Intensive Care Unit Setup Research Articles

Endotracheal Tube Cuff Pressure Changes in Mechanically Ventilated Patients Undergoing General Anaesthesia with O2, N2o & Other Inhalation Agents in Elective O. T. & in Intensive Care Unit Set-Up with O2 and Air - A Prospective Observational Study

Endotracheal Tube Cuff Pressure Changes in Mechanically Ventilated Patients Undergoing General Anaesthesia with O2, N2o & Other Inhalation Agents in Elective O. T. & in Intensive Care Unit Set-Up with O2 and Air - A Prospective Observational Study

Mad honey (wild honey) poisoning: clinical case series from Nepal.

Mad honey is commonly used for hypertension, and coronary artery disease, and as a sexual stimulant. Patients with mad honey poisoning present with dizziness, nausea, syncope, blurred vision, bradycardia, and hypotension with ECG findings of sinus bradycardia, complete AV block, and ST elevation. Here, the authors report five cases admitted to our tertiary care center following the consumption of mad honey. The amount of ingestion of honey varies from 1 to 2 teaspoons (~10-20ml). Most of the cases presented with chief complaints of nausea, dizziness, and vomiting, and all the cases had hypotension and bradycardia. Two cases were admitted to the ward and three of them were admitted to the ICU for further management. They were managed with intravenous fluid, injection atropine along with adjunctive vasopressor and oxygen whenever necessary. Mad honey contains grayanotoxin extracted from the nectar of Rhododendron species. This honey contains grayanotoxin, which binds to sodium channels in its open state causing hyperpolarization of the sodium channel predominantly causing gastrointestinal, neurological, and respiratory symptoms. Intravenous fluids and injection atropine are the mainstays of management in an ICU setup. Some also may require vasopressors. Mad honey poisoning is rare, and limited cases have been reported in Nepal. Physicians should consider mad honey poisoning in cases with ingestion history and clinical symptoms, as it may be a clinical diagnosis due to limited lab tests for grayanotoxin intoxication. Supportive management still forms the cornerstone for its management after diagnosis.

An Observational Study of Maternal and Perinatal Outcome in Preeclampsia Cases in a Tertiary Care Center.

Preeclampsia, a hypertensive disorder in pregnancy, is a multisystem disease of unknown etiology and is associated with an increased risk of maternal mortality and morbidity.Infants from preeclampsia mothers have significantly higher incidence of prematurity, somatic growth retardation, thrombocytopenia, low birth weight, respiratory distress syndrome, and long duration of admission to neonatal intensive care (NICU). This study was done to study the maternal mortality and morbidity and foetal outcome in pregnant women with severe preeclampsia. This observational study was done in the Department of Obstetrics and Gynaecology, of a tertiary care centre, from the period October 2015 to October 2017.Data was collected from all 130 women attending the antenatal clinic of tertiary care hospital and ward admission and all details such as demographic details, obstetrics examination, and all clinical findings were noted and from that made results. Result: After applying inclusion and exclusion criteria all 130 women were observed in this study.Among 130 women 47 were diagnosed with preeclampsia. Mainly primigravida women were diagnosed with preeclampsia in the 21-25 years group. Among 47 preeclampsia women, 39 women had a BMI of 19-25 kg/m2. Thirty-two of 47 (68.09%) women were diagnosed with preeclampsia around 36-39 weeks. Among all preeclampsia, 28 women out of 47 (59.5%) women delivered babies vaginally, 18 of 47 (38.3%) women delivered through cesarean section, and one of 47 (2.13%) underwent preterm vaginal delivery. In preeclampsia, women's babies were delivered mostly (25/47, 53.19%) ≤2.5 kg weight and only one baby was shifted to NICU because of low birth weight. Preeclampsia increases maternal mortality and morbidity but in this study mortality was not done because our hospital is a tertiary care center with all ICU (intensive care unit) and NICU setup. Preterm births and cesarean deliveries were the mild to severe outcomes that were noted. ICU and NICUhospitalizations as a result of severe complications place a heavy demand on medical facilities. There are firm guidelines for the management of pregnancy-induced hypertension and its complications. For appropriate management, there is careful consideration of various factors, and individual case studies are required.

Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital

Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital

Study of Correlation of Arterial Blood Gas Measurements with Peripheral Venous Blood Gas Values in Adult Patients Admitted in ICU in Tertiary Care Hospital in Central India – A Cross-Sectional Study

Objectives: Arterial blood gas (ABG) analysis is an essential investigation for assessment of ventilation, oxygenation and acid–base status in critically ill patients. Arterial puncture to obtain arterial blood is more invasive procedure than venous and has more potential complications. The present study was undertaken to find out the correlation between arterial and peripheral venous blood gas (VBG) values for PO2 (Partial pressure of oxygen), PCO2 (Partial pressure of carbon dioxide), pH (Potential of hydrogen) and HCO3 (bicarbonates). Material and Methods: A total of 131 consecutive patients admitted to intensive care unit (ICU) requiring ABG analysis to determine their acid–base status or ventilatory status were included in the study. Arterial and venous blood samples were obtained with a heparinised syringe within <15 min, after performing modified Allen’s test and were analysed using blood gas analysis machine. The mean of pH, pCO2, HCO3, and PO2, values in arterial and venous samples was determined, along with peripheral arterial oxygen saturation (SpO2) of patients. Results: ABG and VBG analysis correlated well for pH, pCO2 and HCO3, as their correlation coefficient (r) were 0.976, 0.992 and 0.984, respectively, whereas PO2 has correlation coefficient of 0.010 which suggests that there was poor correlation in PO2. For each unit increase in pCO2, pH and HCO3 of VBG, all these ABG changes by 0.9831 units, 0.914 units and 0.992 units, respectively. Peripheral O2 saturation (SpO2) correlates well with arterial O2 saturation, however, does not correlate with venous O2 saturation. Conclusion: The results show that VBG analysis can be a substitute for ABG for evaluation of ventilatory function and acid–base imbalance for pH, pCO2 and HCO3 in patients of ICU setup in many clinical contexts.

Ventilator-associated pneumonia: Study of clinical outcome

Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia that develops within 48 hours or more of mechanical ventilation. It is also associated with significant morbidity including increased ventilatory days, intensive care unit (ICU) stay and higher medical cost that leads to high mortality rate in ICU. Aim: To evaluate the clinical outcome of the patients diagnosed with VAP and also to identify the risk factors for VAP. Methodology: This retrospective study included 27 patients admitted in Medical and casualty ICU's from August 2013 to April 2014 who were diagnosed with various diseases and later developed VAP. The patient's demographic data and diagnosis based on Centres for Disease Control and prevention (CDC) criteria were collected. Results: Among 27 patients, 20 were male patients and 7 were female patients. The order of organism according to the frequency in the current study was found to be Acinectobacter, Klebsiella, Pseudomonas aeruginosa, methicillin resistant Staphylococcus aureus, Streptococcus pneumonia, Hemophilus influenza, Enterobacter sp. Twenty two patients had late onset VAP and five patients had early onset VAP. Overall the survival was 52%. Conclusion: The incidence and the mortality of VAP are high in the current ICU setup. The mortality rate in the current study was 48% and the patients who survived had a longer ICU stay due to ventilator dependence.

Incidence and Associated Risk Factors of Endotracheal and Tracheostomy Tube Blockage in Intensive Care Unit

