Endotracheal Aspirate Research Articles

Microbiological analysis of nosocomial pneumonia at Tanta University Chest Hospital

BackgroundHospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) represent a major health problem among hospitalized patients leading to consequent morbidity and mortality specially after Covid-19 era and spread of multidrug-resistance organisms)MDRO) in hospitals.AimThis study aimed to analyze the commonest microorganisms responsible for HAP and VAP at Tanta University Chest Hospital.MethodsThis prospective observational study was done at Chest Department, Faculty of Medicine, started from June 2022 to February 2023. Fifty HAP patients’ sputum samples and 50 VAP patients (25 endotracheal aspirates and 25 bronchoalveolar lavages) were included. All collected samples were submitted to standard microbiological tests at Microbiology Department, Tanta Faculty of Medicine.ResultsA total number of 50 HAP and 50 VAP cases were included. Microbial isolates were relatively the same in both groups, where Klebsiella pneumoniae was the predominant isolates (56) followed by Staphylococcus aureus (25), Escherichia coli (14), Pseudomonas aeruginosa (13), Acinetobacter baumannii (5), Streptococcus pneumoniae (4), Enterococci (3), Stenotrophomonas maltophilia (2), Citrobacter freundii (2), Streptococcus pyogenes (2), Providencia stuartii (1), and 7 isolates of Candida. Antimicrobial susceptibility showed predominance of drug-resistance organisms in VAP (78%) versus HAP (28%), P-value: < 0.001. Klebsiella pneumonia showed higher rates of resistance (37 out of 56 isolates, P-value = 0.020). Four out of 5 Acinetobacter baumannii isolates were multidrug resistant, and 2 isolates of Stenotrophomonas maltophilia were polydrug resistant. Multivariate logistic regression analysis showed that intravenous antibiotic administration within last 3 months was associated with risk for MDR-HAP, while univariate regression analysis showed that intravenous antibiotic administration within the last 3 months was the strongest predictor for MDR-VAP. A higher mortality rate was recorded in VAP group (66%), versus (14%) in HAP group (P-value: < 0.001).ConclusionMicrobial isolates were relatively the same in both HAP and VAP, but VAP showed significant predominance of drug-resistant organisms. The most significant predictor for risk of MDRO infection in HAP and VAP was intravenous antibiotic administration within last 3 months; so, raising attention towards antibiotic choice may improve the outcome. Finally, VAP was associated with higher mortality compared to HAP.

The pupillary dilation reflex to a nociceptive stimulus as a tool for analgesia management: A diagnostic study

BackgroundMore than 70% of patients demonstrate pain after endotracheal aspiration. Tools are needed to objectify the need for analgesia in non-communicative critically ill patients. ObjectiveThe objective of this study was to identify the lowest intensity electrical stimulus for detecting pain before daily care interventions. MethodsStudy of diagnostic tests to assess pupillometry to detect pain through the pupillary dilation response to noxious stimuli versus the Behavioural Pain Scale. Patients older than 18 years, under analgosedation, subjected to invasive ventilation, baseline Behavioural Pain Scale of 3, and Richmond Agitation-Sedation Scale between −1 and −4 were studied. We assessed the Behavioural Pain Scale and the pupillary dilation response to 10, 20, 30, and 40 mA stimuli. We studied the diagnostic performance based on sensitivity and specificity, negative predictive value, positive predictive value, and accuracy of the selected points after the different stimulations. AlgiScan® Pupillometer measured the pupillary dilation response. The presence of pain was considered as a Behavioural Pain Scale score of ≥4. Significance was defined as p <0.05. ResultsMeasurements were performed on 31 patients. In the 20 mA stimulus, we found an area under the curve of 0.85 (0.69–1.0). The cut-off point of pupillary dilation was 11.5%, with a sensitivity of 100% (34.2–100) and a specificity of 75.9% (57.9–87.8). This point had an accuracy of 77.4 (60.2–88.6) and a Youden's Index of 0.8. ConclusionsPupillary variation measurement during a 20 mA stimulus could help assess the need for analgesia before potentially painful interventions. Further studies are needed to confirm this. RegistrationPhase 1 of the project PUPIPAIN ClinicalTrials.gov Identifier: NCT04078113.

