Endotracheal Aspirate Cultures Research Articles

Yoğun Bakım Ünitesinde Geriatrik Kritik Hastalarda Ultrason Kullanımının Akciğer Patolojilerini Tespit Etmedeki Rolünün Prognoz, Mortalite ve Skorlamalarla Karşılaştırılması

Objective: It is crucial to correctly and promptly diagnose pulmonary diseases and to initiate treatment in elderly patients diagnosed with respiratory failure who are on mechanical ventilator support. The aim of this study is to investigate the effect of lung ultrasound (USG) on prognosis and mortality in geriatric patients we follow up in the intensive care unit, by scoring. Methods: Patients who were followed up in the intensive care unit were grouped as AUSG group (n=48), those who underwent lung USG and NAUSG group (n=74) who underwent chest radiography, computed tomography (CT), magnetic resonance imaging (MRI) or bronchoscopy. The hospital information management system was used to compare the two groups in terms of diagnosis time, number of additional consultations, treatment and discharge time, hospital stay, mortality, and scores. The arterial blood gas analysis, complete blood count, biochemistry, procalcitonin, C-reactive protein, and endotracheal aspirate culture results of the patients were recorded. The clinical pulmonary infection score, pneumonia severity index-65, pulmonary severity index, and acute physiology and chronic health evaluation 2 scores of the groups were compared. Results: The diagnosis time in Group AUSG was 1 ± 0.64 day, the treatment time was 10 ± 4.62 day, and the number of required consultations was 1 ± 0.68, which was significantly lower than in Group NAUSG (p<0.05). The mortality rate was 14 (29.2%) patients in Group AUSG and 25 (33.8%) patients in Group NAUSG (p>0.05). When comparing the scores of the patients, the clinical pulmonary infection score, pneumonia severity index-65 (4 ± 0.79), and pulmonary severity index (3 ± 0.87) were significantly lower in Group AUSG (p<0.05). There was no significant difference in acute physiology and chronic health evaluation 2 scores. Conclusion: Performing lung USG for the diagnosis and treatment of critically ill elderly patients can lead to earlier detection and treatment of lung pathologies, reducing mortality rates, unnecessary imaging and consultations. Its advantages include easy and rapid bedside application and simultaneous results. Keywords: Geriatrics, ultrasonography, lung, prognosis, mortality

The Efficacy and Safety of Intravenous Colistin Plus Aerosolized Colistin Versus Intravenous Colistin Alone in Critically Ill Trauma Patients With Multi-Drug Resistant Gram-Negative Bacilli Infection.

Gram-negative bacteria (GNB) with potential multiple drug resistance (MDR) have emerged as a major group of organisms causing ventilator-associated pneumonia (VAP). Higher concentrations are deposited directly in the lungs when antibiotics are given via inhalation, minimizing systemic side effects. This study aims to compare the efficacy and safety of intravenous plus aerosolized colistin versus intravenous (IV) colistin alone in critically ill trauma patients who reported MDR-GNB infection on endotracheal aspirate culture. A hundred patients were recruited in the Intensive Care Unit, Trauma Centre, Institute of Medical Sciences, Banaras Hindu University, Varanasi, and randomly assigned to the control (n=50) group, which received IVcolistin plus aerosolized colistin and the intervention group (n = 50), which received IVcolistin alone. Changes in total leucocyte count (TLC), renal function test (RFT), endotracheal aspirate culture, 24-hour urine output, length of ICU stay, and 28-day ICU mortality were investigated. Patients receiving intravenous plus nebulized colistin therapy had a better outcome compared to IV colistin alone in terms of faster eradication of MDR-GNB infection. A rise in serum urea and creatinine levels was seen in both groups, which were significantly higher, along with a decrease in urine output in the group receiving intravenous colistin alone. No significant difference was observed in serum sodium and potassium levels in the RFT protocol, length of ICU stay, or 28-day ICU mortality. Intravenous nebulized colistin could be considered a better alternative therapy for VAP caused by multi-drug-resistant Gram-negative bacteria in the ICU in terms of faster microbiological cure and lesser nephrotoxicity.

Nonbronchoscopic Bronchoalveolar Lavage Improves Respiratory Culture Accuracy in Critically Ill Patients.