Background : Different studies had been carried out at different hospitals through- out the world to find out incidence and to assess the risk factor of ETT and TT blockage at ICU setup. The aim of our study was to reach a consensus and to find out the best diagnostic tool to assess the incidence and associated risk factors ETT and TT blockage at ICU setup. To assess the incidence and associated risk factors ETT and TT blockage at ICU setup.
 Materials and methods : Endotracheal Tube (ETT) and Tracheostomy Tube (TT) blockage is a common phenomenon at the Intensive Care Unit (ICU) setup of hospital . This is a cross sectional study carried out in the Medical Centre Hospital Between July 2018 to June 2019. Total 60 patients were included in the study. Data were analyzed and presented as both qualitative and quantitative data as applicable using SPSS version 20.The quantitative data were analyzed by mean, standard deviation. The qualitative data were analyzed by Mc NEMAR test (Mc NEMAR X2 test). For all analytical test, the level of significance was set at 0.05 and p value equal or less then 0.05 was considered as significant, p value more than 0.05 was considered as not significant.
 Results : A total 60 patients were included in the study, who required mechanical ventilation support for different purposes either though ETT and/or TT. The Incidence of ETT/TT blockage was 9(15%). From those ETT was 6(10%) and TT was 3(05%) (p=0.042). Most causes of tube blockage was mucus 5(55.56%), debris 3(33.33%) and kinking of the tube 1(11.11%). The incidence of partial blockage was 5(55.56%) and complete blockage was 4(44.44%) consecutively (P=0.025). so it is statistically significant. During the night shift tube blockage was 6(66.67%) was slightly higher than the day shift, which was 3(33.33%).
 Conclusion : ETT and/or TT blockage is an expected outcome in ICU setup . In spite of all measures, keen observation is very important to find out the blockage problem for early intervention.
 JCMCTA 2021 ; 32 (2) : 132-136

Clinical and Microbiological Profile of Tracheal Aspirates in Chronic Kidney Disease Patients

Introduction: Chronic Kidney Disease (CKD) is a chronic inflammatory state, which inturn suppresses the immune system. CKD patients are hence at more risk for nosocomial infections. Ventilator Associated Pneumonia (VAP) is one of the major nosocomial infections. If not treated early and appropriately, it increases hospital stay and expenses in turn increasing morbidity and mortality. In recent times, due to irrational and rampant use of antibiotics, there is an emergence of multidrug resistant strains of organisms which are difficult to treat. Aim: To study the clinical and microbiological profile of tracheal aspirate samples in CKD patients. Materials and Methods: It was a retrospective cross sectional study conducted in the renal Intensive Care Unit (ICU) of a Tertiary Care Centre, Institute of Nephrourology, Bengaluru over a period of two years from July 2018 to July 2020. Clinical and demographic data of patients who fulfilled the inclusion criteria was recorded. Tracheal aspirates were obtained by convenient sampling technique. The samples were cultured on Blood Agar (BA), chocolate agar, MacConkey agar and Sabouraud’s Dextrose Agar (SDA). Antibiotic sensitivity profiling was done by using Mueller Hinton agar. Statistical analysis was done using Statistical Package For The Social Sciences (SPSS) V23.0 software. Results: Sixty-nine samples were analysed over a period of two years. Males (66.66%) were in majority. Diabetes Mellitus (64%) was the most common associated risk factor. Among the total samples obtained, around 70% showed bacterial growth. Gram negative bacteria (92.4%) were the most commonly isolated microorganism. Among the Gram-negative bacteria, Acinetobacter baumanni (45.3%) was the most common followed by Klebsiella pneumoniae. Majority of the gram negative organisms were sensitive to Polymyxin B, colistin, tigecycline. Acinetobacter and Klebsiella showed resistance to 3rd generation cephalosporins, aminoglycosides and fluoroquinolones. Conclusion: There is emergence of extremely drug resistant gram negative organisms as the cause for VAP. They are dangerous and difficult to treat. They thus increase the hospital expenses by prolonging the hospital stay. Hence, the need of the hour is to formulate an appropriate antibiotic policy based on the population being treated and to follow strict infection control practices in ICU setup.

Point of Care Ultrasound in Coronavirus Disease 2019 Pandemic: One Modality Helping Multiple Specialties.

