CC BY-NC-ND 4.0 · Avicenna J Med 2015; 05(03): 74-78
DOI: 10.4103/2231-0770.160233
ORIGINAL ARTICLE

Antimicrobial resistance of bacterial isolates from respiratory secretions of ventilated patients in a multi-specialty hospital

Nishat Hussain Ahmed
Department of Laboratory Medicine, Delhi State Cancer Institute, Dilshad Garden, New Delhi, India
,
Tabish Hussain
Proteomics and Structural Biology Unit, Institute of Genomics and Integrative Biology, New Delhi, India
,
Indu Biswal
Department of Microbiology, Vardhman Mahavir Medical College, New Delhi, India
› Author Affiliations

Abstract

Context: Ventilator-associated pneumonia (VAP) is a common nosocomial infection occurring in intensive care unit (ICU) settings. VAP occurs due to interplay of three factors - impaired host defense, access of large numbers of pathogenic bacteria to the lower respiratory tract and the virulence of the organism. Knowledge of colonizing microbial flora and their antibiogram in ventilated patients is of great importance in timely institution of empirical therapy, so that mortality and morbidity due to VAP can be reduced. Subjects and Methods: A prospective study was performed over a period of 6 months in a multi-specialty hospital to determine the various pathogens in respiratory secretions and to determine the prevalence of multidrug resistance (MDR). Results: Pseudomonas aeruginosa (26%), Acinetobacter (26%), Klebsiella pneumoniae (26%), followed by Escherichia coli (15%), Staphylococcus aureus (6%) and Citrobacter spp. (1.5%) were the common pathogens isolated in our study. In all, 72.73% (48/66) bacterial isolates were isolated from medical ICU, while 25.76% (17/66) were isolated from surgical ICU. Only one strain (Acinetobacter) was isolated from pediatric ICU. Fifty-seven (86.36%) of the 66 pathogens in our study were MDR. Conclusion: There is increasing colonization of pathogenic bacteria in ventilated patients admitted in ICUs, which are predominantly MDR. These colonizers may cause infection resulting in VAP. Judicious use of antibiotics, guided by local antibiotic resistance profile coupled with strict infection control practices alongside application of VAP bundle are important measures to prevent these pathogens from causing VAP in ICU patients.



Publication History

Article published online:
09 August 2021

© 2015. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Davis KA. Ventilator-associated pneumonia: A review. J Intensive Care Med 2006;21:211-26.
  • 2 Feil S. Guidelines and critical pathways for severe hospital-acquired pneumonia. Chest 2001;119:412S-8.
  • 3 Collee JG, Marr W. Culture of bacteria. In: Marmion BP, Fraser AG, Simmons A, editors. Mackie and McCartney′s Practical Medical Microbiology. 14 th ed. New York: Churchill Livingstone; 1996. p. 113-30.
  • 4 Centers for Disease Control and Prevention. Guidelines for preventing health-care-associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR 2004;53 (No. RR-3).
  • 5 Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty first Informational supplement. CLSI document M100-S2; 2011.
  • 6 Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81.
  • 7 Edwards JR, Peterson KD, Andrus ML, Tolson JS, Goulding JS, Dudeck MA, et al.; NHSN Facilities. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290-301.
  • 8 Weber DJ, Rutala W, Mayhall CG. In: Fishman AP, Fishman JA, Kaiser LR, Senior RM, Elias JA, Elias J, et al. editors. Fishman′s text book of pulmonary diseases and disorders. Nosocomial Respiratory tract infection and Gram negative pneumonia. Ch. 143, 3 rd ed., Vol. 2. New York: McGraw-Hill Publication; 1998. p. 2213-29.
  • 9 Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: Incidence and risk factors. J Infect Dev Ctries 2009;3:771-7.
  • 10 Aly NY, Al-Mousa HH, Al Asar el SM. Nosocomial infections in a medical-surgical intensive care unit. Med Princ Pract 2008;17:373-7.
  • 11 Suka M, Yoshida K, Uno H, Takezawa J. Incidence and outcomes of ventilator-associated pneumonia in Japanese intensive care units: The Japanese nosocomial infection surveillance system. Infect Control Hosp Epidemiol 2007;28:307-13.
  • 12 Noyal MJ, Menezes GA, Harish BN, Sujatha S, Parija SC. Simple screening tests for detection of carbapenemases in clinical isolates of nonfermentative Gram-negative bacteria. Indian J Med Res 2009;129:707-12.
  • 13 Cook D, Mandell L. Endotracheal aspiration in the diagnosis of ventilator-associated pneumonia. Chest 2000;117:195S-7.
  • 14 Craven DE. Epidemiology of ventilator-associated pneumonia. Chest 2000;117:186S-7.
  • 15 Torres A, Aznar R, Gatell JM, Jimenez P, Gonzalez J, Ferrer A, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523-8.
  • 16 Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: Role of multi-drug resistant pathogens. J Infect Dev Ctries 2010;4:218-25.
  • 17 Rocha Lde A, Vilela CA, Cezario RC, Almeida AB, Gontijo Filho P. Ventilator associated pneumonia in an adult clinical-surgical intensive care unit of a Brazilian university hospital: Incidence, risk factors, etiology, andantibiotic resistance. Braz J Infect Dis 2008;12:80-5.
  • 18 Rodrigues PM, Carmo Neto Ed, Santos LR, Knibel MF. Ventilator-associated pneumonia: Epidemiology and impact on the clinical evolution of ICU patients. J Bras Pneumol 2009;35:1084-91.