Multi-drug resistant Acinetobacter species from various clinical samples in a tertiary care hospital from South India

Background

Acinetobacter species are gram-negative coccobacilli belonging to the group of Non-Fermenting Gram-Negative Bacilli, which are ubiquitous in nature. They cause outbreaks in intensive care units and healthcare settings, and are becoming increasingly drug resistant.

Aims

To determine the prevalence of multi-drug resistant Acinetobacter species from various clinical samples.

Method

Clinical samples were processed as per standard microbiological techniques. Antibiotic susceptibility testing was carried out on all the Acinetobacter isolates by Kirby- Bauer disc diffusion method as per CLSI guidelines.

Results

A total of 122 Acinetobacter spp. were isolated. 110 (90.16 per cent) were from inpatients, and 12 (9.83 per cent) were from outpatients. Out of 122 isolates, 44 (36.06 per cent) were from the ICU. The majority of the isolates, 47 (38.52 per cent), were from pus samples followed by 25 (20.49 per cent) from endotracheal tube aspirate. Out of 122 isolates, 87 (71.31 per cent) were multi-drug resistant of which 15 (12.29 per cent) were resistant to all drugs tested.

Conclusion

Acinetobacter infections associated with multi-drug resistant and pan-resistant strains have emerged as important nosocomial pathogens in our setting.     

Spectrum of bacteria associated with diabetic foot ulcer and biofilm formation: A prospective study

Background

India has the world’s largest number of diabetics. Non-traumatic lower limb amputation is the most common devastating complication of diabetes, primarily due to diabetic foot ulcers (DFU) and diabetic foot infections (DFI). In India, the incidence of foot ulcers ranges from 8–17 per cent. DFIs are predominantly polymicrobial and multidrug-resistant (MDR) with the ability to form biofilm, which is an important virulence factor and results in treatment failure.

Aims

The main objectives of the study are to identify the spectrum of multidrug-resistant bacteria associated with these infections, their antibiotic sensitivity pattern, and to detect the biofilm formation.

Methods

This was a prospective study at a tertiary care hospital. One hundred patients over the age of 18, having chronic diabetic foot ulcer, and attending the surgery outpatient department were included. Samples of pus were collected from deep wounds and processed using standard techniques for culture and sensitivity. Biofilm detection was done. Results were compiled and statistically analysed.

Results

One hundred samples were processed and 82 yielded positive cultures. Staphylococcus aureus was the predominant organism, followed by Pseudomonas aeruginosa. Biofilm formation was seen in 38 (46.34 per cent) of the organisms. Biofilms were formed predominantly by Staphylococcus aureus (20 per cent).

Conclusion

The organisms causing chronic diabetic foot ulcers were commonly multidrug-resistant; this was also observed among biofilm formers. Therefore, screening for biofilm formation, along with the usual antibiogram, needs to be performed as a routine procedure in chronic diabetic ulcers to formulate effective treatment strategies for these patients.     

Risk factors and drug-resistance patterns among pulmonary tuberculosis patients in northern Karnataka region,India

Background:

India is one of the high tuberculosis (TB)-burden countries in the world. Resistance to anti-tuberculosis (anti-TB) drugs has already become an important and alarming threat in most of the regions worldwide. India ranks second in the world in harbouring multi-drug resistant cases (MDRTB). Prevalence of MDR-TB mirrors the functional state and efficacy of TB control programmes and realistic attitude of the community towards implementation of such programmes. The most important risk factor in the development of MDRTB is improper implementation in the guidelines in the management of TB, and high rate of defaults on the part of the patients. The study was carried out to evaluate the drug resistance pattern to first line anti-TB drugs in Northern Karnataka region, India.

Materials and Methods:

A prospective study was conducted at J. N. Medical College and its associated Hospitals, Belgaum. Between January 2011 and December 2012, 150 sputum samples of suspected pulmonary TB patients based on the history were examined for the AFB culture by Lowenstein-Jensen (LJ) culture technique. A total of two early morning samples were collected for the smear [Ziehl-Neelsen (ZN) staining] and culture methods. It was observed that ZN staining for AFB was positive in 113 patients (75%), while AFB culture by LJ medium yielded growth in 66 cases (44%). Thus, a total of 66 AFB culture-positive samples by LJ medium were subjected for AFB drug-sensitivity testing (DST). DST was done for Isoniazid (INH), Rifampicin (RIF), Pyrazinamide (PZA), Ethambutol (EMB) and Streptomycin (SM) after isolation by using the resistance proportion method.

