Tube Aspirates Research Articles

Endotracheal Tube Aspirate Microscopy and Culture vs CDC Criteria for Early Diagnosis of VAP in Special Newborn Care Units

Endotracheal Tube Aspirate Microscopy and Culture vs CDC Criteria for Early Diagnosis of VAP in Special Newborn Care Units

Ischemic insular damage and stress ulcer in patients of acute ischemic stroke.

Stress ulcer (SU) is a common complication in patients with acute ischemic stroke. The relationship of infarction location and the incidence of SU was unclear. Herein, we aim to investigate the association between ischemic insular damage and the development of SU. Data were retrieved from the SPARK study (Effect of Cardiac Function on Short-Term Functional Prognosis in Patients with Acute Ischemic Stroke). We included the patients who had experienced an ischemic stroke within 7 days. The diagnosis of SU was based on clinical manifestations, including hematemesis, bloody nasogastric tube aspirate, or hematochezia. Evaluation of ischemic insular damage was conducted through magnetic resonance imaging. Cyclo-oxygenase regression analysis and Kaplan-Meier survival curves were used to assess the relationship between ischemic insular damage and the occurrence of SU. Among the 1357 patients analyzed, 110 (8.1%) developed SUs during hospitalization, with 69 (6.7%) experiencing infarctions in the anterior circulation. After adjusting for potential confounders, patients with ischemic insular damage exhibited a 2.16-fold higher risk of developing SUs compared to those without insular damage (p=.0206). Notably, among patients with infarctions in the anterior circulation, those with insular damage had a 2.21-fold increased risk of SUs (p=.0387). Moreover, right insular damage was associated with a higher risk of SUs compared to left insular damage or no insular damage (p for trend=.0117). Kaplan-Meier curves demonstrated early separation among groups, persisting throughout the follow-up period (all p<.0001). This study identified a significant independent correlation between ischemic insular damage, particularly on the right side, and the development of SU during hospitalization, indicating the need to consider prophylactic acid-suppressive treatment for patients with ischemic insular damage.

Identification of Community- and Hospital Pulmonary Bacterial Infection Using Culture and PCR Panel in COVID-19

Co-infection or secondary infection is associated with a worse outcome in COVID-19. Information concerning the distribution of pathogenic microbes in COVID-19 has yet to be widely studied. This study aims to evaluate the distribution of bacterial infection in COVID-19, detected using conventional culture and molecular methods. This study was conducted in March-May 2021 in Dr. Hasan Sadikin General Hospital, with a study population of moderate, severe, and critical COVID-19 patients. Microorganisms were identified and analyzed from expectorant sputum or Endotracheal tube aspirates using conventional culture methods (VITEK 2 Compact) and multiplex PCR pneumonia panel (Biofire). Data was presented in a table and figures to describe the organism profile among the two methods. From the 450 COVID-19 patients, 59 subjects were included. The positivity rate of microbial identification reached 79.7% in both methods, dominated by Gram-negative bacteria for both community and hospital-acquired infections. The pathogens most frequently detected using conventional methods and multiplex PCR were Acinetobacter baumanii (15.3%; 23.7%) and Klebsiella pneumoniae (23.7%; 28.8%). The multiplex PCR method detected Haemophilus influenzae (15.3%) and respiratory viruses (3.4%), which conventional methods could not detect. Gram-negative bacteria were the most frequent pathogen in COVID-19 in both populations. The multiplex PCR method has the advantage due to its shorter examination time. The application of both methods helps determine antibiotic therapy for COVID-19. Both methods identified Klebsiella pneumoniae and Acinetobacter baumanii as the dominant bacteria in both populations. This study helps establish antibiotic management in COVID-19, thus preventing antibiotic resistance.

