IJCRR - Vol 06 Issue 10, May, 2014
DYNAMIC BACTERIAL PROFILE OF ENDOTRACHEAL ASPIRATES AND ITS SENSITIVITY PATTERN -A CAUSE OF CONCERN
Author: N. Shanmuga Vadivoo, Priya Santharam, K. Sudha, G. Kalaiselvi, B.K. Padmavathi, B. Usha, Amar Kumar, Nitesh Kumar Jaiswal
Aim: To analyse the changing spectrum of aerobic bacteria isolated from endotracheal secretions of Mechanically ventilated patients andto evaluate the antibiotic sensitivity pattern & Multi drug resistance of those isolates Materials and Methods: Endotracheal secretions received during the study period from Oct 2010 to Dec 2012 were processed & all the pathogenic isolates were identified as per the standard guideline. Antibiotic sensitivity was performed for the identified pathogens according to CLSI standards. Clinical condition of the ventilated & tracheotomised patients were recorded. Results: A total of 95 Endotracheal isolates were processed and 73 % of the aspirates were showing growth. The incidence of VAP was 33.3% and most frequently isolated pathogens were Klebsiella spp(36%), Pseudomonas(17%) &Acinetobacter spp(18%).Multidrug resistance was observed in 53% of Klebsiella spp, 26% in Pseudomonas and 56% in Acinetobacter spp.Most of the patients (33%)were ventilated for Trauma and hence most of the patients had prolonged hospital stay –average time being 25 days. Conclusion: In this study we observed that there was a gradual shift in the isolated aerobic bacterial profile. Initially in 2011 the frequent pathogen was Klebsiella spp(41%) &Pseudomonas spp(18%) when Acinetobacter was 10% . In 2012 Acinetobacter was found to be the most prevalent pathogen (30%) and klebsiella spp prevalence reduced to 28%. Multidrug resistant was also observed among the isolated pathogens. Prolonged hospital stay for trauma has resulted in multidrug resistance and change in bacterial profile. Empirical antibiotic therapy was recommended based on the antibiogram of the most prevalent pathogen in ICU.
Keywords: Dynamic, Bacterial profile, Endotracheal aspirates
N. Shanmuga Vadivoo, Priya Santharam, K. Sudha, G. Kalaiselvi, B.K. Padmavathi, B. Usha, Amar Kumar, Nitesh Kumar Jaiswal. DYNAMIC BACTERIAL PROFILE OF ENDOTRACHEAL ASPIRATES AND ITS SENSITIVITY PATTERN -A CAUSE OF CONCERN International Journal of Current Research and Review. Vol 06 Issue 10, May, 112-119
1. Victor D. Rosenthal et al.Device-Associated Nosocomial Infections in 55 Intensive Care Units of 8 Developing Countries.Ann Intern Med. 2006; 145(8):582-591.
2. A. Mehta a, V.D. Rosenthal et al.Deviceassociated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the International Nosocomial Infection Control Consortium (INICC). Journal of Hospital Infection (2007) 67, 168- 174.
3. SS Kanj, ZA Kanafani, N Sidani, L Alamuddin, N Zahreddine, and VD Rosenthal. International Nosocomial Infection Control Consortium Findings of DeviceAssociated Infections Rate in an Intensive Care Unit of a Lebanese University Hospital. J Glob Infect Dis. 2012 Jan-Mar; 4(1): 15–21.
4. SALOMAO, Reinaldo et al. Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev PanamSaludPublica [online]. 2008, vol.24, n.3, pp. 195-202.
5. http://www.who.int/csr/resources/publications/ drugresist/en/whocdscsreph200212.pdf 6. Mukhopadhyay C, Bhargava A, Ayyagari A. Role of mechanical ventilation and development of multidrug resistant organisms in hospital acquired pneumonia. Indian J Med Res 2003; 118:229-35.
7. Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia: role of colonizers and value of routine endotracheal aspirate cultures.Int J Infect Dis. 2010; 14(8):e723-9.