Diagnosis of pneumonia is challenging in critically ill, intubated patients due to limited diagnostic modalities. Endotracheal aspirate (EA) cultures are standard of care in many ICUs; however, frequent EA contamination leads to unnecessary antibiotic use. Nonbronchoscopic bronchoalveolar lavage (NBBL) obtains sterile, alveolar cultures, avoiding contamination. However, paired NBBL and EA sampling in the setting of a lack of gold standard for airway culture is a novel approach to improve culture accuracy and limit antibiotic use in the critically ill patients. We designed a pilot study to test respiratory culture accuracy between EA and NBBL. Adult, intubated patients with suspected pneumonia received concurrent EA and NBBL cultures by registered respiratory therapists. Respiratory culture microbiology, cell counts, and antibiotic prescribing practices were examined. We performed a prospective pilot study at the Cleveland Clinic Main Campus Medical ICU in Cleveland, Ohio for 22 months from May 2021 through March 2023. Three hundred forty mechanically ventilated patients with suspected pneumonia were screened. Two hundred fifty-seven patients were excluded for severe hypoxia (Fio2 ≥ 80% or positive end-expiratory pressure ≥ 12 cm H2O), coagulopathy, platelets less than 50,000, hemodynamic instability as determined by the treating team, and COVID-19 infection to prevent aerosolization of the virus. All 83 eligible patients were enrolled and underwent concurrent EA and NBBL. More EA cultures (42.17%) were positive than concurrent NBBL cultures (26.51%, p = 0.049), indicating EA contamination. The odds of EA contamination increased by eight-fold 24 hours after intubation. EA was also more likely to be contaminated with oral flora when compared with NBBL cultures. There was a trend toward decreased antibiotic use in patients with positive EA cultures if paired with a negative NBBL culture. Alveolar immune cell populations were recovered from NBBL samples, indicating successful alveolar sampling. There were no major complications from NBBL. NBBL is more accurate than EA for respiratory cultures in critically ill, intubated patients. NBBL provides a safe and effective technique to sample the alveolar space for both clinical and research purposes.

Evaluation of Ventilator-Associated Pneumonia Risk Factors and Pathogens in COVID-19 Patients: A Retrospective Study

Objective: Many patients followed in intensive care units during the COVID-19 pandemic required mechanical ventilation. In the present study, the purpose was to examine the risk factors, frequency, and causative pathogens of ventilator-associated pneumonia in COVID-19 patients in intensive care units.
 
 Material and Method: The study had a retrospective study design and was conducted among COVID-19 patients followed in the tertiary intensive care units of a training and research hospital. COVID-19 patients, who were older than eighteen years, and intubated in the tertiary intensive care units between March 2020 and January 1, 2021, were included in the present study. Microbiological data such as reproductions in endotracheal aspirate cultures, infectious microorganisms, and antibiotic susceptibility were collected from the patient files. Univariate and Multivariate Binary Logistic Regression analysis were used to determine the risk factors effective in ventilator-associated pneumonia.
 
 Results: Ventilator-associated pneumonia was observed in 52.9% (108) of patients, which was confirmed by growth in endotracheal aspirate cultures. The hospitalization (17.56±14.09) and intubated follow-up times (14.55±11.66)(day) of the patients who had culture growth were significantly higher than the hospitalization (9.74±6.01) and intubated follow-up (7.12±4.32)(day) times of the patients without growth (P

Ventilator-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia in a Patient with a Negative MRSA Nasal Swab.

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is associated with high morbidity and mortality. Recently, MRSA testing by nasal swab has been utilized to "exclude" pneumonia caused by MRSA, given its high negative-predictive value (NPV). We present, however, a case of MRSA pneumonia diagnosed by endotracheal aspirate culture (EAC) in a patient with a negative MRSA nasal swab. CASE REPORT A 58-year-old woman presented with septic shock and respiratory failure. Chest X-ray (CXR) on admission was unrevealing; however, computed tomography (CT) revealed multifocal pneumonia. Intensive Care Unit (ICU)-level care was required for mechanical ventilation and vasopressors. She initially improved with treatment of community-acquired pneumonia (CAP) and was extubated on hospital day 6; however, she then developed a fever, tachycardia, and respiratory distress necessitating re-intubation later that day. Repeat CXR demonstrated a new left lower lobe infiltrate. Blood cultures were drawn and vancomycin and cefepime were started to cover for ventilator-associated pathogens. An EAC and nasal swab were collected to test for MRSA. The next day (day 7), the MRSA nasal swab returned negative, and vancomycin was discontinued. Our patient continued to experience fevers, worsening leukocytosis, and ongoing vasopressor need. On hospital day 9, the EAC results were obtained, and were positive for MRSA. Vancomycin was restarted and our patient recovered. CONCLUSIONS Negative MRSA nasal screening may be considered grounds to de-escalate empiric MRSA antibiotics if MRSA prevalence is low. However, in critically ill patients with high risk and suspicion for MRSA pneumonia, discontinuing empiric MRSA coverage should be done with caution or clinicians should wait until respiratory culture results are obtained before de-escalating antibiotics.