After the detection of novel coronavirus (2019) as the cause of a cluster of pneumonia in Wuhan, China, at the end of 2019, more than 10 million confirmed cases of coronavirus disease 2019 (COVID-19) have been reported around the globe. In the COVID-19 intensive care unit (ICU), the use of stethoscope is minimal for obvious reasons. Shifting of COVID-19 patients out of ICU setup increases the risk of transmission of infection to health-care workers as well as jeopardizes the safety of patients. Hence, diagnostic imaging has emerged as a fundamental component of the current management of COVID-19. Lung ultrasound (LUS) imaging has become a safe bedside imaging alternative that does not expose the patient to radiation and minimizes the risk of contamination. Ultrasound (USG) can be used to scan almost all vital organs (heart, kidney, vascular, brain, etc.) and also help in rapid decision-making regarding the management of COVID-19 patients. In this note, we review the current state of the art of LUS in evaluating pulmonary changes induced by COVID-19. The goal is to identify characteristic sonographic findings most suited for the diagnosis of COVID-19 pneumonia infections as well as to assess the impact of infection on other organs and utilizing the same in the management of COVID patients without compromising on the safety of patient or health-care provider.

Assessing caregiving burden among primary caregivers in a medical intensive care unit setup: Cross-sectional study.

Objective:Caregiver burden in caring patients in intensive care unit (ICU) settings are stressful and challenging place. Caregivers also play very important role in doctor–patient relationship. In India, there is a skewed trend in doctor–patient relationship. Without addressing caregiver's psychological issues, we may not able to deliver good medical services. “Caregiver burden in primary caregivers of patients admitted to medical ICU (MICU) was measured.Methodology:Its cross-section observational study. We collected the information from total of 100 caregivers whose patient got admitted to MICU. We took only one caregiver. We administered socio-demographic data, Zarit Caregiver Burden Interview (ZBI) for assessing burden in caregivers.Results:The mean age of the caregivers was 38 years with 66% males were being primary caregivers and mean age of education was 8.61 years. The mean duration of patient stay in hospital was 4.67 days with range of 4–18 days. Mean duration of illness in patient was 466 days with range of 4 days to 10 years. Mean score caregivers burden as per ZBI was 5.10 with range of 0–25. Thirty-five percentage of caregiver were felt caregiving was the burden. Correlation analysis shows ZBI negative relationship with caregivers' age and education and patients total duration of illness. There was a positive co-relationship with the duration of ICU admission.Conclusion:Higher burden was observed in caregivers and caregivers felt more burden if patients stays longer duration in ICU. More research is needed in this area.

Antibiotic Resistance and mecA Gene Characterization of Coagulase-negative Staphylococci Isolated from Clinical Samples in Nepal.

BackgroundCoagulase-negative Staphylococci (CoNS) are a significant cause of hospital-acquired and foreign-body-related infections. We conducted this research to assess methicillin susceptibility of CoNS by disc diffusion, agar dilution, and polymerase chain reaction (PCR) methods and to assess the antimicrobial susceptibility pattern.MethodsWe received 123 CoNS isolates from different specimens including blood, endotracheal tube, and central venous catheter. We performed sample processing, identification, and characterization following standard guidelines. Antimicrobial susceptibility was tested based on clinical and laboratory standards institute guidelines. We detected methicillin-resistant coagulase-negative staphylococci (MRCoNS) through mecA gene, disc diffusion method, and agar dilution method and compared the accuracy with PCR as reference.ResultsWe detected eight species of CoNS with Staphylococcus epidermidis as the most common. Most of the samples were received from the intensive care unit and blood was the dominant specimen followed by endotracheal-tube aspirate. Seventy-one percentage of isolates were methicillin-resistant by PCR method; disc diffusion and agar dilution method detected methicillin resistance with an accuracy of 96.7% and 98.3%, respectively. Antimicrobial susceptibility revealed an association between the different origins of samples, and also among the types of sample. Similarly, a comparison of the degree of resistance of antimicrobial agents between mecA gene positive and negative isolates showed significant differences. Vancomycin, linezolid, and teicoplanin are still effective for treating MRCoNS.ConclusionCoNS are a crucial cause of human infections especially in an intensive care unit setup where the use of devices is common. Disc diffusion and agar dilution are reliable for the detection of MRCoNS. The degree of antimicrobial resistance is much higher in organisms obtained from intensive care unit and foreign-body-related infections.

