Indian Journal of Medical Microbiology, (2015) 33(2): 286-289
1
Brief Communication
Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre‑antibiotic era! S Qureshi, *C Agrawal, M Madan, A Pandey, H Chauhan
Abstract The rise in super bugs causing Ventilator‑Associated Pneumonia (VAP) is a major cause of mortality and morbidity despite recent advances in management owing to the looming ‘antibiotic apocalypse’. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU) and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV) for ≥48 hrs. Endotracheal aspirates (ETA) from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP), while Nonfermenting Gram negative bacilli (NFGNB) were significantly associated with late onset VAP (LOVAP). Most of the isolates were multi drug resistant (MDR) super bugs. With limited treatment options left for this crisis situation like the pre‑antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs. Key words: Endotracheal aspirate, non fermenting gram negative bacilli, superbugs, ventilator associated pneumonia
Introduction Ventilator associated pneumonia (VAP) is an infection that occurs in approximately 9-27% of intensive care unit (ICU) patients more than 48 hrs after endotracheal intubation and mechanical ventilation (MV).[1,2] The lower respiratory tract sample collected by invasive or non‑invasive techniques provide an insight into the aetiology.[1,3] As per the American Thoracic Society (ATS) consensus statement, semi quantitative cultures can be performed on Endotracheal aspirates (ETA) for establishing a definitive diagnosis. The frequency of specific multi‑drug resistant (MDR) pathogens causing VAP vary by hospital, patient population, exposure to antibiotics, type of ICU patient and changes over time, emphasizing the need for timely local surveillance data. In view of this rising importance of VAP *Corresponding author (email: ) Department of Microbiology (SQ, CA, MM, AP), Department of Anaesthesiology (HC), Subharti Medical College, Delhi‑Haridwar Bypass, Meerut ‑ 250 005, Uttar Pradesh, India. Received: 06-01-2014 Accepted: 25-09-2014 Access this article online Quick Response Code:
Website: www.ijmm.org
DOI: 10.4103/0255-0857.153566
in ICUs, the present study was conducted to establish the diagnosis, by identifying the causative organisms of VAP and to assess their antimicrobial susceptibility pattern. Materials and Methods A prospective study was conducted over a period of one year from January 2012 to December 2012 in the Department of Microbiology. The study group comprised of patients on MV admitted in medicine and surgical ICUs. All patients above the age of 18 years of either gender on MV for >48 hrs were included in the study. However any patient on MV for 6 as developed by Pugin et al.[4] Endotracheal aspirate was collected prior to start or change of antibiotic therapy and on suspicion of VAP thereafter.Collection was done as per the method described by Dey et al.[5] An acceptable ETA had
1
Brief Communication
Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre‑antibiotic era! S Qureshi, *C Agrawal, M Madan, A Pandey, H Chauhan
Abstract The rise in super bugs causing Ventilator‑Associated Pneumonia (VAP) is a major cause of mortality and morbidity despite recent advances in management owing to the looming ‘antibiotic apocalypse’. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU) and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV) for ≥48 hrs. Endotracheal aspirates (ETA) from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP), while Nonfermenting Gram negative bacilli (NFGNB) were significantly associated with late onset VAP (LOVAP). Most of the isolates were multi drug resistant (MDR) super bugs. With limited treatment options left for this crisis situation like the pre‑antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs. Key words: Endotracheal aspirate, non fermenting gram negative bacilli, superbugs, ventilator associated pneumonia
Introduction Ventilator associated pneumonia (VAP) is an infection that occurs in approximately 9-27% of intensive care unit (ICU) patients more than 48 hrs after endotracheal intubation and mechanical ventilation (MV).[1,2] The lower respiratory tract sample collected by invasive or non‑invasive techniques provide an insight into the aetiology.[1,3] As per the American Thoracic Society (ATS) consensus statement, semi quantitative cultures can be performed on Endotracheal aspirates (ETA) for establishing a definitive diagnosis. The frequency of specific multi‑drug resistant (MDR) pathogens causing VAP vary by hospital, patient population, exposure to antibiotics, type of ICU patient and changes over time, emphasizing the need for timely local surveillance data. In view of this rising importance of VAP *Corresponding author (email: ) Department of Microbiology (SQ, CA, MM, AP), Department of Anaesthesiology (HC), Subharti Medical College, Delhi‑Haridwar Bypass, Meerut ‑ 250 005, Uttar Pradesh, India. Received: 06-01-2014 Accepted: 25-09-2014 Access this article online Quick Response Code:
Website: www.ijmm.org
DOI: 10.4103/0255-0857.153566
in ICUs, the present study was conducted to establish the diagnosis, by identifying the causative organisms of VAP and to assess their antimicrobial susceptibility pattern. Materials and Methods A prospective study was conducted over a period of one year from January 2012 to December 2012 in the Department of Microbiology. The study group comprised of patients on MV admitted in medicine and surgical ICUs. All patients above the age of 18 years of either gender on MV for >48 hrs were included in the study. However any patient on MV for 6 as developed by Pugin et al.[4] Endotracheal aspirate was collected prior to start or change of antibiotic therapy and on suspicion of VAP thereafter.Collection was done as per the method described by Dey et al.[5] An acceptable ETA had