Prevalence of multidrug-resistant Acinetobacter baumannii in endotracheal aspirate samples: Experience at a tertiary hospital

The emergence of resistance to multiple antimicrobial agents in pathogenic bacteria poses a significant public health threat because few or no effective antimicrobials are available for infectious diseases. is a major cause of device-associated infections that pose a serious threat to critically ill patients. Resistance patterns are thought to result in very limited treatment options and high mortality. We examined the prevalence of in endotracheal aspirates samples and explored their antibiotics susceptibility. To determine the value of routine endotracheal aspirate cultures performed prior to the onset of the likely onset of ventilator-associated pneumonia (PVAP) in predicting pathogenic microorganisms and susceptibility to their antibiotics Patients admitted to the ventilatory intensive care unit were tested daily, and endotracheal aspirated (ET) specimens from suspected patients were sent to a microbiology laboratory for culture and sensitivity measurements. Of the 52 patients, only twenty five (48%) developed PVAP. Endotracheal aspirate cultures were positive in all PVAP cases. The most commonly isolated bacteria was 14 (56%), followed by 6 (24%) and 4 (16%). Almost all isolates of are multidrug resistant (MDR). ICU stays greater than 16 days were observed for the pathogen . We believe that multidrug-resistant is a widespread epidemic, leading to high mortality, long ICU stays, and a difficult case for ICU physicians. Further prospective studies are needed to tackle this threat

Assessment of endotracheal aspirate culture appropriateness among adult ICU patients at an academic medical center

Background: Ventilator-associated pneumonia (VAP) is a significant cause of mortality in intensive care units (ICUs), but minimal research exists regarding the appropriateness of ordering endotracheal aspirate cultures (EACs). We evaluated the diagnostic utility of rationales given for EAC collection in ICUs at an academic medical center to assess potentially inappropriate EAC ordering. Methods: The study population comprised all adult patients admitted to an ICU in 2019 who underwent EAC collection. A random 10% sample from this population, stratified by ICU type, was selected. Clinical and diagnostic characteristics within 24 hours of EAC collection were identified by chart review. Clinical documentation was reviewed to identify ICU provider rationales for ordering EAC. Results: In total, 749 patients underwent EAC collection. Among them, 75 patients comprised the random sample, of whom 7 (9.3%) were excluded due to extubation before culture collection. Figure 1 shows patient distribution by ICU type. From these 68 patients, 105 EACs were collected. Of these, 41 (39%) were positive for potential pathogens, and 59 (56.2%) had explicit rationales for EAC collection, including fever (44.1%), hypoxia (18.6%), leukocytosis (16.9%), secretions (11.9%), shock (10.2%), and radiologic findings (8.5%). Also, 43.8% of EACs had no explicit rationale for collection. Table 1 shows sensitivities, specificities, positive likelihood ratios (LRs), and negative LRs for these rationales and related characteristics. Conclusions: EACs were commonly ordered without clear clinical indications. Of the noted rationales for EAC collections, most performed poorly at predicting positive cultures, which challenged common rationales for ordering EAC. This study could serve as a foundation for diagnostic stewardship interventions for EAC, potentially decreasing unnecessary cultures.Disclosures: None

Ventilator associated events:incidence, microbiological profile and outcome in the intensive care unit in a tertiary hospital of eastern Nepal

Ventilator associated events (VAE) refer to new surveillance definition developed by Centre for Disease Control and prevention (CDC)/ National Healthcare Safety Network (NHSN) is in use since the year 2013, switching the focus of surveillance from ventilator associated pneumonia (VAP) to ventilator associated events (VAE). A number of studies have been conducted in the United States and other Western countries to evaluate its practicality. However, information on VAE in Asian countries is scarce. The purpose of this preliminary study was to illuminate the incidence and microbiological profile of VAEs in tertiary hospital in Nepal, as a first step in the effort to determine its practicality.The objective of the study was to determine the incidence, etiological agent and mortality of VAE in patients on mechanical ventilation in medical Intensive care unit (ICU) of a tertiary hospital. Patients admitted in ICU on Mechanical Ventilation were evaluated daily using the VAE surveillance criteria. At least 2 days of stable or decreasing ventilator settings followed by at least 2 days of increased ventilator settings was used as definition of VAE. Three tiered approach of VAE, namely Ventilator-Associated Condition (VAC), Infection-related Ventilator-Associated Complication (IVAC) and Possible VAP (PVAP) was used for the final classification of cases. Of the 313 patients admitted to the ICU over the period of one year, 52 patients received MV for ≥2 days and met baseline criteria for VAEs Surveillance. Out of 52 patients, 14(27%) developed VAC only, 13(25%) developed IVAC only and 25(48%) patients developed PVAP. Endotracheal aspirate culture was positive in 25 patients (48%). The organisms isolated 14(53.84%), 7(26.92%), 4(15.38%), and 1(3.84%). Polymicrobial growth was observed in one Almost all the isolates 25 (96%) being multidrug resistant. Overall mortality rate in patients with VAE was 36.5% with highest mortality rate in PVAP (44%). Early onset PVAP was observed in 9 (36%) where as 16 (64%) had late‑ onset VAP.VAE mostly being health care associated event and prevalence of multidrug resistance in as observed in this study warrant clinician to practices infection control measures and rationale use of antimicrobials as effective measures for infection control.