Intensive Care Unit Setup for COVID-19

The coronavirus pandemic has become a challenge to all the healthcare systems in the world. Urgent creation of an intensive care unit (ICU) for the same is the need of the hour. The ideal ICU for COVID -19 should be isolated, fully equipped with invasive and noninvasive monitoring, with 24/7 trained medical personnel, nursing staff and laboratory support. As the coronavirus infection is transmitted by droplets and is highly contagious, protection of healthcare workers is crucial. Personnel working inside the ICU should get personal protective equipment (PPE). Strict guidelines for donning and doffing of PPE should be followed to prevent cross-contamination. Respiratory failure being the commonest complication of COVID-19, knowing the ventilator management for the same is essential. It is of great importance to meticulously manage all the resources to combat this contagion.

Incidence and Treatment Protocol for Maxillofacial Fungal Osteomyelitis: A 12-Year Study

The aim was to retrospectively determine the incidence of fungal osteomyelitis and outcome of the surgical protocol and complications. Data were recorded from the medical records of patients treated from 2006 to 2018. Predictor variables were drawn from demographic characteristics (age and gender), etiology, most common site, associated comorbidities involved, and treatment protocol followed.The outcome variables were the success rate and associated complications. We identified 50 patients with fungal osteomyelitis out of 153 who were treated for various types of osteomyelitis for 12years. The incidence was 32.6%; men were affected more than women, at a ratio of 2.5:1; and most common site was the maxilla (56%), followed by the mandible (32%) and other sites (12%). Treatment protocols were dependent on the nature of the lesion, site, and optimization of underlying comorbid conditions. The outcome of our protocol showed that 28 patients (56%) healed well. Patients with complications such as palatal fistula (13 [26%]) underwent revision surgery using a local advancement flap and the buccal fat pad. During the immediate postoperative period, 2 patients (4%) had wound dehiscence; 2 patients (4%) had nasal regurgitation; and 1 patient (2%) had a reduced mouth opening that was managed with a mouth-opening exercise regimen. In 1 patient (2%) with recurrence, secondary correction was performed after 6months and postoperative antifungal therapy was administered for 3months. The incidence of fungal osteomyelitis was high owing to associated comorbidities. The surgical outcome was markedly influenced by a prompt diagnosis based on the clinical presentation and histopathology, identification and optimization of comorbidities, correction of electrolyte imbalances, 2 doses of amphotericin B preoperatively under an intensive care unit setup, intraoperative collection of specimens for fungal culture by a microbiologist, curettage and debridement of the soft tissue and bone, closure of the defect with either a local or regional flap, and postoperative antifungal therapy.

Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital.

ABSTRACTObjectiveTo evaluate the antibiotic sensitivity and resistance pattern in an intensive care unit (ICU) setting of a tertiary care hospital.Materials and methodsA cross-sectional, retrospective study was conducted for a period of 1 month in October 2017 on a total of 195 patients who were admitted to ICU of tertiary care hospital. The culture and sensitivity pattern of clinical isolates from blood, urine, sputum, endotracheal tube (ET) aspirate, catheter sites, and wound swabs were analyzed. Positive cultures were segregated and their antibiotic sensitivity testing was performed under the guidelines of clinical and laboratory standard institute (CLSI).ResultsOf the total 195 ICU admissions, cultures were sent for 167 cases. Of which 127 patients were culture positive and 40 cases were culture negative. Isolated bacteria were mostly gram-negative bacilli, of which Escherichia coli was (18.6%), Acinetobacter (14.5%), Klebsiella (11.6%), Pseudomonas (9.8%), and Proteus (1.74%). Among the gram-positive organisms, coagulase negative staphylococcus (CoNS) (15.6%) was most commonly isolated followed by Streptococcus (2.32%). Fungal growth was also seen in 26 (15.11%) samples. Samples that grew organisms were blood (n = 48), sputum (n = 17), urine (n = 39), ET aspirate (n = 40), pus (n = 11), catheter (n = 4), ear swab (n = 2), and stool (n = 1).ConclusionGram-negative bacterial infections are increasing in ICUs, leading to inappropriate selection of antibiotics. Hence, antibiotic sensitivity and resistance pattern in a hospital setup has to be studied so as to guide the treating consultant to initiate empirical antibiotics in critical cases.How to cite this articleSavanur SS, Gururaj H. Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital. Indian J Crit Care Med 2019;23(12):547–555.