Results:

A total of 66 AFB culture-positive specimens, 20 (30.3%) cases were sensitive to all the five drugs while 46 (69.7%) cases showed resistance to one or more drugs. Among these, the resistance to rifampicin was highest (80.4%), while resistance to isoniazid, pyrazinamide, ethambutol and streptomycin were observed to be 60%, 58.7%, 52.1% and 63%, respectively. It was also observed that, resistance to all five drugs was highest (39.18%). MDR isolates were obtained in 52.2% of the cases. Illiteracy, low socio-economic status, previous history of TB and alcoholism were found to have statistically significant association for the development of MDR.

Conclusions:

The prevalence of drug resistance in the present study was observed to be 69.7%. More than half of the cases were multi-drug resistant. The most common resistant pattern observed in this study was resistance to all the first-line drugs. Therefore, during initiation of new case proper explaining and completion of the treatment is very important to avoid the development of future drug resistance in the society.     

A study of acute otitis externa at Wellington Hospital, 2007–2011

Background

Acute otitis externa (AOE) is a common inflammatory condition affecting the external ear that occasionally presents with persistent, severe pain, which may be unresponsive to first-line therapy and require assessment and treatment in the hospital setting.

Aims

To identify the microorganisms responsible for cases of otitis externa presenting to Wellington Hospital, New Zealand, over a five-year period between 2007 and 2011. We also aim to evaluate current management of this condition and to recommend future treatment options.

Method

A five-year retrospective study, with data obtained from case notes and electronic records for all patients presenting with otitis externa to Wellington Hospital between 2007 and 2011.

Results

Of 347 cases identified, 144 were included in the study. Pseudomonas aeruginosa (P. aeruginosa) was the most common organism (46.5 per cent), while Staphylococcus aureus (S. aureus) was the second most common (31.9 per cent). Most patients received appropriate topical treatment. However, a significant number were treated with systemic antibiotics alone without adverse outcomes.

Conclusion

Pseudomonas aeruginosa is the most common microbe causing acute otitis externa in patients that require hospital level management in Wellington, New Zealand. In most cases, patients received appropriate topical therapy; however, it appears a large number received systemic antibiotic therapy without topical treatment. We recommend broad-spectrum topical antimicrobial therapy in all patients with uncomplicated AOE and culture-sensitive topical treatment with consideration of systemic antimicrobials for severe AOE requiring hospital admission.     

Detection of metallo-beta-lactamase producing Pseudomonas aeruginosa in intensive care units

Background

Metallo-beta-lactamase (MBL) producing Pseudomonas aeruginosa has emerged as a threat to hospital infection control, due to its multi-drug resistance, especially in intensive care units (ICUs).

Aims

This study was carried out to detect MBL producing P. aeruginosa isolates from medical and surgical ICUs, to compare and evaluate different phenotypic methods currently in use and to determine antibiograms.

Method

A prospective study was undertaken to detect MBLs in P. aeruginosa isolates obtained from various clinical samples. A total of 49 strains were recovered from patients admitted in inpatient wards and ICUs, and screened for imipenem resistance by Kirby Bauer disk diffusion method. Detection of MBLs was further done by imipenem-EDTA disk synergy test and combined disk test.

Results

Out of 49 isolates, 11 isolates (22.4 per cent) were imipenem resistant. All 11 imipenem resistant P. aeruginosa strains, when further tested, were positive for MBL production by combined disk test, but, only eight showed positive results by imipenem-EDTA disk synergy test.

Conclusion

MBL production was the main resistance mechanism in the 11 carbapenem resistant P. aeruginosa isolates collected, with multidrug resistance associating significantly with MBL production in P. aeruginosa from our institution.     

Antibacterial effect of Allium sativum cloves and Zingiber officinale rhizomes against multiple-drug resistant clinical pathogens

Objective

To evaluate the antibacterial properties of Allium sativum (garlic) cloves and Zingiber officinale (ginger) rhizomes against multi-drug resistant clinical pathogens causing nosocomial infection.