Risk Factors for 7-Day and 21-Day Mortality in Patients with Ventilator-Associated Pneumonia Caused by Gram-Negative Multidrug Resistant Bacteria

Objective: Incidence of ventilator-associated pneumonia, caused by gram-negative multidrug resistant bacteria, is on the increase and early mortality rate is high.
 We aimed to investigate the effects of aging, comorbidities, high Charlson comobidity index score, high Acute Physiology and Chronic Health Evaluation II score, leukocytosis, high C-reactive protein level, inappropriate empirical antibiotic therapy and antibiotic resistance on mortality in ventilator-associated pneumonia caused by gram-negative multidrug-resistant bacteria.
 Methods: The study was planned as a retrospective cohort study. Patients aged 18 years and older who were hospitalized between January 01, 2015, and January 01, 2020, diagnosed with ventilator-associated pneumonia, and had Gram-negative multidrug resistant pathogen was detected in blood and/or bronchoalveolar lavage fluid specimen or quantitative endotracheal aspirate cultures were included in the study.
 Results: A total of 370 patients were included in the study. Median age of the patients was 74 (19-95) years. Most frequent bacteria was Acinetobacter baumannii (52.4%). Resistance to ceftriaxone, meropenem, and colistin was 99%, 68%, and 4%, respectively. 7-day and 21-day mortality rates were 38.3% (n=142) and 85.1% (n=315). In multivariate analysis, 7-day mortality was associated with a Charlson comorbidity index score of ≥4, and risk factors for 7-day mortality were septic shock, amikacin resistance, and white blood cell count ≥15000/mm3. Advanced age was found to be a risk factor for 21-day mortality, and a high Acute Physiology and Chronic Health Evaluation II score and a high Charlson comorbidity index score were associated with 21-day mortality. It was found that the risk of 7-day mortality in patients with tracheostomy was lower than in patients without tracheostomy.
 Conclusion:Consideration of clinical scoring systems, closer monitoring of elderly patients, following-up with tracheostomy, may provide a decrease in mortality of ventilator-associated pneumonia, caused by multidrug resistant pathogens.

Role of endotracheal tube culture or aspirate culture in identifying mechanically ventilated patients at risk for ventilator-associated pneumonia in neonatal intensive care unit at a tertiary care centre

Background: Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection in Neonatal intensive care units (NICU). The standard methods of diagnosis are not popular because of their invasive nature and cost. Endotracheal aspirate (ETA) is a relatively easy and non-invasive method. The aim of the study was to document the role of routine endotracheal aspirate culture performed in predicting causative organism and selecting effective antibiotic therapy in the event of subsequent ventilator-associated pneumonia.Methods: This study was conducted in the NICU of a medical college over ten months (September 2019 to June 2020). Newborns up to 28 days of life admitted in NICU and mechanically ventilated for more than 48 hours were enrolled in this prospective observational study (cross-sectional study). After 48 hours of ventilation, ET aspirate is collected and sent for culture and sensitivity testing in the microbiology lab. A Chi-square test was applied. P value<0.05 was considered statistically significant.Results: A total of 50 patients were included in this study, of which 15 patients developed VAP. Among the 6 VAP pathogens in this study, 94.12% were gram negative bacilli and 5.88% were gram positive cocci. Acinetobacter baumanii (52.80%) was the most predominating causative organism, followed by Klebsiella, Pseudomonas and E. coli (11.76%), followed by coagulase-negative staphylococcus and Enterobacter cloacae (5.88%).Conclusions: Acinetobacter baumanii was the most common organism isolated. Endotracheal tube aspirate cultures help in the early identification of patients at risk for developing VAP.

Impact of Organism Reporting from Endotracheal Aspirate Cultures on Antimicrobial Prescribing Practices in Mechanically Ventilated Pediatric Patients.

Endotracheal aspirate cultures (EACs) help diagnose lower respiratory tract infections in mechanically ventilated patients but are limited by contamination with normal microbiota and variation in laboratory reporting. Increased use of EACs is associated with increased antimicrobial prescribing, but the impact of microbiology reporting on prescribing practices is unclear. This study was a retrospective analysis of EACs from mechanically ventilated patients at Children's Hospital Colorado (CHCO) admitted between 1 January 2019 and 31 December 2019. Chart review was performed to collect all culture and Gram stain components, as well as antibiotic use directed to organisms in culture. Reporting concordance was determined for each organism using American Society for Microbiology guidelines. Days of therapy were calculated for overreported and guideline-concordant organisms. A multivariable model was used to assess the relationship between organism reporting and total days of therapy. Overall, 448 patients with 827 EACs were included in this study. Among patients with tracheostomy, 25 (8%) organisms reported from EACs were overreported and contributed 48 days of excess therapy, while 227 (29%) organisms from the EACs of endotracheally intubated patients were overreported, contributing 472 excess days of therapy. After adjustment, organism overreporting was associated with a >2-fold-higher rate of antimicrobial therapy than guideline-concordant reporting (incident rate ratio [IRR], 2.83; 95% confidence interval [CI], 1.23, 6.53; P < 0.05). Overreported organisms from respiratory cultures contribute to excess antimicrobial therapy exposure in mechanically ventilated patients. Microbiology laboratories have an opportunity to mitigate antimicrobial overuse through standardized reporting practices.