Microbiome Profiling Demonstrates Concordance of Endotracheal Tube Aspirates With Direct Lower Airway Sampling in Intubated Patients

BackgroundEndotracheal aspirates (ETAs) are widely used for microbiological studies of the respiratory tract in intubated patients but involve sampling through an established endotracheal tube using suction catheters, both of which can acquire biofilms that may confound results. Research questionDoes standard clinical ETA in intubated patients accurately reflect the authentic lower airway bacterial microbiome? Study design and methodsWe applied comprehensive quantitative bacterial profiling using 16S rRNA V1V2 gene sequencing to compare bacterial populations captured by standard clinical ETA with contemporaneous “gold standard” samples acquired directly from the lower airways through a freshly-placed sterile tracheostomy tube in 13 patients undergoing percutaneous tracheostomy following prolonged (median 15 days) intubation. Metrics of bacterial composition, diversity and relative quantification were applied to samples. ResultsPre-tracheostomy ETAs closely resembled the gold-standard immediate post-tracheostomy airway microbiomes in bacterial composition and community features of diversity and quantification. Endotracheal tube and suction catheter biofilms also resembled cognate ETA and fresh tracheostomy communities. Interpretation.Unbiased molecular profiling demonstrates that standard clinical endotracheal aspirate sampling has good concordance with the authentic lower airway microbiome in intubated patients.

Pattern of Antibiotic Sensitivity and Resistance in Various Cases of Sepsis in a Mixed Intensive Care Unit set up in a Tertiary Hospital

Introduction: Sepsis has been shown to be one of the critical reasons for Intensive Care Unit admissions of patients for which early and empirical use of antibiotics have been used. Antibiotics resistance is becoming a matter of serious concern, especially in developing countries like ours. In this study, all the cases those were diagnosed with sepsis and had culture positive results for bacteria have been evaluated.&#x0D; Aims: To find out the common organisms responsible for sepsis in patients admitted to the Intensive Care Unit and to know the antibiotic sensitivity/resistance patterns.&#x0D; Methods: The study was done from May 2022 to April 2023 in mixed Intensive Care Units on the clinical isolates from blood, urine, sputum, endotracheal tube aspirate, central venous catheter tips and wound swabs and those were sent to microbiology department for culture and sensitivity. All the organisms were identified morphologically and biochemically and antibiotic susceptibility pattern was determined by standard laboratory procedure.&#x0D; Results: We took a total of 102 samples in which organisms were isolated. The most frequently isolated bacteria were Klebsiella (24.91%) followed by Staphylococcus aureus (24.5%), both were sensitive to Doxycycline and Tazobactam-piperacillin in most cases. Other organisms isolated were Escherichia coli (15.69%), Streptococcus (9.8%), Pseudomonas (8.82%), Acinetobacter (6.86%), Enterobacter species (3.92%) and Proteus (0.98%). Azithromycin was found to be the most resistant drug followed by Amoxycillin/clavulanic acid and Levofloxacin.&#x0D; Conclusion: Klebsiella was found to be the most prevalent cause of sepsis in ICU. Most of the frequently isolated pathogens were resistant to Beta lactamase inhibitors, Cephalosporins and Quinolones. Regular surveillance of antibiotic susceptibility pattern is very important for setting a guideline to the clinician in choosing an appropriate therapy for patients with sepsis.

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.

Current Trends in Antimicrobial Resistance Patterns in Bacterial Pathogens among Adult and Pediatric Patients in the Intensive Care Unit in a Tertiary Care Hospital in Kolkata, India

Nosocomial infections by multidrug-resistant (MDR) bacteria are among the main causes of morbidity and death in patients hospitalized in intensive care units (ICUs) worldwide. Antibiotic resistance has become a major concern for treating the patients with nosocomial infections. The aim of this study was to describe the antibiotic resistance patterns of pathogens causing infections in adult and pediatric patients in the ICUs of a tertiary care hospital in Kolkata, India. A cross-sectional, retrospective study was conducted from January 2022 to October 2022 on a total of 139 adult and 146 pediatric patients. Depending on clinical symptoms of the patients, samples were collected and subjected to antibiotic sensitivity testing. The culture and sensitivity pattern of clinical isolates from blood, urine, sputum, endotracheal tube (ET) aspirate, and central line catheter insertion site swabs were analyzed. A total of 695 and 556 specimens were obtained from adult and pediatric ICU, respectively. Culture positivity rate among adults and pediatric patients were 37% and 40%, respectively. The most commonly isolated organisms were Gram-negative Enterobacterales and non-fermenters. Most of the bacterial isolates showed very high resistance against multiple antibiotics. Escherichia coli from adult and pediatricpatients were found to be resistant to second generation cephalosporins (95% and 96%, respectively), beta-lactams (95% and 63%, respectively), fluoroquinolones (95% and 81%, respectively), and cotrimoxazole (85% and 78%, respectively). Klebsiella spp. from adult patients were found to be resistant to aminoglycosides (75%), second generation cephalosporins (100%), beta-lactams (94%), fluoroquinolones (92%), carbapenems (88%), and cotrimoxazole (83%). Proteus spp., Acinetobacter baumannii, and Pseudomonas spp. werefound to be resistant to multiple antibiotics. Enterococcus spp. from ICUs showed more than 90% resistance against ampicillin and more than 75% resistance against fluoroquinolones. MDR bacterial infections are increasing in both adult and pediatric ICUs, leading to significant therapeutic challenges. A frequent study of antimicrobial resistance patterns is imperative for antibiotic stewardshipin combatting the deadly effect of the MDR bacteria in critically ill patients.