Methods

The cloves of garlic and rhizomes of ginger were extracted with 95% (v/v) ethanol. The ethanolic extracts were subjected to antibacterial sensitivity test against clinical pathogens.

Results

Anti-bacterial potentials of the extracts of two crude garlic cloves and ginger rhizomes were tested against five gram negative and two gram positive multi-drug resistant bacteria isolates. All the bacterial isolates were susceptible to crude extracts of both plants extracts. Except Enterobacter sp. and Klebsiella sp., all other isolates were susceptible when subjected to ethanolic extracts of garlic and ginger. The highest inhibition zone was observed with garlic (19.45 mm) against Pseudomonas aeruginosa (P. aeruginosa). The minimal inhibitory concentration was as low as 67.00 µg/mL against P. aeruginosa.

Conclusions

Natural spices of garlic and ginger possess effective anti-bacterial activity against multi-drug clinical pathogens and can be used for prevention of drug resistant microbial diseases and further evaluation is necessary.     

芦荟药理研究进展

分别从芦荟的生物活性与有效成分研究、外用功能的药理研究、作用机制研究、毒副作用和安全性研究5个方面进行了综述,并对芦荟外用功能研究进行了评述。芦荟具有很大的药用价值,尤其是外用治疗应用广泛,近年来芦荟产品的开发研究倍受青睐,应用范围日趋扩大,成为全世界关注的药食多用植物。     

Antiobiotic resistance pattern of biofilm-forming uropathogens isolated from catheterised patients in Pondicherry,India

Background

Microbial biofilms pose a public health problem for persons requiring indwelling medical devices, as micro-organisms in biofilms are difficult to treat with antimicrobial agents. Thus the present study includes biofilm formation and antibiotic resistance pattern of uropathogens in hospitalised patients with catheter associated urinary tract infections (UTI).

Method

This prospective analysis included 100 urine samples from catheterised patients with symptoms of UTI over a period of six months. Following identification, all isolates were subjected to antibiotic sensitivity using modified Kirby- Bauer disc diffusion method. Detection of biofilms was done by tube adherence method and Congo red agar method.

Results

E.coli was found to be the most frequently isolated uropathogen 70%, followed by Klebsiella pneumoniae 16%, Pseudomonas aeruginosa 4%, Acinetobacter spp 2%, coagulase negative Staphylococci 6% and Enterococci Spp 2%. In the current study 60% of strains were in vitro positive for biofilm production. Biofilm positive isolates showed 93.3%, 83.3%, 73.3% and 80% resistance to nalidixic acid, ampicillin, cephotaxime and cotrimoxazole, respectively, compared to 70%, 60%, 35%, 60% resistance showed by biofilm non-producers for the respective antibiotics. Approximately 80% of the biofilm producing strains showed multidrug resistant phenotype

Conclusion

To conclude E.coli was the most frequent isolate, of which 63% were biofilm producers. The antibiotic susceptibility pattern in the present study showed quinolones were the least active drug against uropathogens. The uropathogens showed the highest sensitivity to carbapenems. The next best alternatives were aminoglycosides. Significant correlation between biofilm production and multi-drug resistance was observed in our study.     

芦荟药理研究进展

分别从芦荟的生物活性与有效成分研究、外用功能的药理研究、作用机制研究、毒副作用和安全性研究5个方面进行了综述,并对芦荟外用功能研究进行了评述。芦荟具有很大的药用价值,尤其是外用治疗应用广泛,近年来芦荟产品的开发研究倍受青睐,应用范围日趋扩大,成为全世界关注的药食多用植物。     

Comparative evaluation of botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in treatment of palmar hyperhidrosis

Background

Hyperhidrosis is generalised or focal excessive sweating and carries a substantial psychological and social burden. This study compares botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in palmar hyperhidrosis.

Methods

The study included 60 cases of palmar hyperhidrosis randomly allocated to 2 groups. One group was given botulinum toxin type A 100 units per palm and the other group subjected to digital iontophoresis with topical application of aluminium chloride hexahydrate lotion for 4 weeks. They were assessed 4 weeks later and those without improvement were crossed over to the other arm for another 4 weeks. Those with improvement were followed up in the same arm for 6 months.

