Volume 18, Issue 3 (May-Jun 2024)                   mljgoums 2024, 18(3): 8-12 | Back to browse issues page


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Dwivedi S, Rahangdale V, Bhise S, Zodpey S. An update on the increasing prevalence of multidrug-resistant pathogens found in mechanically ventilated patients in central India. mljgoums 2024; 18 (3) :8-12
URL: http://mlj.goums.ac.ir/article-1-1762-en.html
1- Department of Microbiology, Indira Gandhi Government Medical College and Hospital Nagpur, 440018, India , sonakshidwivedi6@gmail.com
2- Department of Microbiology, Government Medical College and Hospital (GMCH) Nagpur, 440003, India
3- Department of Microbiology, Indira Gandhi Government Medical College and Hospital Nagpur, 440018, India
Abstract:   (1334 Views)
 Background: Rampant and irrational use of antibiotics led to antimicrobial resistance in intensive care units, directly influencing the clinical outcome. The prior introduction of antibiotics, especially broad-spectrum antibiotics, has been identified as a leading cause of hospital-acquired pneumonia. The present study aims to examine the existing scenario of antibiotic resistance due to multidrug-resistant organisms that are detected in mechanically ventilated patients.
Methods: This cross-sectional study was conducted in the department of Microbiology of a tertiary care hospital in Central India. A total of 410 endotracheal secretions were collected. The endotracheal aspirate of adult patients admitted to the medicine intensive care unit and on mechanical ventilation was received at the microbiology laboratory for processing by standard bacteriological techniques. Drug susceptibility testing was done using the Kirby-Bauer disc diffusion method according to the indications mentioned in Clinical and Laboratory Standards Institute 2021.
Results: Out of 410 collected endotracheal secretion samples, 332 (81 %) samples demonstrated bacterial growth. A total of 265 (80%) cases fulfilled the inclusion criteria. From 265 samples, 92 (34.7 %) patients were clinically and microbiologically confirmed as cases of ventilator-associated pneumonia. Over eighty percent of gram-negative bacilli were multidrug-resistant strains (Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa).
Conclusion: Real understanding of multidrug-resistant pathogens, early isolation as well as avoiding long-term antibiotic intake can reduce mortality levels currently linked with late-onset ventilator-associated pneumonia.
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Research Article: Original Paper | Subject: Microbiology
Received: 2023/12/18 | Accepted: 2024/06/18 | Published: 2024/11/12 | ePublished: 2024/11/12

References
1. Chandra D, Laghawe A, Tukaram Prabhu KS. Microbiological Profile and Antimicrobial Sensitivity Pattern of Endotracheal Tube Aspirates of Patients in ICU of a Tertiary Care Hospital in Bhopal, India. Int J Curr Microbiol Appl Sci. 2017; 6(3): 891-5. [View at Publisher] [DOI]
2. Rajesh E, Katragadda R, Ramani CP. Bacteriological profile and antimicrobial resistance pattern of ventilator associated pneumonia in tertiary care hospital. Indian J Microbiol Res. 2021; 8(3): 191-5. [View at Publisher] [DOI]
3. Luo W, Xing R, Wang C. The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days. BMC Infect Dis. 2021; 21: 1-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Rice LB. Federal Funding for the Study of Antimicrobial Resistance in Nosocomial Pathogens : No ESKAPE. J infect dis. 2008; 197(8): 1079-81. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Santajit S, Indrawattana N. Mechanisms of Antimicrobial Resistance in ESKAPE Pathogens. Biomed Res Int. 2016; 2016: 1-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Sangale A, Bhat V, Kelkar R, Biswas S. Microbiology of ventilator-associated pneumonia in a tertiary care cancer hospital. Indian Journal of Critical Care Medicine. 2021; 25(4): 421-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Alnimr A. Antimicrobial Resistance in Ventilator-Associated Pneumonia : Predictive Microbiology and Evidence- Based Therapy. Infect Dis Ther. 2023; 12(6): 1527-52. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Klompas M. Ventilator-associated events: What they are and what they are not. Respir Care. 2019; 64(8): 953-61. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Procop GW, Church DL, Hall GS, Janda WM, Koneman EW, Schreckenberger PC, et al. Koneman's Color Atlas and Textbook of Diagnostic Microbiology. 7th ed. Philadelphia : Wolters Kluwer Health; 2017. [View at Publisher] [Google Scholar]
10. Bauer AW, Kirby WMM, Sherris JC, Turck M. Antibiotic Susceptibility Testing by a Standardized Single Disk Method. Am J Clin Pathol. 1966; 45(4): 493-6. [View at Publisher] [DOI] [PMID]
11. Lewis II J, Weinstein M, Bobenchik AM, Campeau S, Cullen SK, Galas MF, et al. Clinical and Laboratory Standards Institute. M100 Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. 2021; 42: 1-325. [View at Publisher]