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&lt;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.

Comparison of ultrasound-guided residual gastric volume measurement between diabetic and non-diabetic patients scheduled for elective surgery under general anesthesia.

ABSTRACTBackground and Aims:The presence of gastric content increases the risk of aspiration during general anesthesia. Diabetic patients have delayed gastric emptying; however, despite adequate fasting because of diabetic gastroparesis these patients have a high risk of aspiration. This study aimed to compare ultrasound-guided measurement of residual gastric volume between diabetic and non-diabetic patients scheduled for elective surgery under general anesthesia.Methods:This prospective observational study included 80 patients divided into two groups of 40 diabetic patients with a minimum of 8 years history of diabetes and 40 nondiabetic patients aged >18 years, American Society of Anesthesiologists’ physical status I–II kept with similar fasting intervals. Before induction of general anesthesia, gastric ultrasound was performed using standard gastric scanning protocol to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross-sectional area (CSA) and gastric volume in semi-sitting (SS) and right lateral decubitus (RLD) position using curved array probe. The gastric antrum volume (GV) was classified as Grade 0, 1, or 2, and risk stratification for aspiration was done. The nasogastric tube was inserted after induction of anesthesia to aspirate and compare the gastric content.Results:In the semi-sitting position, the mean CC and AP diameters were 16.38 ± 3.31 mm and 10.1 ± 2.53 mm in the non-diabetic group and 25.19 ± 4.08 mm and 15.8 ± 3.51 mm in the diabetic group, respectively. In RLD, CC was 1.91 ± 0.38 cm and AP was 1.19 ± 0.34 cm in the non-diabetic group as compared to the CC of 2.78 ± 0.4 cm and AP of 1.81 ± 0.39 cm in the diabetic group. The calculated CSA of 318.23 ± 97.14 mm2 and 4 ± 1.1 cm2 in diabetic were significantly higher than 133.12 ± 58.56 mm2 and 1.83 ± 0.83 cm2 of non-diabetic, in SS (p < 0.0001) and RLD (p < 0.0001) positions, respectively. The GV of 15.48 ± 11.18 ml in the diabetic group was significantly higher than (-) 9.77 ± 18.56 ml in the non-diabetic group (p < 0.0001). Despite the differences in CSA and GV between diabetic and non-diabetic groups, both groups showed a low gastric residual volume (<1.5 ml/kg). The gastric tube aspirate in the non-diabetic and diabetic groups was 0.3 ± 0.78 ml and 1.24 ± 1.46 ml, respectively, and was statistically significant (p = 0.0006).Conclusion:Patients with long-standing diabetes showed higher gastric residual and antral CSA when compared with non-diabetic patients. The clinical significance of these findings needs further evidence for the formulation of specific guidelines for diabetic patients.

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.

Bacterial Profile And Sensitivity Test Overview From Endotracheal Tube Aspirate Specimens From Confirmed Positive For Covid-19 Patients In Special Isolation Room Dr. Soetomo Hospital Surabaya