Awareness and impact of educational intervention regarding kangaroo mother care among pediatricians of Marathwada region of Maharashtra

Objective: The objective of the study was to compare knowledge and attitudes toward kangaroo mother care (KMC) among pediatric practitioners in Marathwada region before and after a workshop on KMC. Material and Methods: A prospective comparative study was conducted among 40 pediatricians practising in the rural area of Marathwada region. Clinicians having at least Level 2 neonatal intensive care unit setup at their place were enrolled in the study. Every pediatrician satisfying the selection criteria and willing to participate was enrolled in the study. They were given a questionnaire, consisting 25 questions, which were supposed to be answered at the time of enrolment, i.e., pre-test. After that, the participant was given a short booklet on KMC to read, and then after a gap of 7 days, the participant attended a workshop on KMC for 4 h, in which details regarding KMC, advantages of KMC, and videos showing actual practice of KMC were shown to participants. After completion of workshop, participants were given the same questionnaire and pre- and post-test scores were calculated. Results: The mean score in basic knowledge was 20

Applying Judgment Analysis Theory and Methods to Obtain an Insight Into Clinical Judgments: Implementation and Findings With a Simulated Neonatal Intensive Care Unit Setup.

Clinicians who provide acute care are required to quickly identify and judge the illness severity of patients who experience deterioration in their clinical state. Accuracy of judgments can only be tested with respect to a valid reference, but in most health care areas, there is no such score. Judgment analysis theory and methods are presented and proposed as a framework to obtain insight into clinical judgments. A study in a simulated neonatal intensive care unit setup is described to demonstrate the applicability of the proposed methodology. Sixteen participants from a neonatal intensive care unit department reviewed 31 clips of simulated cases. The participants were directed to use a 5-point scale to rate their personal interpretation regarding the illness severity of the simulated patient. Judgment analysis techniques were used to identify the judgment capabilities of the participants and to determine factors that influence those capabilities. Most participants interpreted the clinical signs information consistently, but interpretation varied remarkably between clinicians, providing possible explanation to the differences between the clinicians' judgments. Significant correlations were found between the doctors' years of medical experience and attributes of their judgments. Judgment analysis can be used to obtain insight into clinical judgments and to identify and quantify factors that affect clinicians' judgments. Judgment analysis can promote health care by enhancing clinical assessment teaching, by providing objective and personalized feedback to team members about their judgment performance, and by introducing a unified and objective method to study elements that affect clinical judgments.

Feasibility of nonoperative management of grade III and IV splenic injury in hemodynamically stable patients in limited ICU settings: A prospective study

Background: The management of splenic injuries has evolved over the years. The objective of this study was to evaluate the feasibility of nonoperative management (NOM) of higher grades (grade III and IV) of splenic trauma in limited intensive care unit (ICU) settings. Patients and Methods: This prospective study was carried out in the Department of Surgery Government Medical College, Srinagar over a period of 1.5 year from January 2012 to June 2013. The study included 50 hemodynamically stable patients with computed tomography (CT) documented grade III or IV splenic trauma (30 patients with grade III and 20 patients with grade IV). Vigorous monitoring was done in general surgical ward setup during first 2-3 days of trauma consisting of hourly monitoring by the resident doctor on the 1 st day and 3-hourly monitoring thereafter. Results: Most common mode of trauma was road traffic accident (20, 40%) followed by fall from height (15, 30%), human violence (10, 20%), and others including animal assault (5, 10%). Ninety-four percent of our patients were managed nonoperatively without any mortality. Fourteen patients from group A (grade III) and 17 patientsfrom group B (grade IV) required blood transfusions. Ninety-three percent of the patients from group A and 45% of patients from group B were managed in the ward setting without any need for ICU setup. Children with grade III laceration showed complete resolution on CT after an average of 5.2 months and those with grade IV laceration on CT after an average of 9.3 months. Conclusion: NOM of higher grades of splenic trauma appears to be feasible in centers with limited ICU facilities, though it demands strict and continuous monitoring during initial 2-3 days.