ANTIBIOTIC RESISTANCE RATES OF BACTERIA ISOLATED FROM ENDOTRACHEAL ASPIRATE SAMPLES OF INTENSIVE CARE UNIT PATIENTS

Amaç&#x0D; Nozokomiyal enfeksiyonlar hastanede yatan hastaların&#x0D; önemli mortalite ve morbidite nedenleri arasında&#x0D; yer almaktadır. Yoğun bakım ünite (YBÜ)’lerinde&#x0D; görülen enfeksiyonlar nozokomiyal enfeksiyonların&#x0D; %25’ini oluşturmakta, bunların içerisinde en sık solunum&#x0D; sistemi enfeksiyonları bildirilmektedir. Bu enfeksiyonlardan&#x0D; izole edilen etkenler ve antibiyotik direnç&#x0D; durumları hastaneler arasında farklılıklar gösterebileceği&#x0D; gibi aynı ünite içinde de zamanla değişiklikler&#x0D; görülebilmektedir. Endotrakeal aspirat (ETA) kültürleri,&#x0D; tüm dünyada solunum yolu örneklemesinde en&#x0D; yaygın kullanılan mikrobiyolojik tanı yöntemi olarak&#x0D; karşımıza çıkmaktadır. Bu çalışmada Süleyman Demirel&#x0D; Üniversitesi YBÜ’sindeki hastaların ETA örneklerinden&#x0D; izole edilen bakteriyel etkenler ve antibiyotik&#x0D; direnç oranlarının retrospektif olarak araştırılması&#x0D; amaçlanmıştır.&#x0D; Gereç ve Yöntem&#x0D; Ocak 2018- Ocak 2021 tarihleri arasında YBÜ’deki&#x0D; hastaların ETA örneklerinden izole edilen bakteriyel&#x0D; etkenler ve bu etkenlerin antibiyotik duyarlılık testleri&#x0D; (ADT) hastane veri tabanından retrospektrif olarak&#x0D; elde edildi. Duyarlılık sonuçları European Committee&#x0D; on Antimicrobial Susceptibility Testing (EUCAST) ve&#x0D; gerektiğinde Clinical &amp; Laboratory Standards Institute&#x0D; (CLSI) önerileri doğrultusunda değerlendirildi. Aynı&#x0D; hastaya ait tekrarlayan üremeler değerlendirme dışı&#x0D; bırakıldı.&#x0D; Bulgular&#x0D; Değerlendirilen süre zarfında 1031 adet ETA örneğinden&#x0D; 413’ü (%90,2) gram negatif, 45’i (%9,8) gram&#x0D; pozitif olmak üzere toplam 458 (%44,4) bakteri izole&#x0D; edildi. Gram negatif bakterilerden en sık Acinetobacter&#x0D; baumannii (%43,9), gram pozitif etkenlerden en&#x0D; sık Staphylococcus aureus (%5,9) tespit edildi. İzole&#x0D; edilen A. baumannii suşlarınının tüm yıllarda birçok&#x0D; antibiyotiğe yüksek direnç gösterdiği tespit edilmiş&#x0D; olup, en yüksek direnç %96,6 oranıyla karbapenem&#x0D; grubuna karşı saptandı. Genişlemiş spektrumlu beta&#x0D; laktamaz (GSBL) pozitifliği Escherichia coli suşlarında&#x0D; %48,1; Klebsiella pneumoniae suşlarındaysa&#x0D; %70,8 oranlarında tespit edildi. Çalışmamızda Metisiline&#x0D; dirençli Staphylococcus aureus (MRSA) %20,7,&#x0D; metisiline dirençli Koagülaz negatif Stafilokok (KNS),&#x0D; %76,9 oranında tespit edildi.&#x0D; Sonuç&#x0D; YBÜ’sinde yatan hastalarda gelişen enfeksiyonların&#x0D; belirgin özelliği sıklıkla antibiyotiklere dirençli patojenlerin&#x0D; etken olmasıdır. Enfeksiyona neden olan etkenin&#x0D; tanımlanması, antibiyotik direnç profilinin belirlenmesi&#x0D; antibiyotik seçimine yön verecek ve YBÜ’deki uygunsuz&#x0D; antibiyotik kullanımının önüne geçilmesine ve direnç&#x0D; oranlarını azaltmaya katkı sağlayacaktır.

Microbial isolates and their antimicrobial resistance pattern from endotracheal aspirates: a retrospective observational study over one year at a tertiary care hospital of Bangladesh