Background: Patients with COVID-19 who are treated in the Special Isolation Room (RIK) 1 are patients who experience respiratory failure and therefore use mechanical ventilation. The use of mechanical ventilation has a very high risk of infection in the respiratory tract accompanied by increased morbidity, especially in Multidrug Resistant (MDR) microorganism infections. This study aims to determine the profile of bacteria and the description of their sensitivity to antibiotics from Endotracheal Tube (ETT) aspirate specimens in COVID-19 patients at RIK 1 RSUD Dr. Soetomo Surabaya. Methods: This study is a descriptive study of secondary data on aerobic culture of ETT aspirate specimens of COVID-19 patients treated at RIK 1 RSUD Dr. Soetomo Surabaya for the period March 2020-December 2020. Results: Collected as many as 107 data from bacterial culture and sensitivity test to antibiotics. Gram negative bacteria were the most common microorganisms, namely 71 (59.6%), while Gram positive bacteria were 32 (26.9%). Acinetobacter baumannii was the most common Gram negative bacteria, namely 27 (22.7%). Then 12 (10.1%) Klebsiella pneumoniae ESBL and 11 (9.2%) Klebsiella pneumoniae. From the group of Gram positive bacteria the most were Streptococcus viridans 8 (6.7%), Corynebacterium striatum and Staphylococcus aureus each with 3 (2.5%). MRSA bacteria were found as many as 2 (1.7%). The antibiotic that has the highest sensitivity to Acinetobacter baumannii, Klebsiella pneumoniae and Klebsiella pneumoniae ESBL is Amikacin. While the 2nd, MRSA found were still sensitive to Linezolid, Rifampicin, Quinupristin dalfopristin, Tetracyclin, Teicoplanin and Vancomycin. Conclusion: Acinetobacter baumannii was the most common microorganism isolated from ETT aspirate specimens in RIK 1 COVID-19 patients at Dr. Soetomo Surabaya and has the highest sensitivity to Amikacin antibiotics.

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.

SARS-CoV-2 Rapid Antigen Detection in Respiratory and Nonrespiratory Specimens in COVID-19 Patients.

Rapid antigen testing for coronavirus disease 2019 (COVID-19) available at present provides immediate results at low cost with less expertise and without any need of sophisticated infrastructure. Most of these test kits available are for nasopharyngeal samples. This is a novel study to detect the presence of COVID antigen in samples other than throat and oropharyngeal. Various samples received from patients admitted in the COVID-19 dedicated center were tested for the presence of antigen. Same procedure was followed as done for the nasopharyngeal sample. A total of 150 samples were tested, which included ascitic fluid, pleural fluid, drain fluid, bile, bronchoalveolar lavage, cerebrospinal fluid, endotracheal tube aspirate, sputum, tissue, and urine. Out of 150, 11 (7.33%) were positive and 138 (92.66%) were negative for the antigen test. The COVID-19 antigen test kit, though designed for nasopharyngeal samples, was able to detect the presence of antigen in other clinical samples.

Sulbactam and Colistin Susceptibility Pattern Among Multidrug-Resistant Acinetobacter Isolates From Respiratory Samples

BackgroundAcinetobacter species are known to be important hospital-acquired pathogens. Unfortunately, multidrug-resistant Acinetobacter spp. has very limited options for an effective treatment.AimTo identify the common pathogens causing lower respiratory tract infections (LRTI), their antimicrobial susceptibility pattern, and determine the minimum inhibitory concentration (MIC) of sulbactam and colistin for Acinetobacter spp.Materials and methodsA prospective study was done for a period of six months in a tertiary care hospital in Eastern India. The organisms causing LRTI were identified by conventional biochemical techniques and VITEK 2 Compact System (bioMérieux Inc., France). Antimicrobial susceptibility testing was performed using the Kirby‑Bauer disc diffusion method. MIC was also measured for Acinetobacter spp. to confirm certain antimicrobial agents using E-strips and micro broth dilution techniques.ResultsA total of 542 sputum and endotracheal tube aspirate (ETA) samples were examined during the study period. Among these, 109 samples showed growth of significant colony count of one or two organisms, yielding a sum of 115 isolates. Among these, there were 51 (44.35%) isolates of Klebsiella pneumoniae, 32 (27.83%) isolates of Pseudomonas spp., 30 (26.09%) isolates of Acinetobacter spp., and two (1.74%) isolates of Stenotrophomonas maltophilia. Although they were susceptible to colistin, Acinetobacter spp. was highly resistant to sulbactam.ConclusionAlthough colistin susceptibility was noted, the common pathogens causing LRTI were highly resistant to most drugs. Therefore, the causative organisms of LRTI and their susceptibility pattern should be determined to manage these cases effectively.

