 50 cases were diagnosed as VAP by CPIS. Gender ratio was 30:20 (male to female) higher incidence 42% of VAP was seen in the age group of 46-60 years. Majority were Gram negative bacilli; 96%-Klebsiella 36%, Acinetobacter 26% E. coli 16%, Pseudomonas 14%, and Citrobacter 4% along with coagulase positive Staphylococcus in 4%. Of the 50 VAP patients, single organism was isolated in 92% and polymicrobial in 8%. Most of the isolates showed resistance to Amoxiclav, Cefepime, Cefixime and Meropenem. CONCLUSIONS Good compliance with VAP bundle adopted in critical care areas by the health care workers will reduce the incidence of VAP. Early and accurate diagnosis, appropriate empirical and specific antimicrobial use may significantly improve patient outcome.
https://www.ijrrjournal.com/IJRR\_Vol.7\_Issue.12\_Dec2020/Abstract\_IJRR0016.html, 2020
Introduction: Ventilator associated pneumonia is a serious life threatening condition and a major problem in intensive care units despite advances in diagnostic and treatment modalities. Incidence of this clinical entity varies widely based on agent, host and environment factors. An understanding of these variables in local setting is important so as to allow judicious and more effective use of antimicrobials. Aims: To determine the incidence of VAP in the surgical intensive care unit (SICU) of the institute, to enumerate the bacterial pathogens causing it and their susceptibility profile. Material and methods: Data of all the patients diagnosed with VAP for a period of three years (2017-2019) was analysed retrospectively and variables such as age, sex, Clinical Pulmonary Infection Score, diagnosis at the time of SICU admission, duration of ventilation, antibiotics received, sample submitted, type of organism isolated and its susceptibility profile recorded. Statistical analysis was carried out using the MedCalC and NCSS software (trial version). Results: The incidence of VAP was found to be 33.6%. It was more common in male patients (61.4%) and the mean ± SD age was 43.4 ± 14.7. Most common diagnosis at the time of ICU admission was trauma. Late onset VAP was more common in the study group. A significant portion of patients with VAP were on mechanical ventilation >10 days. Multi-drug resistant Acinetobacter spp and Klebsiella pneumoniae were the most common Gram negative and Staphylococcus aureus and Enterococcus spp most common Gram positive organisms recovered from these patients. Cefoxitin resistance among S. aureus was 74.6% and vancomycin resistance in Enterococci was 24.1%. Mortality in VAP patients was 46.7%. Conclusion: VAP due to multidrug resistant microorganismsis a serious problem in our hospital with late onset VAP being more common. Emergence of polymyxin B resistance in Gram negative organisms, increasing methicillin resistance in S. aureus and vancomycin resistance in Enterococcus spp is quite alarming.
The Journal of Infection in Developing Countries, 2010
Background: Ventilator-Associated Pneumonia (VAP) is the most frequent intensive-care-unit (ICU)-acquired infection. The aetiology of VAP varies with different patient populations and types of ICUs. Methodology: A prospective study was performed over a period of 15 months in a tertiary care hospital to determine the various aetiological agents causing VAP and the prevalence of multidrug resistant (MDR) pathogens. Combination disk method, Modified Hodge test, EDTA disk synergy (EDS) test and AmpC disk test were performed for the detection of extended spectrum beta-lactamases (ESBL), carbapenemases, metallo-beta-lactamases (MBL) and AmpC β-lactamases respectively. Results: Enterobacteriaceae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Candida spp. were more common in early-onset VAP, while non-fermenters (Pseudomonas spp. and Acinetobacter spp.) were significantly associated with late-onset VAP (P value 0.0267, Chi-square value 4.91). Thirty-seven (78.7%) of the 47 VAP pathogens were multidrug resistant. ESBL was produced by 50% and 67% of Escherichia coli and Klebsiella pneumoniae respectively. MBL was produced by 20% of P. aeruginosa. AmpC beta-lactamases were produced by 33.3% and 60.7% of the Enterobacteriaceae and non-fermenters respectively. Of the S. aureus isolates, 43% were methicillin resistant. Prior antibiotic therapy and hospitalization of five days or more were independent risk factors for VAP by MDR pathogens. Conclusions: VAP is increasingly associated with MDR pathogens. Production of ESBL, AmpC beta-lactamases and metallo beta-lactamases were responsible for the multi-drug resistance of these pathogens. Increasing prevalence of MDR pathogens in patients with late-onset VAP indicate that appropriate broad-spectrum antibiotics should be used to treat them.