Background: Emergence of multidrug resistant (MDR) organisms causing ventilator-associated pneumonia (VAP) is an increasing threat with substantial mortality in critically ill patients. Aetiology and treatment of VAP in mechanically ventilated patients can be evaluated by analysis of culture reports periodically for better understanding of microbial isolates and their antimicrobial susceptibility pattern. The present study aimed to analyze the culture and sensitivity pattern of endotracheal aspirates in intensive care unit (ICU) patients.&#x0D; Methods: A hospital-based retrospective study was done in the Department of Microbiology, BIRDEM General Hospital, Dhaka, Bangladesh from January to December, 2019. Data were obtained from the laboratory record book conserved in the Department of Microbiology. Isolates of endotracheal aspirates from 715 patients were identified and their antibiotic susceptibility were (done by standard microbiological methods) recorded.&#x0D; Results: Out of total 715 endotracheal aspirates, growth was obtained from 482 (67.4%) samples. Among the 482 culture positive samples, 714 isolates were identified of which 250 (51.9%) yielded single organism and 232 (48.1%) were double organisms. Among total isolates, 642 (89.9%) were bacteria and 72 (10.1%) were fungi. Gram negative bacilli were mostly isolated organisms (85.6%) followed by fungi (10.1%) and gram positive cocci (4.3%). Acinetobacter sp. (40.6%) was the most prevailing of all isolates followed by Klebsiella sp.(29.4%), Pseudomonas sp. (11.2%), Candida sp. (8.7%), Staph. aureus (3.8%), Esch. coli (2.8%) and Aspergillus sp. (1.3%). Almost all (90-100%) of the Acinetobacter sp., Klebsiella sp., and Esch. coli showed resistance to 3rd generation cephelasporin, aztreonam, amoxicillin-clavulunate and ciprofloxacin and lowest resistance was noted to tigecycline (5.2%, 13% and 0% respectively). Imipenem was found resistant to 97.6%, 77.4% and 30% in Acinetobactersp, Klebsiella sp. and Esch.coli respectively. Resistant pattern of Pseudomonas sp. to ceftazidime (72.5%), aztreonam (81.2%), imipenem (75%), aminoglycosides (70-76%), ciprofloxacin (72.5%), piperacillintazobactum (41.2%) and colistin (11.2%) were also noted. Methicillin-resistant Staph. aureus (MRSA)were 77.8% and 75% Enterococcus sp. showed high level resistance to gentamicin (HLGRE). No vancomycin resistant Staph. aureus(VRSA) or Enterococcus sp. (VRE) was detected in this study.&#x0D; Conclusion: Gram negative isolates were large-scale than any other microorganism. Of them, Acinetobacter sp. was most quotidian followed by Klebsiella sp. Acinetobacter sp. and Klebsiella sp. were highly resistant to different antibiotics including imipenem and piperacillin-tazobactum. High rate of colistin resistant Pseudomonas sp. were also observed. Combined clinical, microbiological and infection control strategies can guide appropriate patient management and antimicrobial stewardship program to combat antibiotic resistance in critical care set up in Bangladesh.&#x0D; BIRDEM Med J 2022; 12(3): 195-200

Endotracheal Aspirate and Ventilator-Associated Pneumonia in Neonates: Revisiting an Age-Old Debate.

To explore the utility of endotracheal aspirates (ETA) for analyzing microbiological yield, incidence, risk factors for VAP, and clinically relevant outcomes. Ventilated neonates suspected to have VAP were studied prospectively; they were classified as "VAP" or "No VAP" based on a predefined combination of clinical, radiological, and laboratory criteria. The microbiological yield from blood and ETA cultures was analyzed. Of 165 neonates who were ventilated for > 48h, 65 were suspected of having VAP. Thirty-six (22.9%) were classified as VAP. Microbiological agents could be identified in 31 cases (86.1%) by ETA/blood cultures. Acinetobacter sp was the common organism identified. Duration of ventilation, and a higher number of reintubations before suspicion of VAP were significant risk factors for VAP. Positive ETA culture was associated with a greater duration of oxygen therapy and ventilation days after suspicion of VAP. The commonest culture yield from ETA in those suspected to have VAP was gram-negative bacilli. Duration of ventilation and reintubations were identified as significant risk factors for VAP. These are potentially modifiable factors. Positive ETA culture was associated with longer needs for respiratory supports. Negative ETA culture might encourage clinicians to stop antibiotics. Clinical Trials Registry of India No. CTRI/2019/03/017912, www.ctri.nic.in.

A STUDY TO DETERMINE THE INCIDENCE OF BACTERIAL AND FUNGAL INFECTIONS IN ICU PATIENTS ON MECHANICAL VENTILATION AND ASSOCIATED OUTCOME