A retrospective study on bacteriological profile and antibiotics prescription practice in a tertiary level intensive care unit

BACKGROUND Antibiotics are the most commonly prescribed medicines in intensive care units (ICU). The irrational use of antibiotics leads to the development of multidrug-resistant organisms (MDR). The aim of the study is to determine the bacteriological profile of infections in our ICU and antibiotic prescription practice, before and after the culture results. METHODOLOGY This is a retrospective study conducted in a tertiary-level, 33-bedded ICU in Nepal to evaluate the bacteriological profile and antibiotic prescription practice. The patients who were admitted between a period of 3 months (January 2023 to March 2023) were enrolled. The data variables collected were; patients' details, culture samples sent (blood, urine, endotracheal (ET) aspirate, sputum, cerebrospinal fluid (CSF), wound swab, pleural fluid, ascitic fluid, tissue culture, and peritoneal fluid), gram stain results, culture sensitivity results, empirical antibiotics used, and change in antibiotics following culture results. RESULTS A total of 378 culture samples were obtained from 230 patients. A positive culture report was obtained for 165 (43.65%) of the 378 samples sent. Urine was the most common sample sent for microbiology (28%), followed by blood (25.3%) and sputum (22.75%). The percentage occurrence of gram-negative bacteria was 84%, while that of gram-positive bacteria was 16%. Methicillin- resistant coagulase-negative staphylococcus (MRCONS) was the most common gram-positive organism isolated (46.15%), and Klebsiella pneumoniae was the most common gram-negative organism (38.84%). Cephalosporin was the commonest group of empirical antibiotics used in our ICU, followed by carbapenem. Empirical antibiotic treatment was continued in 108 patients (47%), changed following the culture results in 92 patients (40%), and discontinued in 30 patients (13%). Escalation of antibiotics was done in 78 patients (85%) and de-escalation in 14 patients (15%). CONCLUSION Antimicrobial resistance and the irrational prescription of antibiotics can lead to a global economic burden. Hence, antibiotic stewardship programs are required to reduce the irrational prescribing patterns of antibiotics.

Antimicrobial resistance pattern in aerobic bacteria isolated from endotracheal aspirate in ventilator-associated pneumonia: Ten years observation from a tertiary care hospital.

Ventilator-associated pneumonia (VAP) is a nosocomial infection associated with high morbidity and mortality. This study was undertaken to monitor the trend of the demographical details, comorbid conditions, bacterial etiological agents, and their antibiogram causing VAP in adults in the year 2008, 2013 and 2018. A retrospective study conducted at the Department of Microbiology, Hospital Infection control and Quality Control at a tertiary care teaching hospital. All the adult patients with more than 48 h of the mechanical ventilator with endotracheal intubation with Clinical Pulmonary infection Score >6 with suspicion of VAP were included in the study at a difference of 5 years, i.e., 2008, 2013, and 2018. A total of 338 patients were included in the study, of which males accounted for more than two-third of the patients studied. Nearly 45% of the patients belonged to geriatric (>60 years) age group. The most common comorbid conditions were chronic obstructive pulmonary disease, hypertension and diabetes mellitus. Among the gram-negative isolates, Klebsiella pneumoniae, Acinetobacter species, and Pseudomonas aeruginosa were the most common. There is an emergence of resistance to most commonly administered antimicrobial agents like aminoglycosides, levofloxacin, piperacillin/tazobactum, and carbapenems during the study period. This is a ten-year study on the antibiotic resistance pattern of organisms causing VAP. As far as the authors are aware, this is the first study addressing the pattern of change in drug resistance in the organisms causing VAP over a decade. The emergence of multi-drug resistant (MDR) MDR pathogens, especially in intensive care unit (ICU), is a great concern for the intensivist and infection control physicians. Preventive measures need to be undertaken to control the spread of these pathogens to the patients in the ICU.