International Journal of Research in Medical Sciences, 2014
Ventilator associated pneumonia (VAP) is the most common infection diagnosed in intensive care units (ICUs). VAP is defined as pneumonia that occurs 48 hours or more after endotracheal intubation or tracheostomy, caused by infectious agents not present or incubating at the time mechanical ventilation was started. 1 It can be of two types. Early-onset VAP, defined as occurring within the first 4 days of mechanical ventilation, usually carries a better prognosis, and is more likely to be caused by antibiotic sensitive bacteria. Late onset VAP occuring 5 days or more after mechanical ventilation is more likely to be caused by multidrug resistant (MDR) pathogens, and is associated with increased patient mortality and morbidity. 2 The specific microbial causes of VAP are many and varied. Gram negative bacteria, including Pseudomonas aeruginosa, Acinetobacter spp and enteric gram negative rods are implicated in 55-85% of VAP cases. High rates of ABSTRACT Background: Ventilator-associated pneumonia (VAP) is the most common infection diagnosed in intensive care units (ICUs). The causative organisms of VAP vary among different populations and are increasingly associated with resistance against various antimicrobial agents. Objective of current study was to determine the bacteriological etiology of VAP, antimicrobial susceptibility pattern of the isolates and detect the presence of extended-spectrum lactamases (ESBL), metallo β-lactamases (MBL) and AmpC -lactamases in multidrug resistant isolates causing VAP in the medical ICU. Methods: A prospective study was carried out over a year to know the various etiological agents of VAP and their drug susceptibility patterns. ESBL, MBL and AmpC -lactamases were detected in various isolates by combination disk method, imipenem-EDTA combined disk method and AmpC disk method respectively. Results: The majority of bacterial isolates causing VAP were found to be gram negative bacilli. Acinetobacter spp accounted for 34.28% of VAP cases followed by Pseudomonas aeruginosa which was responsible for 25.71% cases. Other gram negative bacilli isolated were Klebsiella pneumoniae, Citrobacter freundii, Enterobacter spp, and Escherichia coli. Out of the total 70 isolates, 67 (95.7%) were multidrug resistant and not even a single isolate was sensitive to all the drugs tested. Conclusions: Most of the pathogens causing VAP in our institute were multidrug resistant and in many isolates this resistance was due to production of ESBL, MBL, and AmpC β-latamases. Polymixin-B and colistin were found to be highly effective against multidrug resistant Acinetobacter spp and P. aeruginosa.
Bacteriological Study of Ventilator-Associated Pneumonia and Antibiotic Susceptibility of Isolates
International journal of current pharmaceutical research, 2024
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 culturepositive 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 Grampositive organisms isolated, 3 (3.1%) were MSSA, and 1(1.1%) was MRSA. VAP is increasingly associated with multidrug-resistant (MDR) pathogens due to the production of ESBL, Amp C β-lactamase, Metalloβ-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.
