Abstract
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. 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 beta-lactamases respectively. 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. 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.
Highlights
Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after endotracheal intubation and initiation of mechanical ventilation (MV) including pneumonia developing even after extubation [1]
Methicillin sensitive S. aureus (13%) was the most common Gram-positive bacteria associated with early-onset Ventilator-Associated Pneumonia (VAP) (Table 1)
Multidrug resistant pathogens such as P. aeruginosa, A. baumannii and S. aureus (42.9% of them being MRSA) were the common organisms causing VAP. This highlights the need for treatment of the VAP cases with second-line antibiotics effective against these multidrug resistant (MDR) pathogens
Summary
Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after endotracheal intubation and initiation of mechanical ventilation (MV) including pneumonia developing even after extubation [1]. VAP is the most frequent intensive-care-unit (ICU)-acquired infection, occurring in 9 to 24% of patients intubated for longer than 48 hours [2,3]. Late-onset VAP, which develops five or more days after initiation of MV, is caused by multidrug-resistant (MDR) pathogens and is associated with increased morbidity and mortality [4]. Pseudomonas spp., Acinetobacter spp., Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus were identified as the common VAP pathogens, with varying prevalence [5,6,7]. 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. Increasing prevalence of MDR pathogens in patients with late-onset VAP indicate that appropriate broad-spectrum antibiotics should be used to treat them
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