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

Comparison of Mini-bronchoalveolar Lavage Technique with Endotracheal Aspirate and Bronchoscopic Specimens in Isolating Ventilator-associated Pneumonia Factors in Patients Under Intensive Care

Comparison of Mini-bronchoalveolar Lavage Technique with Endotracheal Aspirate and Bronchoscopic Specimens in Isolating Ventilator-associated Pneumonia Factors in Patients Under Intensive Care

Etiology and Multi-Drug Resistant Profile of Bacterial Infections in Severe Burn Patients, Romania 2018-2022.

Infections in severe burns and their etiology are and will remain a big concern for the medical field. The multi-drug resistant strains of bacteria are a challenge of today's medicine. The aim of our study was to identify the etiological spectrum of bacterial infections in severe burn patients in Romania and their multi-drug resistant patterns. We performed a prospective study that included 202 adult patients admitted to the intensive care unit (ICU) of the Clinical Emergency Hospital of Plastic, Reconstructive Surgery and Burns, Bucharest, Romania (CEHPRSB), from 1 October 2018 to 1 April 2022, a period which includes the first 2 years of the outbreak of COVID-19. From each patient, wound swabs, endotracheal aspirates, blood for blood culture, and urine were collected. The most frequently isolated bacterium was Pseudomonas aeruginosa (39%), followed by Staphylococcus aureus (12%), Klebsiella spp. (11%), and Acinetobacter baumannii (9%). More than 90% of Pseudomonas aeruginosa and Acinetobacter baumannii were MDR, regardless of the clinical specimen from which they were isolated.

Comparison of endotracheal aspirate and bronchoalveolar lavage fluid metagenomic next-generation sequencing in severe pneumonia: a nested, matched case–control study

ObjectivesTo compare clinical outcomes in patients with severe pneumonia according to the diagnostic strategy used.MethodsIn this retrospective, nested, case–control study, patients with severe pneumonia who had undergone endotracheal aspirate (ETA) metagenomic next-generation sequencing of (mNGS) testing (n = 53) were matched at a ratio of 1 to 2 (n = 106) by sex, age, underlying diseases, immune status, disease severity scores, and type of pneumonia with patients who had undergone bronchoalveolar lavage fluid (BALF) mNGS. The microbiological characteristics and patient’s prognosis of the two groups were compared.ResultsAn overall comparison between the two groups showed no significant differences in bacterial, fungal, viral, or mixed infections. However, subgroup analysis of 18 patients who received paired ETA and BALF mNGS showed a complete agreement rate for the two specimens of 33.3%. There were more cases for whom targeted treatment was initiated (36.79% vs. 22.64%; P = 0.043) and fewer cases who received no clinical benefit after mNGS (5.66% vs. 15.09%; P = 0.048) in the BALF group. The pneumonia improvement rate in the BALF group was significantly higher than in the ETA group (73.58% vs. 87.74%, P = 0.024). However, there were no significant differences in ICU mortality or 28-day mortality.ConclusionsWe do not recommend using ETA mNGS as the first-choice method for analyzing airway pathogenic specimens from severe pneumonia patients.

