Microbiological Organisms and Their Antimicrobial Sensitivity Causing Ventilator Associated Pneumonia (VAP).

UmerUl Haq; Haq Nawaz Awan; Waseem Raja; Waseem Wali; Nadia Sultan

Author(s)

UmerUl Haq Combined Military Hospital Lahore, Pakistan

Haq Nawaz Awan National University of Sciences and Technology, Islamabad, Pakistan

Waseem Raja 141 Medical Battalion Rawalpindi, Pakistan

Waseem Wali Military Hospital/National University of Medical Sciences Rawalpindi (NUMS) Pakistan

Nadia Sultan Military Hospital/National University of Medical Sciences Rawalpindi (NUMS) Pakistan

Abstract

Objective: To determine the frequency of different causative bacteriological organisms and their antibiotic sensitivity from Endotracheal Aspirate (EA) of patients suffering from Ventilator Associated Pneumonia (VAP). Study Design: Prospective cross sectional study. Place and Duration of Study: Intensive Care Unit (ICU), Combined Military Hospital (CMH) Lahore, from May 2013 to Nov 2013. Material and Methods: A total of 180 cases of VAP, fulfilling the inclusion criteria and admitted in the ICU, were included in the study using the non-probability consective sampling technique. A written informed consent was obtained from the family. All these patients underwent endotracheal aspirate for microscopy and culture. Antibiotic sensitivity was determined using standard antibiotics regimens. Results: Out of 180 patients, 165 (91.7%) were culture positive while 15 (8.3%) were culture negative. Gramnegative bacilli accounted for about 70% of all isolates. The most common organism isolated was Pseudomonas aeruginosa 25% (n=45) followed by MRSA 18.9% (n=34), Klebsiella 15.6% (n=28), Actinobacter spp 13.3% (n=24), E.coli 11.7% (n=21) and Citrobacter spp 4.4% (n=8). Carbapenem was the most sensitive drug that was seen in our setup but still 43.9% of the isolates showed resistance against it and resistance was noted still higher with Actinobacter spp, where 83% isolates were resistant. Quinolones showed resistance in 100% of the isolates of Actinobacter, MRSA and Citrobacter. While more than 50% strains of Pseudomonas, E.coli and Klebsiella were also resistant to quinolones. Cephalosporins showed excellent sensitivity towards gram negative bacteria which included Citrobacter (100% sensitive) and E.coli (80% sensitive). Polymxins showed more than 50% sensitivity to Pseudomonas aeruginosa, Actinobacter, E. coli and Klebsiella. Conclusion: VAP remains a very important hospital-acquired infection. The most prevalent etiological organism in our study was Pseudomonas aeruginosa and the most effective antibiotics were carbapenems.

Publication Details

Page(s) 191-197

DOI DOI not available

Published Journal: Pakistan Armed Forces Medical Journal, Volume: 68, Issue: 2, Year: 2018

Request the full text from PASTIC

References

MathaiAS,PhillipsA,IsaacR, 2016.Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units! Lung India: official organ of Indian Chest Society, 33 512 -6

WahidF,MasoodN,JafriA, 2005.Nosocomial pneumonia in mechanically ventilated patients,Pak Armed Forces Med J 55 202 -7

CharlesMP,KaliA,EasowJM,JosephNM,RavishankarM,SrinivasanS, 2014.Ventilator-associated pneumonia,Australas Med J 7 334 -44

MineiJP,NathensAB,WestM,HarbrechtBG,MooreEE,ShapiroMB, 2006.Inflammation and the Host Response to Injury, a Large-Scale Collaborative Project: patient-oriented research core--standard operating procedures for clinical care. II. Guidelines for prevention, diagnosis and treatment of ventilatorassociated pneumonia (VAP) in the trauma patient,J Trauma 60 1106 -13

ChawlaR.,Epidemiology, 2008.diagnosis of hospitalacquired pneumonia and ventilator-associated pneumonia in Asian countries,Am J Infect Control 36 S93 -100

RosenthalVD,GuzmanS,CrnichC, 2004.Device-associated nosocomial infection rates in intensive care units of Argentina,Infect Control Hosp Epidemiol 25 251 -5

SafdarN,CrnichCJ,MakiDG, 2005.The pathogenesis of ventilatorassociated pneumonia: its relevance to developing effective strategies for prevention,Respir care 50 41 -39

AliHS,KhanFY,GeorgeS,ShaikhN,Al-AjmiJ, 2016.Epidemiology and Outcome of Ventilator-Associated Pneumonia in a Heterogeneous ICU Population in Qatar,Biomed Res Int 8231787 -

CorreaRde,A , Luna,CM , Anjos,JC , Barbosa,EA , Rezende,CJ , Rezende,AP, 2014.Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial,J bras pneumol 40 643 -51

ScholteJB,van DesselHA,LinssenCF,BergmansDC,SavelkoulPH,RoekaertsPM, 2014.Endotracheal aspirate and bronchoalveolar lavage fluid analysis: interchangeable diagnostic modalities in suspected ventilator-associated pneumonia,J Clin Microbiol 52 3597 -604

2005.Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare-associated pneumonia,American journal of respiratory and critical care medicine 171 388 -416

KumarA,RazzaqueS,JamaliA,MohammadJ, 2014.Ventilator associated pneumonia; prevalence and microbial patterns,Pak J Chest Med 20 61 -9

KidwaiA,RazzaqS,JamalQ,AatifS,ParachaS., 2011.Antibiotic resistance among gram negative bacilli causing ventilator associated pneumonia,Pak J Chest Med 17 11 -6

KaratasM,SaylanS,KostakogluU,YilmazG., 2016.An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit,Pak J Med Sci 32 817 -22