Accidental epidural injection of Atropine

Intrathecal injection of drugs for anesthesia, regional analgesia, and chronic pain management are common practice now. Local anesthetic, adjuvants, and opioids are in common use. Human error in the Operation Theater and the Intensive Care Unit setup is also known and reported, due to stress and overwork. A case of unintentional atropine injection intrathecally, which was closely observed for any untoward effects, is reported here.

Characterisation of aerobic bacteria isolated from endotracheal aspirate in adult patients suspected ventilator associated pneumonia in a tertiary care center in Mangalore

Background and Objectives:Despite advances in antimicrobial therapy, better supportive care modalities and use of a wide range of preventive measures, ventilator-associated pneumonia (VAP) continues to be an important cause of morbidity and mortality in intensive care unit (ICU). VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, to prevent mortality and morbidity. Inappropriate and inadequate antibiotic treatment causes emergence of drug resistance in pathogens and poor prognosis in patients. Early detection of pathogens causing VAP helps to control their spread by administration of suitable antibiotics and proper infection control measures. The study was conducted to know the pathogens causing VAP in Fr. Muller Medical College Hospital, Mangalore, and their susceptibility pattern.Methods:A total of 100 patients, on mechanical ventilation for more than 48 h, who were suspected to have VAP were included in the study between December 2008 and November 2009. Their endotracheal aspirates (ETAs) were collected and processed. From 100 ETA, 138 isolates of count > 105 CFU/ mL were characterized and antibiogram was determined using standard antibiotics regime.Results:Incidence of VAP was found to be 44.2% among the mechanically ventilated patients. Klebsiella pneumoniae (34%) was the most common pathogen isolated, followed by Pseudomonas aeruginosa (20%). Among them, most of the K. pneumoniae and P. aeruginosa isolates were resistant to penicillins, cephalosporins, fluoroquinolones was observed but were sensitive to piperacillin/tazobactum, cefaperazone/sulbactum, and carbapenems. All isolates were sensitive to amikacin.Interpretation and Conclusion:The present study shows prevalence of multidrug-resistant organisms in the study region. Klebsiella species was the most common pathogen isolated in ETA. Acinetobacter species were the most resistant pathogens prevailing in our ICU setup, leading to the increased mortality in the ventilated patients. Patients with chronic obstructive pulmonary disease is the most common predisposing factor for VAP in the study group.

High load of multi-drug resistant nosocomial neonatal pathogens carried by cockroaches in a neonatal intensive care unit at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.

BackgroundCockroaches have been described as potential vectors for various pathogens for decades; although studies from neonatal intensive care units are scarce. This study assessed the vector potential of cockroaches (identified as Blatella germanica) in a neonatal intensive care unit setup in Tikur Anbessa Hospital, Addis Ababa, Ethiopia.MethodsA total of 400 Blatella germanica roaches were aseptically collected for five consecutive months. Standard laboratory procedures were used to process the samples.ResultsFrom the external and gut homogenates, Klebsiella oxytoca, Klebsiella pneumoniae, Citrobacter spp. Enterobacter cloacae, Citrobacter diversus, Pseudomonas aeruginosa, Providencia rettgeri, Klebsiella ozaenae, Enterobacter aeruginosa, Salmonella C1, Non Group A streptococcus, Staphylococcus aureus, Escherichia coli, Acinetobacter spp. and Shigella flexneri were isolated. Multi-drug resistance was seen in all organisms. Resistance to up to all the 12 antimicrobials tested was observed in different pathogens.ConclusionCockroaches could play a vector role for nosocomial infections in a neonatal intensive care unit and environmental control measures of these vectors is required to reduce the risk of infection. A high level of drug resistance pattern of the isolated pathogens was demonstrated.