Results

Botulinum therapy showed significant improvement in the initial (80%) as well as cross over cases (75%) as compared to iontophoresis and aluminium chloride (47%) for initial cases and (17%) for cross over cases.

Conclusion

Better improvements were seen with botulinum therapy than with iontophoresis and topical therapy. Residual effects of relief lasted on an average for 4 months for botulinum toxin whereas it was one month with iontophoresis and topical therapy. Advantage with iontophoresis and topical therapy was that it was non invasive and did not require regional anaesthesia as with botulinum therapy.     

Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis

Background:

Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system.

Aim:

To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications.

Study Design:

Prospective non-randomized comparative study.

Materials and Methods:

Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ² test.

Results:

Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant (P = 0.609).

Conclusion:

Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.     

Antimicrobial susceptibility patterns of Streptococcus pneumoniae over 6 years at Gondar University Hospital,Northwest Ethiopia

Objective

To assess the magnitude and antimicrobial susceptibility patterns of Streptococcus pneumoniae isolates from various clinical specimens.

Methods

A record based on retrospective study was conducted at Gondar University Teaching Hospital from September 2007 to January 2012. All patients who visited Gondar University Hospital and provided clinical specimens (body fluids, discharge, swab and blood) for routine bacteriological culturing and antimicrobial susceptibility testing were taken for analysis. Clinical specimens were processed for bacterial culture according to the standard procedures. Antimicrobial susceptibility test for isolated organisms was done using agar disk diffusion method. The data were entered and analyzed using SPSS software version 16 package.

Results

One hundred and fifty three Streptococcus pneumoniae were isolated from patients who visited Gondar University Teaching Hospital bacteriology laboratory for culture. Majority of the pneumococcal isolates were from inpatients [111(72.5%)], and 74(48.4%) were from body fluids. Out of the total isolates, 93(61%) were found to be resistant to at least one antibiotic used for susceptibility testing. Forty eight (43.2%) of the isolates were multi-drug resistant (resistant to two or more drugs). The resistance rate noted for both ciprofloxacin 17(11.1%) and ceftriaxone 15(9.8%) were alarming.

Conclusions

High proportions of the isolates tend to be increasingly resistant to the commonly prescribed drugs. The recommended drug of choice like ciprofloxacin and ceftriaxone were found to be less susceptible in the study area. Based on the findings, we therefore recommend that antimicrobial agents should be inspected for acceptable activity before they are prescribed and administered empirically. Further study with a better design and survey of antimicrobial susceptibility at large scale shoule be performed to draw advanced information.     

The Little India riot: experience of an emergency department in Singapore

INTRODUCTION

Singapore experienced its second riot in 40 years on 8 December 2013, in the area known as Little India. A retrospective review of 36 casualties treated at the emergency department was conducted to evaluate injury patterns.

METHODS

Characteristics including the rate of arrival, injury severity, type and location, and disposition of the casualties were analysed.

RESULTS

The injuries were predominantly mild (97.2%), with the most common injuries involving the head (50.0%) and limbs (38.9%). 97.2% of the casualties were managed as outpatient cases.

CONCLUSION

The majority of the injuries in this incident were mild and could be managed as outpatient cases. Important lessons were learnt from the incident about the utilisation of manpower and safety of staff in the emergency department.     

Febrile seizures in Kaduna,north western Nigeria

Background:

Febrile seizure is the most common seizure of childhood and has a good prognosis. However its presentation is fraught with poor management, with grave consequences, in our environment. Thus a review of its current status is important.

Objective:

To review the status of febrile seizures in Kaduna metropolis.

Materials and Methods:

A review of cases seen in the Department of Paediatrics, 44 Nigeria Army Reference Hospital, Kaduna between June 2008 and June 2010.