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

A national survey of PICU clinician practices and perceptions about respiratory cultures for invasively ventilated patients

Background: Respiratory cultures are commonly obtained from patients with suspicion for ventilator-associated infections (VAIs). In the absence of specimen ordering and collection guidelines, management practices may differ. We characterized current respiratory culture collection practices and perceptions and identified potential barriers to changing practices among a national collaborative of pediatric intensive care units (PICUs). Methods: We conducted an electronic survey of PICU physicians, advanced practice providers (APPs), respiratory therapists (RTs), and nurses at 16 US academic pediatric hospitals across the United States. Positive Likert-scale responses (eg, “agree” and “strongly agree”) were grouped. To account for varying hospital representation, we analyzed the results as the median proportion of participants with that response across the hospitals. Results: After excluding incomplete responses, 568 (44%) of 1,301 invited participants responded (range, 16–107 per site); the median hospital response rate was 60% (range, 17%–83%). Roles included physicians (35%), APPs (10%), RTs (24%), and nurses (31%). Moreover, 44% of the participating units cared for cardiac surgery patients. Across hospitals, specimens are often collected by RTs, followed by nurses, typically via inline endotracheal aspirate for either endotracheal tubes or tracheostomies. Saline lavage is a common practice, but only 4% reported a standardized approach. Examining the likeliness to obtain cultures for different clinical symptoms, the widest variation in responses were for fever and inflammatory markers without respiratory symptoms (median proportion, 68%; IQR, 54%–79%), isolated change in secretion characteristics (67%; IQR, 54%–78%), isolated increased secretions (55%; IQR, 40%–65%), isolated inflammatory markers (49%; IQR, 38%–57%) or isolated fever (49%; IQR, 38%–61%). Overall, 75% (IQR, 70%–86%) of reported respiratory cultures were likely to be obtained as a “pan culture.” Most respondents (median proportion, 69%) felt confident about the indications to obtain cultures, but 60% felt that clinicians had a low threshold, and 84% reported clinical practice variation. Barriers to change included reluctance to change (70%), opinion of consultants (64%), and fear of missing a diagnosis of VAI (62%). Respondents agreed that they would find clinical decision support (CDS) tools helpful (79%). In addition, 83% expected that they would follow CDS, and 82% thought that CDS would help align ICU and/or consulting teams. Conclusions: Among 16 participating hospitals, we detected a lack of standardized respiratory-culture specimen collection and ordering practices. Most respondents agreed that CDS tools would be helpful. Diagnostic stewardship of respiratory cultures using CDS must account for potential reluctance to change and needs to address stakeholder perspectives, including fear of missing infections.Disclosure: None

Comparison of the effects of open and closed aspiration on end-expiratory lung volume in acute respiratory distress syndrome.

Alveoli tend to collapse in patients with acute respiratory distress syndrome (ARDS). Endotracheal aspiration may increase alveolar collapse due to the loss of end-expiratory lung volume (EELV). We aimed to compare the loss of EELV after open and closed suction in patients with ARDS. This randomized crossover study included 20 patients receiving invasive mechanical ventilation for ARDS. Open and closed suction were applied in a random order. Lung impedance was measured using electric impedance tomography. The change in end-expiratory lung impedance end of suction and at 1, 10, 20, and 30 min after suction, was used to represent the change in EELV. Arterial blood gas analyses and ventilatory parameters such as the plateau pressure (Pplat), driving pressure (Pdrive), and compliance of the respiratory system (CRS) were also recorded. Less volume loss was noted after closed suction than after open suction (mean ΔEELI: -2661 ± 1937 vs. -4415 ± 2363; mean difference: -1753; 95% CI [-2662, -844]; P = 0.001). EELI returned to baseline 10 min after closed suction but did not return to baseline even 30 min after open suction. After closed suction, the Pplat and Pdrive decreased while the CRS increased. Conversely, the Pplat and Pdrive increased while the CRS decreased after open suction. Endotracheal aspiration may result in alveolar collapse due to loss of EELV. Given that closed suction is associated with less volume loss at end-expiration without worsening ventilatory parameters, it should be chosen over open suction in patients with ARDS.

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.

Distribution and antibacterial susceptibility pattern of isolated bacteria from endotracheal aspirates among ventilator-assisted pneumonia patients in Indonesia.