Development and validation of ester impregnated pH strips for locating nasogastric feeding tubes in the stomach\u2014a multicentre prospective diagnostic performance study

BackgroundNG (nasogastric) tubes are used worldwide as a means to provide enteral nutrition. Testing the pH of tube aspirates prior to feeding is commonly used to verify tube location before feeding or medication. A pH at or lower than 5.5 was taken as evidence for stomach intubation. However, the existing standard pH strips lack sensitivity, especially in patients receiving feeding and antacids medication. We developed and validated a first-generation ester-impregnated pH strip test to improve the accuracy towards gastric placements in adult population receiving routine NG-tube feeding. The sensitivity was improved by its augmentation with the action of human gastric lipase (HGL), an enzyme specific to the stomach.MethodsWe carried out a multi-centred, prospective, two-gate diagnostic accuracy study on patients who require routine NG-tube feeding in 10 NHS hospitals comparing the sensitivity of the novel pH strip to the standard pH test, using either chest X-rays or, in its absence, clinical observation of the absence of adverse events as the reference standard. We also tested the novel pH strips in lung aspirates from patients undergoing oesophageal cancer surgeries using visual inspection as the reference standard. We simulated health economics using a decision analytic model and carried out adoption studies to understand its route to commercialisation. The primary end point is the sensitivity of novel and standard pH tests at the recommended pH cut-off of 5.5.ResultsA total of 6400 ester-impregnated pH strips were prepared based on an ISO13485 quality management system. A total of 376 gastric samples were collected from adult patients in 10 NHS hospitals who were receiving routine NG-tube feeding. The sensitivities of the standard and novel pH tests were respectively 49.2% (95% CI 44.1‑54.3%) and 70.2% (95% CI 65.6‑74.8%) under pH cut-off of 5.5 and the novel test has a lung specificity of 89.5% (95% CI 79.6%, 99.4%). Our simulation showed that using the novel test can potentially save 132 unnecessary chest X-rays per check per every 1000 eligible patients, or direct savings of £4034 to the NHS.ConclusionsThe novel pH test correctly identified significantly more patients with tubes located inside the stomach compared to the standard pH test used widely by the NHS.Trial registrationhttp://www.isrctn.com/ISRCTN11170249, Registered 21 June 2017—retrospectively registered

Antibiogram Profile of Bacteria Colonizing the Endotracheal Tubes (ETTs) of Patients Admitted to Intensive Care Units (ICUs) in a Tertiary Care Hospital of Nepal

Hospital acquired infection (HAI) in intensive care units (ICU) are responsible for high morbidities and mortalities worldwide due to emergence of resistant bacteria. In developing countries, due to lack of knowledge of proper surveillance, proper resources and proper guidance this burden was somewhat underestimated. Thus, the aim of this study was to look for the spectrum of bacteria colonizing the ETTs and to determine proper empirical antibiotic therapy. We collected endotracheal tube aspirates from 188 patients of admitted in ICU of Manipal Teaching Hospital, Pokhara. All bacteria were identified by conventional techniques. Antimicrobial sensitivity testing was performed on Mueller-Hinton agar plates with commercially available antibiotic discs using Kirby-Bauer disc diffusion techniques and interpreted as per the guidelines of CLSI. The antibiotic discs (conc.) used were: piperacillin/tazobactam (100/10mcg), ciprofloxacin (5mcg), amikacin (30mcg), imipenem (10mcg), gentamicin (10mcg), cefaperazone sulbactum(75/10mcg), for Gram negative bacteria and erythromycin (15mcg), amikacin (30mcg), gentamicin (10mcg), ciprofloxacin (5mcg), and clindamycin (2mcg) for Gram positive bacteria. A total of 188 ETTs investigated, 128(68.08%) yielded positive culture. Single type of organisms was found in 119 (63.29%) and 9 (4.7%) cases yielded mixed type of growth. Acinetobacter spp. were the most predominant organism among all gram-negative organisms, which was found to be in 71 (51.82%) cases, followed by Klebsiella pneumoniae in 27 (19.7%), Pseudomonas aeruginosa in 23 (16.78%), Escherichia coli in 5 (3.64%), Enterobacter in 2 (1.46%). Whereas, Staphylococcus aureus (4.37%) was the commonest among all gram-positive organism followed by coagulase negative Staphylococcus in 2 (1.46%) and Enterococcus in 1 (0.73%). Most of Acinetobacter spp. showed resistance to ciprofloxacin (84.5%), while 74.6% were resistant to amikacin, 73.2% to gentamicin, 71.83% to piperacillin-tazobactam and 42.2% towards imipenem. Out of the 6 strains of S. aureus, 5 (83.3%) were methicillin resistant. Due to the increasing incidence of organisms in ICUs, an early and correct diagnosis of ETT associated infections is a challenge for optimal antibiotic therapy. Therefore, the best approach to manage the respiratory infections following ETT application will be appropriate use of antibiotics with adaptation of proper infection control measures, which could help to prevent further spread of infection.