Zagazig Journal of Pharmaceutical Sciences
According to World Health Organization (WHO), lower respiratory tract infections are the third most common cause of death worldwide. These infections are mainly caused by multidrugresistant (MDR) bacteria. Between 8-28% of patients receiving mechanical ventilation are affected by ventilator associated pneumonia (VAP). The aim of current study was to characterize bacteria isolated from VAP patients and to evaluate the effectiveness of some antimicrobial agents. Clinical bacterial isolates were recovered from patients having pneumonia associated with mechanical ventilation from intensive care units of Zagazig University Hospital and identified using conventional microbiological methods. Antimicrobial susceptibility profile of these isolates against various antimicrobials was tested by the disk diffusion method. A total of 233 isolates were recovered from 153 samples of endo-tracheal aspirates, compromising 203(87.1%) Gram negative and 30 (12.9%) Gram positive bacteria. The major isolates were Klebsiella pneumoniae (36.9%), Escherichia coli (21.04%), Acinetobacter baumannii (14.95%), Pseudomonas aeruginosa (14.16%) and Staphylococcous aureus (12.02%), coagulase negative Staphylococcus spp (0.86%), Serratia mercescens (0.43%). The isolates were highly resistant to antimicrobial agents. Two hundreds and twelve isolates (90.9%) were MDR and one hundred seventy two isolates (73.8%) were extensively drug resistant (XDR). Our study recommends that antimicrobial susceptibility should be performed for bacteria isolated from VAP patients before antimicrobial therapy to avoid emergence of MDR strains.
Medical Laboratory Journal, 2024
Background: Rampant and irrational use of antibiotics led to antimicrobial resistance in intensive care units, directly influencing the clinical outcome. The prior introduction of antibiotics, especially broad-spectrum antibiotics, has been identified as a leading cause of hospital-acquired pneumonia. The present study aims to examine the existing scenario of antibiotic resistance due to multidrug-resistant organisms that are detected in mechanically ventilated patients. Methods: This cross-sectional study was conducted in the department of Microbiology of a tertiary care hospital in Central India. A total of 410 endotracheal secretions were collected. The endotracheal aspirate of adult patients admitted to the medicine intensive care unit and on mechanical ventilation was received at the microbiology laboratory for processing by standard bacteriological techniques. Drug susceptibility testing was done using the Kirby-Bauer disc diffusion method according to the indications mentioned in Clinical and Laboratory Standards Institute 2021. Results: Out of 410 collected endotracheal secretion samples, 332 (81 %) samples demonstrated bacterial growth. A total of 265 (80%) cases fulfilled the inclusion criteria. From 265 samples, 92 (34.7 %) patients were clinically and microbiologically confirmed as cases of ventilator-associated pneumonia. Over eighty percent of gram-negative bacilli were multidrug-resistant strains (Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa). Conclusion: Real understanding of multidrug-resistant pathogens, early isolation as well as avoiding long-term antibiotic intake can reduce mortality levels currently linked with late-onset ventilator-associated pneumonia.
Background-Ventilator associated pneumonia (VAP) is one of the most common hospital acquired infections among patients in intensive care units and is major cause of mortality and morbidity despite recent advances in diagnosis and treatment. VAP is usually complicated by infection with multidrug resistant organisms. This study was conducted to evaluate the microbial causative agents and their antimicrobial susceptibility pattern in VAP patients and presence of Extented spectrum β lactamase (ESBL) and Methicillin Resistant Staphylococcous aureus (MRSA) in the isolates. Materials and methods: The present study was conducted from April 2018 to October 2018 and includes 33 patients who were under mechanical ventilation for more than 48 hrs and clinically suspected as VAP. Suction tips and Endotracheal aspirates were obtained from these patients and processed as per standard protocol. Isolates were identified and Antimicrobial susceptibility testing was done by Kirby Baeur disc diffusion method according to CLSI guidelines 2017. Results: Among 44 samples obtained from 33 patients 12(36%) samples were culture positive. The most common organisms isolated was Klebsiella pneumonia 6 (50%) followed by Eschereria coli 3 (25%) , Pseudomonas 1(8.3%), Citrobacter 1(8.3%) and CoNS 1(8.3%). All Gram-negative isolates were sensitive to imipenem and Gram positive organisms are sensitive to cefoxitin. Conclusion: (18.1%) isolates of Gram negative organisms were ESBL producers and no MRSA was isolated in the present study.