Results:

Out of the 635 cases admitted in the department 17 (2.7%) fulfilled the criteria for febrile seizures. There were 11 Males and 6 Females (M: F, 1.8:1). Age range was from 9 months to 5 years with a mean of 2.2 years ± 1.1 and peak age of 3 years. Twelve (70.6%) were in the upper social classes (I-III). Fever, convulsion, catarrh and cough were major presenting symptoms. Incidence of convulsion was least on the 1st day of complaint. Fourteen (82.4%) of the cases were simple febrile seizures while 3 were complex. There was a positive family history in 5 (29.4%) of the cases. Eleven (64.7%) had orthodox medication at home, before presentation, 5 (29.4%) consulted patient medicine sellers and 7 (41.7%) received traditional medication as part of home management. Malaria and acute respiratory infections were the identifiable causes. Standard anti-malaria and anti-biotic therapy were instituted, where indicated. All recovered and were discharged.

Conclusion:

There was a low prevalence of febrile seizures among the hospitalized children and a poor pre-hospitalization management of cases. It highlighted the need for improved community awareness on the prevention and management of febrile seizures.     

Ventilator-associated pneumonia

Background

Ventilator-associated pneumonia (VAP) is a type of nosocomial pneumonia that occurs in patients who receive mechanical ventilation (MV). According to the International Nosocomial Infection Control Consortium (INICC), the overall rate of VAP is 13.6 per 1,000 ventilator days. The incidence varies according to the patient group and hospital setting. The incidence of VAP ranges from 13–51 per 1,000 ventilation days. Early diagnosis of VAP with appropriate antibiotic therapy can reduce the emergence of resistant organisms.

Method

The aim of this review was to provide an overview of the incidence, risk factors, aetiology, pathogenesis, treatment, and prevention of VAP. A literature search for VAP was done through the PUBMED/MEDLINE database. This review outlines VAP’s risk factors, diagnostic methods, associated organisms, and treatment modalities.

Conclusion

VAP is a common nosocomial infection associated with ventilated patients. The mortality associated with VAP is high. The organisms associated with VAP and their resistance pattern varies depending on the patient group and hospital setting. The diagnostic methods available for VAP are not universal; however, a proper infection control policy with appropriate antibiotic usage can reduce the mortality rate among ventilated patients.     

Importance of accurate sampling techniques in microbiological diagnosis of endophthalmitis

Background

Endophthalmitis is an ocular emergency and bacteria are the commonest aetiological agents of infectious endophthalmitis. Any delay in treatment will result in serious complications like complete loss of vision. Therefore, obtaining the most appropriate sample is of paramount importance for a microbiologist to identify the aetiological agents that help the ophthalmologist in planning treatment.

Objetive

This study was undertaken to determine the intraocular specimen that is most likely to yield a positive culture on microbiological examination.

Methods

From 60 cases, intraocular samples were collected in the operation theatre under anaesthesia. The samples obtained were aqueous humour and vitreous humour by vitreous tap, vitreous biopsy or pars plana vitrectomy. The specimens were processed within half an hour, first by inoculating onto culture media and then direct smear examination by Gram’s Stain

Results

Eighty samples were obtained from 60 cases of which the most were vitreous fluid (vitreous biopsy/tap + vitrectomy fluid), i.e., 75%. Culture was positive in 88% vitrectomy fluid as compared to 74% in vitreous tap/biopsy followed by 20% in aqueous fluid.

Conclusion

Vitrectomy fluid appears to be the best sample for culture from clinically diagnosed endophthalmitis cases.     

Cardio-pulmonary resuscitation in the intensive care unit: An experience from a tertiary hospital in Sub-Saharan Africa

Background:

Cardiopulmonary resuscitation (CPR) is one the most commonly performed procedures in the intensive care unit (ICU). However, success rate of CPR vary widely from 3.1% to 16.5%.

Patients and Methods:

We conducted a retrospective study of all cardiac arrests prompting CPR in our ICU for a period of 12 months. Data retrieved from ICU records included patients demographic characteristics, diagnosis at admission, length of ICU stay, time and day of cardiac arrest, cardiac rhythm, duration of CPR and outcome of CPR.

Results:

A total of 156 CPRs were performed within the study period with 8.3% success rate. Male: female ratio was 1.2:1. Indications for ICU admission, length of stay in ICU, time and day of cardiac and duration of CPR were found to be determinants of outcome.

Conclusions:

There is an urgent need to constitute a cardiac arrest team (CAT) which will be available at all times for improved successful outcome after cardiac arrest in our ICU.     