An accurate and timely identification of causative microorganisms as well as determination of their antibiotic susceptibility patterns will help in the selection of proper antibiotics and prevention of their misuse in pneumonia patients. The aim of this study was to determine the distribution and antibiotic susceptibility pattern of bacteria isolated from endotracheal aspirates of ventilator-assisted pneumonia patients in Indonesia. A retrospective cross-sectional study was conducted at Dr. Zainoel Abidin Hospital, a provincial reference hospital in Banda Aceh, Indonesia, from January to December 2021. Ventilator-assisted pneumonia patients aged ≥17 years treated in the hospital were considered eligible. Antibiotic susceptibility was valuated using Kirby-Bauer disc-diffusion followed with VITEK 2 Compact. We included 57 patients of which 73.7% males and 26.3% aged 56-65 years (represent the majority group of the patients). Each patient reported at least one comorbidity and the average duration of receiving mechanical ventilation was 8.68 days, and more than half (59.7%) of the patients had a poor clinical outcome (died). A total 57 bacteria isolates (consisting nine species) were recovered; 68.5% Gram-negative and 31.5% Gram-positive bacteria. Among 57 patients, Acinetobacter baumannii was the most frequent isolated Gram-negative bacteria (19.3%), followed by Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (15.8%), and Achromobacter denitrificans (12.3%). A. baumannii exhibited <70% sensitivity to aminoglycoside and carbapenem antibiotics and 100% resistance to third-generation cephalosporins. The most abundant Gram-positive bacteria was Staphylococcus aureus (17.5%), followed by S. haemolyticus (10.5%) and S. epidermidis (3.5%). All S. aureus were sensitive to linezolid, tigecycline, vancomycin, and macrolide antibiotics (azithromycin, clarithromycin, clindamycin, and erythromycin), whereas 50% were sensitive to some beta-lactams. However, 50% of S. aureus were methicillin resistant S. aureus (MRSA). Given the magnitude of multi-drug resistance, an empiric antimicrobial therapy in particular to specific settings and implementation of antibiotic stewardship programs are crucial.

BACTERIAL ISOLATES OF THE RESPIRATORY TRACT INFECTION AND THEIR CURRENT SENSITIVITY PATTERN AMONG PATIENTS ADMITTED IN TERTIARY CARE HOSPITAL.

Background &amp; Objectives: This study was aimed to observe the susceptibility pattern of bacterial isolates from respiratory tract infection (RTI). Respiratory tract infection is considered as one of the major public health problems and a leading cause of morbidity and mortality in many developing countries. Respiratory tract is the part of the human system that plays a vital role in breathing processes. In human, the respiratory system can be subdivided into an Upper respiratory tract and a Lower respiratory tract based on anatomical features. The respiratory tract is constantly exposed to microbes due to the extensive surface area. Methods: The present study was conducted retrospectively for a period of one year November 2021 to October 2022. All respiratory specimens included Sputum, BAL, throat swab; endotracheal aspirate specimens were collected aseptically from patients and cultured on the appropriate bacteriological media (Blood agar, MacConkey agar &amp; Chocolate Agar). Bacterial isolates were identified by biochemical tests and antimicrobial susceptibility performed by standard methods as per CLSI 2022. Results: 152 (72.3%) of total 210 samples were positive for bacterial culture. 126 (82.8%) were gram negative bacilli (GNB) and 26 (17.1%) were gram positive cocci (GPC). The predominant pathogen isolated was K. pneumoniae 46 (30.2%) followed by Escherichia coli 28 (18.4%).The overall susceptibility of GNB was highest towards Imipenem, Meropenem followed by Piperacillin tazobactam and Amikacin. Gram positive organisms exhibited highest susceptibility towards Vancomycin and Linezolid. Conclusion: Imipenem is the most sensitive antibiotic followed by Piperacillin tazobactam and Amikacin which can be used for empirical therapy for respiratory tract infections (RTI). The antibiotic therapy should be modified as per the culture and sensitivity report. Regular determinations of the type of bacterial pathogens and updation of antibiogram must be followed in every institution to aid in better patient management by helping the clinician in the judicious use of antibiotics.

