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

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 (BioMerieux, 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 comorbidities. 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.