Background: Infection in intensive care unit (ICU) patients, occurring predominantly in patients whose lungs are ventilated, at a rate of 1% to 3% per day of mechanical ventilation. Bacterial and fungal pathogens from clinical cultures were evaluated to characterize community- and ICU infections, including describing temporal changes in predominant organisms on presentation and throughout hospitalization. Aims &amp; objective: To determine the incidence of bacterial and fungal infections in ICU patients on mechanical ventilation. Methods &amp; materials: The study was Prospective observational case study was conducted at Medicine department in SRN Hospital, Prayagraj, U.P. India between July 2020 to June 2021. Endotracheal aspirates were collected aseptically from 100 ICU patients The various patient data such as age, gender, address, date of admission ,level of consciousness, risk factors involved, underlying diseases, duration of mechanical ventilation, prior antibiotic therapy etc. were recorded. Result: In this study total 100 out of 81 patients show micro-organism infection, 76 patients had bacterial infections and 5 had fungal infections and 19 patients had no growth, as conrmed by endotracheal tube aspirate (ETA) culture growth. Participants in the Bacterial group ETA Gram Staining was 38.2% had no abnormality detected (NAD), 52.6% had Gram Negative Bacilli and 9.2% of the participants had Gram Positive Bacilli, 100.0% of the participants in the Fungal group ETA Gram Staining had NAD. There was a signicant difference between the various groups in terms of distribution of ETA Gram Staining (χ2 = 7.366, p = 0.028). In the Bacterial endotracheal tube (ET) aspirate culture 35.5% of the participants had Klebsiella, 25.0% had Staphylococcus, 18.4% had E. coli, 18.4% had Pseudomonas, 0.0% had Candida spp, 1.3% had Acinetobacter, 1.3% had Proteus. In the Fungal ET aspirate culture group 100.0% of the participants had Candida spp. There was a signicant difference between the various groups in terms of distribution of ET aspirate: Culture (χ2 = 81.000, p = &lt;0.001 Conclusion: Gram Negative Bacilli was the most common infection in patients on mechanical ventilation in gram staining. Klebsiella was the most common bacterial infection and Candida species was fungal infection. The poorest outcome occurred in patients with, E. coli, and Proteus group infection and good outcome occurred in Acinetobacter.

Low diagnostic yield and time to diagnostic confirmation results in prolonged use of antimicrobials in critically ill children.

Background: Broad-spectrum antimicrobial therapy is a key driver of antimicrobial resistance. Here, we aimed to review indications for antimicrobial therapy, determine the proportion of suspected bacterial infections that are confirmed by culture, and assess the time taken for microbiology test results to become available in the paediatric intensive care unit (PICU). Methods: A single-centre prospective observational cohort study of 100 consecutive general PICU admissions from 30 October 2019 to 19 February 2020. Data were collected from the hospital medical record and entered into a study database prior to statistical analysis using standard methods. Results: Of all episodes of suspected infection, 22% of lower respiratory tract infection, 43% of bloodstream and 0% of central nervous system infection were associated with growth on microbiology culture. 90% of children received antimicrobial therapy. Hospital-acquired infection occurred less commonly than primary infection, but an organism was grown in a greater proportion (64%) of cultures. Final laboratory reports for negative cultures were issued at a median of 120.3 hours for blood cultures and 55.5 hours for endotracheal tube aspirate cultures. Conclusions: Despite most critically children receiving antimicrobial therapy, infection was often not microbiologically confirmed. Novel molecular diagnostics may improve rationalisation of treatment in this population.

Low diagnostic yield and time to diagnostic confirmation results in prolonged use of antimicrobials in critically ill children

Background: Broad-spectrum antimicrobial therapy is a key driver of antimicrobial resistance. Here, we aimed to review indications for antimicrobial therapy, determine the proportion of suspected bacterial infections that are confirmed by culture, and assess the time taken for microbiology test results to become available in the paediatric intensive care unit (PICU). Methods: A single-centre prospective observational cohort study of 100 consecutive general PICU admissions from 30 October 2019 to 19 February 2020. Data were collected from the hospital medical record and entered into a study database prior to statistical analysis using standard methods. Results: Of all episodes of suspected infection, 22% of lower respiratory tract infection, 43% of bloodstream and 0% of central nervous system infection were associated with growth on microbiology culture. 90% of children received antimicrobial therapy. Hospital-acquired infection occurred less commonly than primary infection, but an organism was grown in a greater proportion (64%) of cultures. Final laboratory reports for negative cultures were issued at a median of 120.3 hours for blood cultures and 55.5 hours for endotracheal tube aspirate cultures. Conclusions: Despite most critically children receiving antimicrobial therapy, infection was often not microbiologically confirmed. Novel molecular diagnostics may improve rationalisation of treatment in this population.

P48 The limited yield of cultures in the critically ill child

BackgroundBroad-spectrum antimicrobial therapy is a key driver of antimicrobial resistance. Here, we aimed to review indications for antimicrobial therapy, determine the proportion of suspected bacterial infections that are confirmed by culture, and assess the time taken for microbiology test results to become available in the paediatric ICU (PICU).MethodsA single-centre prospective observational cohort study of 100 consecutive general PICU admissions from 30 October 2019 to 19 February 2020. Data were collected from the hospital medical record and entered into a study database prior to statistical analysis using standard methods.ResultsOf all episodes of suspected infection, 22% of lower respiratory tract infection, 43% of bloodstream and 0% of central nervous system infection were associated with growth on microbiology culture. Ninety percent of children received antimicrobial therapy. Hospital-acquired infection occurred less commonly than primary infection, but an organism was grown in a greater proportion (64%) of cultures. Final laboratory reports for negative cultures were issued at a median of 120.3 h for blood cultures and 55.5 h for endotracheal tube aspirate cultures.ConclusionsDespite most critically children receiving antimicrobial therapy, infection was often not microbiologically confirmed. Novel molecular diagnostics may improve rationalization of treatment in this population.