Blunt Dissection: A Solution to Prevent Bile Duct Injury in Laparoscopic Cholecystectomy

Background:

Laparoscopic cholecystectomy (LC) has been a standard operation and replaced the open cholecystectomy (OC) rapidly because the technique resulted in less pain, smaller incision, and faster recovery. This study was to evaluate the value of blunt dissection in preventing bile duct injury (BDI) in laparoscopic cholecystectomy (LC).

Methods:

From 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years (14–84 years). The Calot''s triangle was bluntly dissected and each duct in Calot''s triangle was identified before transecting the cystic duct.

Results:

Two hundred and thirty-nine patients (1.1%) were converted to open procedures. The postoperative hospital stay was 2.1 (0–158) days, and cases (46%) had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less; BDI was occurred in 20 cases (0.09%) including 6 cases of common BDI, 2 cases of common hepatic duct injury, 1 case of right hepatic duct injury, 1 case of accessory right hepatic duct, 1 case of aberrant BDI 1 case of biliary stricture, 1 case of biliary duct perforation, 3 cases of hemobilia, and 4 cases of bile leakage.

Conclusion:

Exposing Calot''s triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BDI.     

Antimicrobial use and antimicrobial resistance in nosocomial pathogens at a tertiary care hospital in Pune

Background

Resistance to antimicrobial agents is emerging in wide variety of nosocomial and community acquired pathogens. Widespread and often inappropriate use of broad spectrum antimicrobial agents is recognized as a significant contributing factor to the development and spread of bacterial resistance. This study was conducted to gain insight into the prevalent antimicrobial prescribing practices, and antimicrobial resistance pattern in nosocomial pathogens at a tertiary care hospital in Pune, India.

Methods

Series of one day cross sectional point prevalence surveys were carried out on four days between March and August 2014. All eligible in patients were included in the study. A structured data entry form was used to collect the data for each patient. Relevant samples were collected for microbiological examination from all the clinically identified hospital acquired infection cases.

Results

41.73% of the eligible patients (95% CI: 39.52–43.97) had been prescribed at least one antimicrobial during their stay in the hospital. Beta-lactams (38%) were the most prescribed antimicrobials, followed by Protein synthesis inhibitors (24%). Majority of the organisms isolated from Hospital acquired infection (HAI cases) were found to be resistant to the commonly used antimicrobials viz: Cefotaxime, Ceftriaxone, Amikacin, Gentamicin and Monobactams.

Conclusion

There is need to have regular antimicrobial susceptibility surveillance and dissemination of this information to the clinicians. In addition, emphasis on the rational use of antimicrobials, antimicrobial rotation and strict adherence to the standard treatment guidelines is very essential.     

Outcome of ventilator-associated pneumonia: Impact of antibiotic therapy and other factors

Background

Ventilator-associated pneumonia (VAP) is the most frequent infection in patients intubated for longer than 48 hours. There is a great interest in determining the factors influencing the outcome of VAP, as it may help in reducing the associated morbidity and mortality. This study aimed to determine the impact of appropriate antibiotic therapy based on endotracheal aspirate cultures on the outcome of VAP. We have also studied the other factors that may influence the outcome of VAP.

Method

A cohort study was conducted in the intensive care units of a tertiary care hospital in South India over a period of 15 months.The outcome of VAP was assessed by prolongation of the duration of mechanical ventilation and/or death of the patient.

Results

The duration of mechanical ventilation was significantly prolonged in patients with VAP (16.61 ± 8.2 d vs. 8.21 ± 5.9 d, P < 0.0001). VAP patients receiving partially or totally inappropriate therapy (defined as lack of coverage of one or all the significant VAP pathogens) were at significantly high risk for death (Relative risk, 2.00; 95% confidence interval, 1.14 to 3.52; P 0.0008). A delay of > 2 days in administering the first dose of appropriate antibiotic therapy significantly prolonged the duration of ventilation (P < 0.0001). Infection by multi-drug resistant pathogens, polymicrobial infection and time of onset of VAP did not have significant impact on the outcome of VAP.

Conclusion

Early administration of appropriate antibiotic therapy, based on the antibiogram of the VAP pathogens identified by quantitative culture of endotracheal aspirate, could lead to an improved outcome of patients with ventilator-associated pneumonia.