8. T.J.J.InglisE,W.Lim G,,.H.Lee,Cheong NG. Endogenous source of bacteria in tracheal tube and proximal ventilator breathing system in intensive care patients.British journal of Anaesthesia 1998; 80:41-45.
9. Fagon JY, Chastre J, Hance AJ, Montravers P, Novara.A, Gibert C. Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993; 94:281–8. [Pub Med: 8452152]
10. Niederman MS, Ferranti RD, Zeigler A and Reynolds HY () Respiratory infection complicating long-term tracheostomy. The implication of persistent gramnegative tracheobronchial colonization. Chest 1984; 85(1): 39-44
11. Donald E. Craven and Karin I. Hjalmarson. Ventilator-Associated Tracheobronchitis and Pneumonia: Thinking Outside the Box. Clinical Infectious Diseases 2010; 51(S1):S59–S66. 12. MS Tullu, CT Deshmukh, SM Baveja .acterial profile and antimicrobial susceptibility pattern in catheter related nosocomial infections..JPGM, 1998: 44 : 1 : 7-13.
13. ArindamDey , Indira Bairy.Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: A nine months' prospective study. AnnThorac Med. 2007 Apr-Jun; 2 (2): 52–57.
14. Ramakrishna PaiJakribettu and RekhaBoloor.Characterisation of aerobic bacteria isolated from endotracheal aspirate in adult patients suspected ventilator associated pneumonia in a tertiary care center in Mangalore.Saudi J Anaesth. 2012 Apr-Jun; 6(2): 115–119.
15. Gotsman MS and Whitby JL .Respiratory infection following tracheostomy. Thorax 1964; 19:89-96
16. S Kaul, KN Brahmadathan, M Jagannati, TD Sudarsanam, K Pitchamuthu, OC Abraham.One year trends in the gramnegative bacterial antibiotic susceptibility patterns in a medical intensive care unit in South India.. Indian Journal of Medical Microbiology, (2007) 25 (3):230-5.
17. JoãoManoel da Silva Júnior, EderlonRezendeetal .Epidemiological and Microbiological Analysis of VentilatorAssociated Pneumonia Patients in a Public Teaching Hospital. BJID2007; 11(5):482-488.
18. PratirodhKoirala, Dwij Raj Bhatta, PrakashGhimire, Bharat Mani Pokhrel, UpendraDevkota.Bacteriological Profile of Tracheal Aspirates of the Patients Attending a Neuro-hospital of Nepal. Int J Life Sci 4:60- 65.
19. SantoshKhanal,Dev Raj Joshi, Dwij Raj Bhatta, UpendraDevkota,and Bharat Mani Pokhrel. β-Lactamase-Producing MultidrugResistant Bacterial Pathogens from Tracheal Aspirates of Intensive Care Unit Patients at National Institute of Neurological and Allied Sciences, Nepal. ISRN Microbiology.Volume 2013. Article ID 847569, 5 pages.
20. Shalini s, Kranthi k, Gopalkrishnabhat k. The Microbiological Profile of Nosocomial Infections in the Intensive Care Unit. Journal of Clinical and Diagnostic Research. 2010 October ;(4):3109-3112.
21. YaseenArabi a, Nehad Al-Shirawi a, ZiadMemish b, Antonio Anzueto. Ventilatorassociated pneumonia in adults in developing countries: a systematic review. International Journal of Infectious Diseases (2008) 12, 505—512.
22. Werarak P, Kiratisin P, Thamlikitkul V. Hospital-acquired pneumonia and ventilatorassociated pneumonia in adults at SirirajHospital: etiology, clinical outcomes, and impact of antimicrobial resistance. Med Assoc Thai. 2010 Jan; 93 Suppl 1:S126-38.
23. Maryam Amini , Ahmad Javanmard, Ali Davati ,GhasemAzimi . Bacterial Colonization in Tracheal Tubes of ICU Patients. Iranian journal of pathology. 2009; 4: (3).123-127.