BACTERIOLOGY AND ANTIBIOTIC SENSITIVITY PATTERNS IN VENTILATOR-ASSOCIATED PNEUMONIA

Background: Ventilator-Associated Pneumonia is the most common cause of hospital-acquired infections among patients admitted in Intensive Care Unit with mechanical ventilation. Identification of bacteria and their susceptibility to commonly used antibiotics is very essential for the treatment of the patients. The aim of this study was to determine the bacteriological profile and antibiotic sensitivity patterns in the Endotracheal Aspirate cultures that were sent in Microbiology laboratory. Methods: A hospital-based 3-year retrospective analysis on culture of Endotracheal Aspirate was done. Data from Intensive Care Unit was collected from January 2018 to January 2021, and the laboratory reports were used to determine Ventilator-Associated Pneumonia, pathogen profile and antimicrobial sensitivity patterns. Data entry and analysis was done using Statistical Package for Social Sciences version 16. Results: Out of 147 ventilated patients in Intensive Care Unit, 115 samples were sent to microbiology laboratory with suspected Ventilator-Associated Pneumonia among which 95 (82.60 %) were positive cultures. The most common etiological agent causing Ventilator-Associated Pneumonia was found to be Klebsiella pneumoniae with 24 isolates (25.26%) and multidrug resistance was also mainly found with Klebsiella pneumoniae in 17 samples (70.83%). All of the gram-negative isolates were sensitive to colistin and resistant to ampicillin. All gram-positive isolates were sensitive of linezolid and vancomycin and most were resistant to penicillin. Conclusions: Klebsiella pneumoniae is one of the most common organisms that is associated with nosocomial infection like Ventilator-Associated Pneumonia. The emergence of multidrug resistance is still a great threat and hindrance for the treatment of Ventilator-Associated Pneumonia.

Evaluation of bacterial agents isolated from endotracheal aspirate cultures of Covid-19 general intensive care patients and their antibiotic resistance profiles compared to pre-pandemic conditions

BackgroundEarly reports have shown that critically ill patients infected with SARS-CoV-2 have a high prevalence of nosocomial pneumonia, particularly ventilator-associated pneumonia (VAP). MethodIn the present study, we determined the bacterial agents isolated from endotracheal aspirate (ETA) cultures of Covid-19 general intensive care patients and evaluated the antibiotic resistance profiles of common bacterial agents compared to the pre-pandemic period. ResultsWhile a total of 119 significant growths with polymicrobial growths were detected in the ETA cultures of 73 (7.5%) of 971 patients hospitalized in the intensive care unit before the pandemic, 87 significant growths were detected in the ETA cultures of 67 (11.1%) of 602 patients hospitalized in the Covid-19 intensive care unit (ICU) after the pandemic. While 61 (83.6%) of patients in the ICU died before the pandemic, 63 (94.0%) of patients in the Covid-19 ICU died after the pandemic. In terms of age, gender, and mortality, there was no significant difference between the two ICUs (p > 0.05). Before the pandemic, the mean length of stay in the ICU was 33.59 ± 32.89 days, and after the pandemic, it was 13.49 ± 8.03 days. This was a statistically significant difference (p < 0.05). Acinetobacter baumannii (28.5%), Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (15.9%), Staphylococcus aureus (6.7%), Escherichia coli (7.5%), Candida spp. (5.0%) were the most prevalent causal microorganisms discovered in pre-pandemic ICU ETA samples, whereas A. baumannii (54.0%), K. pneumoniae (10.3%), P. aeruginosa (6.8%), E. faecium (8%), and Candida spp.(13.7%) were the most common causative microorganisms detected in Covid-19 ICU ETA samples. Except for tigecycline, antibiotic resistance rates in A. baumannii strains increased following the pandemic. Only tobramycin showed a significant difference in the increase of resistance among these antibiotics (p = 0.037). The rate of tigecycline resistance, on the other hand, was 17.6% before the pandemic and 2.2% afterward (p < 0.05). After the pandemic, increased resistance of K. pneumoniae strains to colistin, meropenem, ertapenem, amoxicillin-clavulanic acid, piperacillin-tazobactam, ciprofloxacin, tigecycline, and cefepime antibiotics was observed. However, these increases were not statistically significant. Except for imipenem, antibiotic resistance rates in P. aeruginosa strains increased following the pandemic. The increase in resistance of ceftazidime and levofloxacin was statistically significant (p < 0.05). ConclusionAs a result, the Covid-19 pandemic requires intensive care follow-ups at an earlier age and with a more mortal course. Although the length of stay in the intensive care unit has been shortened, it is observed that this situation is observed due to early mortality. In P. aeruginosa strains, a significant difference was detected in the resistance increase of the ceftazidime and levofloxacin (p < 0.05) and with the exception of tigecycline, antibiotic resistance rates in A. baumannii strains increased following the pandemic. Only tobramycin showed a significant difference in the increase of resistance among these antibiotics (p = 0.037). Secondary infections in patients create more difficult treatment processes due to both Covid-19 and increasing antibiotic resistance today.