A clinico - microbiological study in patients undergoing mechanical ventilation in a tertiary care hospital
Keywords:Endotracheal aspirates, Intensive care unit, Ventilator associated pneumonia
Background:Ventilator associated pneumonia (VAP) is an important and common complication of mechanically ventilated patients. It is the leading cause of morbidity and mortality in Intensive Care Units (ICU) worldwide. Objective of the study was to isolate and identify the organisms causing VAP and to know their resistance pattern.
Methods: A prospective study was carried out over a period of one year in the ICU of a tertiary care hospital. All patients on mechanical ventilation for more than 48 hours were included in the study. The pathogens were identified based on standard procedures including Gram’s stain, colony morphology on Blood agar, Mac Conkey agar and SDA and biochemical reactions.
Results: The incidence of VAP in our study was 32% and was more common in males compared to females (65.62%) Gram negative organisms were most commonly isolated. Among them Klebsiella, Pseudomonas, Acinetobacter were the commonest organisms. Gram positive bacteria were Staphylococcus aureus, Coagulase negative staphylococci and Pneumococci. In 2% of cases Candida spp were isolated.
Conclusions: Gram negative bacteria were the major pathogenic organisms of VAP in our ICU. Culture of endotracheal aspirates for early diagnosis and its antibiogram will guide for an approach to targeted treatment.
Koenig SM, Truwit JD. Ventilator-associated pneumonia: Diagnosis, treatment and prevention. Clin Microbiol Rev. 2006;19:637-57.
Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. An Rev Respir Dis. 1989;139:877-84.
Dey A, Bairy I. Incidence of multidrug - resistant organisms causing ventilator - associated pneumonia in a tertiary care hospital: a nine months prospective study. Ann Thorac Med. 2007;2:52-7.
Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Sutler PM. Diagnosis of ventilator - associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic blind bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143:1121-9.
Collee JG, Miles RB, Watt B. Tests for identification of bacteria. In- collee JG, Fraser AG, Marimion BP, Simmons A, editors. Mackie and Mc Cartney Practical Medical Microbiology. 14th ed. New York: Chorchill Livingstone; 1996:131-49.
Shalini S, Kranthi K, Gopal Krishna Bhat K. Microbiological profile of infections in ICU. J of clinical and Diagnostic Research. 2010;4:3109-12.
Rakshit P, Nagar VS, Deshpande AK. Incidence, clinical outcome and risk stratification of ventilator: associated pneumonia - a prospective cohort study. Indian J Crit Care Med. 2005;9(4):211-6.
Gadani H, Vyas A, Kar AK. A study of ventilator- associated pneumonia: incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesth. 2010:54:535-40.
Set R, Bobade O, Shastri J. Bacteriology profile among patients with ventilator: associated pneumonia from a medical intensive care unit at a tertiary care center in Mumbai. IJPM. 2011;2:54.