Quantitative correlation of colony forming units of Acinetobacter baumannii obtained from endotracheal tube aspirate culture with clinical pulmonary infection score.

Background and Aims:Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection in adult critical care units. The reason behind the different levels of severity and the outcome in different individuals is not established yet.Co-morbidities and age may be a valid reason.In an attempt to find out the reason behind the different levels of severity of VAP in different individuals, we conducted a studywith the primary objective being to assess the quantitative correlation between the colony forming units (CFU) of Acinetobacter baumannii in the endotracheal tube aspirate and the Clinical Pulmonary Infection Score (CPIS) in mechanically ventilated patients without co-morbidities. The secondary objective was to see whether the severity of VAP depends on the number of CFU(>105/ml).Methods:This observational study was conducted in a 27-bedded intensive care unit of a tertiary care hospital in northern India. Endotracheal tube aspirate was collected from patients with suspected VAP.A total of 81 patients without any prior co-morbidity and having Acinetobacter baumannii in their endotracheal tube aspirate were included in the study group. Quantification of Acinetobacter baumannii was done by counting CFU.The CPIS was calculated for all Acinetobacter baumannii positive patients. Correlation between CFU of Acinetobacter baumannii and CPIS was assessed using Spearman's Rho correlation coefficient.Results:Among 81 patients having Acinetobacter baumannii infection, only 61.9% had a CPIS >4. There was an insignificant correlation between the quantity of CFUs of Acinetobacter baumannii and CPIS (P value = 0.784).Conclusion:Number of CFU >105/ml in an endotracheal tube aspirate culture bears no relation to the severity of VAP as predicted by the CPIS.

A Microbiological Study of Acinetobacter calcoaceticus baumannii with Special Reference to Multidrug Resistance.

Introduction The outbreak of Acinetobacter calcoaceticus baumannii ( ACB ) is mainly reported to be a notorious pathogens at health-care settings. It is the major problem on the health-care system with high morbidity and mortality rates because of the broad range of antibiotic resistance and lack of understanding the mechanism of developing new antibiotic resistance rapidly. It emphasizes the importance of local surveillance in describing or understanding and predicting microbial resistance patterns so that there will be limited use of antibiotics by developing strategies to control the extensive use of antimicrobial chemotherapy in clinical environment, which is still considered as one of the factors in the emergence of multidrug resistance microorganisms. Objectives The study aims to detect the occurrence rate of ACB infections from various clinical samples, identify the resistance levels to different groups of antimicrobial agents, and the occurrence rate of multidrug resistant (MDR) ACB clinical isolates from a tertiary hospital in Durgapur, West Bengal, India. Material and Methods The study was performed in the Department of Microbiology of the IQ City Medical College and Hospital, Durgapur, West Bengal, India, for the 24 months duration, that is, from January 1, 2018 to December 31, 2019. Altogether 15,800 clinical samples consisting of endotracheal tube aspirates, sputum, pus, blood, catheter tips, urine, tissue, and other body fluids were studied. ACB from clinical samples were identified by its characteristic colonies (nonlactose fermenting, glistening, small mucoid colonies), Gram-staining pattern (Gram-negative coccobacillus), and standard biochemical reactions. It was further confirmed in the Department of Microbiology of the Healthworld Hospital, Durgapur, West Bengal, India, by Vitek2 compact system (bioMerieux, Inc., Durham, North Carolina, United States). Antibiotic susceptibility testing was performed using automated broth microdilutions by Vitek2 compact system (bioMerieux, Inc.) and Kirby-Bauer disk diffusion test on Mueller-Hinton Agar (HiMedia). Results Nonrepetitive 289 ACB were isolated from various clinical samples. A total of 277 (96%) isolates of ACB were MDR strains. Conclusion ACB was mostly isolated from the intensive care unit department and was found to be the most MDR type in the tertiary care hospital by this study.