Pattern of microbial profile and their susceptibility pattern in a tertiary level neonatal intensive care unit, Dubai, UAE: 11 years surveillance study

Introduction: Neonatal sepsis is a global burden on the health and wellbeing of the neonates. It mounts too many neonatal mortality and morbidity. However, rational use of antimicrobial therapy and aggressive supportive management has modified the outcome over the past few decades. A good knowledge of locally prevalent microbes and antibiotics sensitivity pattern help in formulating antibiotics regimen. Methodology: This study is a retrospective analysis of prevalent microorganisms isolated from various culture samples collected from neonates aged 0 - 90 days, suspected to have early or late onset neonatal sepsis. All the neonates were admitted to Neonatal intensive care unit (NICU) of Latifa Women and Children Hospital (LWCH) over an 11 year period (from January 2011 till December 2021). Descriptive analyses were used with results presented as proportions. Data were analyzed using Microsoft excel 2016 and online calculators. Results: A total of 4849 microbial culture positive isolates were identified from our NICU. These isolates included samples taken from, blood, cerebrospinal fluid, endotracheal aspirates, throat/nasopharynx, urine, rectal, stool, eyes and superficial cultures. Gram-negative bacteria were isolated in 56.3% (n= 2730). Gram positive bacteria accounted for 43.7% (n=2119) of isolates. Most common isolated bacterial species were Klebsiella pneumoniae (15.7%), Coagulase Negative Staphylococcus (CONS) (14.6%), Stenotrophomonas maltophilia (11.5%) and Pseudomonas aeruginosa (11.1%). Among the multidrug resistant organism (MDRO), Extended spectrum beta lactamase (ESBL) K. pneumoniae (n=208, 4.3%) and Methicillin resistant staphylococcus aureus (MRSA) (n=145, 3%) are the predominant strain. Over the study period, there is a significant reduction in both gram positive and gram negative bacterias (n=1055 in 2011 to 226 in 2021). Discussion/conclusion: The need of the hour is implementation of strict infection control measures and rationalized use of broad-spectrum antibiotics and continuous surveillance of emergence of MDROs. Regular tracking of the microbiological prevalence pattern kept us updated regarding prevailing organisms and emergence of MDROs. Our NICU antimicrobial policy modified in accordance with the surveillance data.

Increased antimicrobial resistance in bacterial pneumonia among Egyptian Children during the COVID-19 pandemic

BackgroundPneumonia is the major cause of morbidity and mortality among children worldwide. During the COVID-19 pandemic, the use of antibiotics increased which led to the development of antibiotic-resistant strains of pathogenic organisms causing pneumonia in children. So, studies should be directed to register antimicrobial resistance in each country and to develop local antimicrobial stewardship. This study aimed to identify the distribution of bacteria causing pneumonia among Egyptian children in the year 2020 and their antimicrobial sensitivity. A cross-sectional study was done, it included fifty immunocompetent children with pneumonia admitted to Children's Hospital, Ain-Shams University from June 2020 to December 2020. Bacterial cultures were done on sputum collected using cough swab, or endotracheal tube aspirate, with their antimicrobial sensitivity.ResultsThirty children had Community-acquired pneumonia (CAP), while twenty had Hospital-acquired pneumonia (HAP). Streptococcus pneumonia was the most frequently cultured organism in CAP group 7/30 (23.3%). The sensitivity results found linezolid (50%), followed by fluoroquinolones to be the least resistant. While in the HAP group, Klebsiella pneumonia 9/20 (45%) was the most common organism. Colistin (90%) followed by tigecycline (50%), Amikacin (35%), fluoroquinolones (25%), gentamicin (25%), and imipenem (20%) had the least resistance in the HAP group.ConclusionNo pathognomonic shift of the bacteria that causes pediatric pneumonia was detected. Although, an increase in antimicrobial resistance was noticed.

Changing Trend in the Antibiotic Resistance Pattern of Klebsiella Pneumonia Isolated From Endotracheal Aspirate Samples of ICU Patients of a Tertiary Care Hospital in North India.

Introduction Klebsiella pneumonia is one of the most prevalent bacteria that cause nosocomial infections, particularly in critically ill patients in the intensive care unit (ICU). Multi-drug-resistant Klebsiella pneumoniae (MDRKP) has become an urgent risk to public health as its prevalence has sharply surged around the globe in recent decades. Therefore, this research was conducted to evaluate shifts over a four-year period in drug susceptibility patterns among Klebsiella pneumoniae isolates from mechanically ventilated intensive care unit patients. Materials and methods This is a retrospective observational study conducted in a tertiary care multi-specialty hospital and teaching institute in North India and was approved by the institutional ethics committee. The research comprised Klebsiella pneumoniae isolates from endotracheal aspirates (ETA) of patients on mechanical ventilation admitted to the general intensive care unit (ICU) of our tertiary care facility. The data from January to June 2018 and January to June 2022 were collected. According to the antimicrobial resistance profile of the strains, they were categorized as susceptible, resistant to one or two antimicrobial categories, multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant (PDR). The criteria for MDR, XDR, and PDR were proposed by the European Centre for Disease Prevention and Control (ECDC). IBM Statistical Package for the Social Sciences (SPSS) for Windows, Version 24.0, Armonk, NY, IBM Corp., was used for data input and analysis. Results A total of 82 cases of Klebsiella pneumonia were included in the study. Of these 82 isolates, 40 were isolated over a period of six months from January to June 2018, and the remaining 42 were isolated from January to June 2022. Among the 2018 group, five strains (12.5%) were classified as susceptible, three (7.5%) as resistant, seven (17.5%) as MDR, and 25 (62.5%) as XDR. The highest percentages of antimicrobial resistance in the 2018 group were observed with amoxicillin/clavulanic acid (90%), ciprofloxacin (100%), piperacillin/tazobactam (92.5%), and cefoperazone/sulbactam (95%). In comparison, the 2022 group showed no strain as susceptible; nine strains (21.4%) were classified as resistant; three strains (7%) as MDR; and 30 strains (93%) were classified as XDR. There was a significant increase in resistance to amoxicillin, from 10% in 2018 to nil in 2022. Overall, the rate of resistant Klebsiella pneumonia (K. pneumonia) increased from 7.5% (3/40) in 2018 to 21.4% (9/42) in 2022, while XDR Klebsiella pneumonia among the mechanically ventilated ICU patients significantly increased from 62.5% (25/40) in 2018 to 71% (30/42) in 2022. Conclusion K. pneumoniae antibiotic resistance is a real threat in Asia and requires close monitoring to be controlled. More careful attempts should be made to create a new generation of antimicrobials since the prevalence of resistance to existingmedications is rising. Antibiotic resistance should be monitored and reported by healthcare institutions regularly.

Enhanced bacterial killing with a combination of sulbactam/minocycline against dual carbapenemase-producing Acinetobacter baumannii

Carbapenem-resistant Acinetobacter baumannii (CRAB) is often difficult to treat. Considering the current circumstances, there is an unquestionable need for new therapeutic options to treat CRAB infections. In the present study, the synergistic activity of sulbactam-based combination was determined against genetically characterized CRAB isolates. Non-duplicate CRAB isolates (n = 150) recovered from blood culture and endotracheal aspirates were included in this study. The minimum inhibitory concentrations (MICs) of tetracyclines (minocycline, tigecycline, eravacycline) and their comparators (meropenem, sulbactam, cefoperazone/sulbactam, ceftazidime/avibactam, and colistin) were determined using the microbroth dilution method. Six isolates were tested for the synergistic activity of various sulbactam-based combinations using time-kill experiments. Tigecycline and minocycline showed a wide spread of MICs with most isolates in the range of1 to 16mg/L. The MIC90 of eravacycline (0.5mg/L) was four dilutions lower than that of tigecycline (8mg/L). Minocycline with sulbactam was the most active dual combination against OXA-23 like (n = 2) and NDM with OXA-23 like producers (n = 1), which resulted in ≥ 2 log10 kill. The combination of ceftazidime-avibactam with sulbactam showed ≥ 3 log10 kill against all the three tested OXA-23 like producing CRAB isolates, but showed no activity against dual carbapenemase producers. Sulbactam with meropenem showed ≥ 2 log10 kill against one OXA-23 like producing CRAB isolate. The findings suggest that sulbactam-based combination may confer therapeutic benefits against CRAB infections.

COVID-19 Pnömonili Hastaların Solunum Yolu Örneklerinde Sekonder Bakteriyel Ajanlar ve Antibiyotik Direnç Profilleri

Objective: To assess secondary bacterial pneumonia agents and antibiotic resistance rates in patients with COVID-19 pneumonia and to compare findings with the pre-pandemic period. Materials and Methods: Bacteria grown in endotracheal aspirate fluid and bronchoalveolar fluid samples of patients diagnosed with COVID-19 between January 2020 and December 2020, and antibiotic resistance rates were retrospectively compared with samples of the year before the pandemic. Isolates were identified at the species level with an automated system (VITEK 2, bioMérieux, France), and antimicrobial susceptibility was determined according to EUCAST criteria. Results: A total of 900 culture results were examined in 2019. Acinetobacter baumannii was detected in 36%, Klebsiella pneumoniae in 23%, Pseudomonas aeruginosa in 14%, and Staphylococcus aureus in 8%. In 2020, 660 culture results were examined, and the same bacteria were detected in 43%, 23%, 16%, and 5%, respectively. K. pneumoniae's resistance to third-generation cephalosporins, and A. baumannii's resistance to gentamycin and tobramycin, were found to have increased significantly during the pandemic period. Conclusions: The growth of multidrug-resistant Gram-negative bacteria was frequently detected in respiratory secretions obtained during the COVID-19 pandemic. Regional bacterial agents and antibiotic resistance profiles should be clarified, and empirical therapy should be selected accordingly in COVID-19.

Changes in upper airways microbiota in ventilator-associated pneumonia

BackgroundThe role of upper airways microbiota and its association with ventilator-associated pneumonia (VAP) development in mechanically ventilated (MV) patients is unclear. Taking advantage of data collected in a prospective study aimed to assess the composition and over-time variation of upper airway microbiota in patients MV for non-pulmonary reasons, we describe upper airway microbiota characteristics among VAP and NO-VAP patients.MethodsExploratory analysis of data collected in a prospective observational study on patients intubated for non-pulmonary conditions. Microbiota analysis (trough 16S-rRNA gene profiling) was performed on endotracheal aspirates (at intubation, T0, and after 72 h, T3) of patients with VAP (cases cohort) and a subgroup of NO-VAP patients (control cohort, matched according to total intubation time).ResultsSamples from 13 VAP patients and 22 NO-VAP matched controls were analyzed. At intubation (T0), patients with VAP revealed a significantly lower microbial complexity of the microbiota of the upper airways compared to NO-VAP controls (alpha diversity index of 84 ± 37 and 160 ± 102, in VAP and NO_VAP group, respectively, p-value < 0.012). Furthermore, an overall decrease in microbial diversity was observed in both groups at T3 as compared to T0. At T3, a loss of some genera (Prevotella 7, Fusobacterium, Neisseria, Escherichia–Shigella and Haemophilus) was found in VAP patients. In contrast, eight genera belonging to the Bacteroidetes, Firmicutes and Fusobacteria phyla was predominant in this group. However, it is unclear whether VAP caused dysbiosis or dysbiosis caused VAP.ConclusionsIn a small sample size of intubated patients, microbial diversity at intubation was less in patients with VAP compared to patients without VAP.