12. Sanders CC, Sanders WE, Goering R V. In Vitro Antagonism of Beta-Lactam Antibiotics by Cefoxitin. Antimicrob Agents Chemother. 1982; 21(6): 968-75. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem-EDTA Disk Method for Differentiation of Metallo-β-Lactamase producing Clinical Isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2002; 40(10): 3798-801. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Melsen WG, Rovers MM, Groenwold RHH, Bergmans DCJJ, Camus C, Bauer TT, et al. Articles Attributable mortality of ventilator-associated pneumonia : a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013; 13(8): 665-71. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Chastre J, Fagon JY. State of the Art Ventilator-associated Pneumonia. Am J Respir Crit Care Med. 2002; 165: 867-903. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Waters B, Muscedere J. A 2015 Update on Ventilator-Associated Pneumonia: New Insights on Its Prevention, Diagnosis, and Treatment. Curr Infect Dis Rep. 2015; 17(8): 1-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Koirala P, Bhatta DR, Ghimire P, Pokhrel BM, Devkota U. Bacteriological Profile of Tracheal Aspirates of the Patients Attending Neuro-hospital Nepal. International Journal of Life Sciences. 2010; 4: 60-5. [View at Publisher] [DOI] [Google Scholar]
18. Tullu M, Deshmukh C, Baveja S. Bacterial profile and antimicrobial susceptibility pattern in catheter related nosocomial infections. J Postgrad Med. 1998; 44(1): 7-13. [View at Publisher] [PubMed] [Google Scholar]
19. Amini M, Javanmard A, Davati A, Azimi G. Bacterial Colonization in Tracheal Tubes of ICU Patients. Iran J Pathol. 2009;4(3):123-7. [View at Publisher] [Google Scholar]
20. Joseph NM, Sistla S, Kumar Dutta T, Shankar Badhe A, Rasitha D, Chandra Parija S. Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens. j infect dev ctries. 2010; 4(4): 218-25. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Goel N, Chaudhary U, Aggarwal R, Bala K. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit. Indian J Crit Care Med. 2009; 13(3): 148-51. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Goossens H. MYSTIC program: Summary of European data from 1997 to 2000. Diagn Microbiol Infect Dis. 2001; 41(4): 183-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Khanal S, Joshi DR, Bhatta DR, Devkota U, Pokhrel BM. Bacterial Pathogens from Tracheal Aspirates of Intensive Care Unit Patients at National Institute of Neurological and Allied Sciences , Nepal. ISRN Microbiol. 2013; 2013: 1-5. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. 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(2): 52-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Kumari HBV, Nagarathna S, A C. Antimicrobial Resistance Pattern Among Aerobic Gramnegative Bacilli of Lower Respiratory Tract Specimens of Intensive Care Unit Patients in a Neurocentre. Indian J Chest Dis Allied Sci. 2007;49(1):19-27. [View at Publisher] [PubMed] [Google Scholar]
26. V.S. Silpha, Aruna. A Study to Assess the Bacterial Pathogens of Ventilator Associated Pneumonia in the Intensive Care Unit Patients in a Tertiary Care Hospital in South India. Int J Sci Res. 2019; 8(8): 1281-4. [View at Publisher]
27. Vila J, Martí S, Sánchez-Céspedes J. Porins, efflux pumps and multidrug resistance in Acinetobacter baumannii. J Antimicrob Chemother. 2007; 59(6): 1210-5. [View at Publisher] [DOI] [PMID] [Google Scholar]
28. Ashwath P, Kotian A, Deekshit VK, J. P, Dharnappa Sannejal A. Klebsiella pneumoniae Infections and Antimicrobial Drug Resistance. In: Siddhardha B, Syed A, Dyavaiah M, editors. Model Organisms for Microbial Pathogenesis, Biofilm Formation and Antimicrobial Drug Discovery. 2020; 195-226. [View at Publisher] [DOI]
29. Livermore DM. Multiple Mechanisms of Antimicrobial Resistance in Pseudomonas aeruginosa: Our Worst Nightmare? Clin Infect dis. 2002; 34(5): 634-40. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Wagner S, Sommer R, Hinsberger S, Lu C, Hartmann RW, Empting M, et al. Novel Strategies for the Treatment of Pseudomonas aeruginosa Infections. J Med Chem. 2016; 59(13): 5929-69. [View at Publisher] [DOI] [PMID] [Google Scholar]
31. Jain A, Roy I, Gupta MK, Kumar M, Agarwal SK. Prevalence of extended-spectrum β-lactamase-producing Gram-negative bacteria in septicaemic neonates in a tertiary care hospital. J Med Microbiol. 2003; 52(5): 421-5. [View at Publisher] [DOI] [PMID] [Google Scholar]
32. Jacoby GA, Medeiros AA. More Extended-Spectrum Beta-Lactamases. Antimicrob Agents Chemother. 1991;35(9):1697-704. [View at Publisher] [DOI] [PMID] [Google Scholar]
33. Hirakata Y, Matsuda J, Miyazaki Y, Kamihira S, Kawakami S, Miyazawa Y, et al. Regional variation in the prevalence of extended-spectrum β-lactamase-producing clinical isolates in the Asia-Pacific region (SENTRY 1998-2002). Diagn Microbiol Infect Dis. 2005; 52(4): 323-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
34. Poudyal S, Bhatta DR, Shakya G, Upadhyaya B, Dumre SP, Buda G, et al. Extended Spectrum â-lactamase producing multidrug resistant clinical bacterial isolates at National Public Health Laboratory. Nepal. Nepal Med Coll J. 2011; 13(1): 34-8. [PubMed] [Google Scholar]
35. Philippon A, Arlet G, Jacoby GA. Plasmid-determined AmpC-type β-lactamases. Antimicrob Agents Chemother. 2002; 46(1): 1-11. [View at Publisher] [DOI] [PMID] [Google Scholar]
36. Golia S, Sangeetha KT, Vasudha CL. Microbial profile of early and late onset ventilator associated pneumonia in the intensive care unit of a tertiary care hospital in Bangalore, India. J Clin Diagn Res. 2013; 7(11): 2462-6. [View at Publisher] [Google Scholar]
37. Girish N, Rajendran R. Bacteriological Profile of Ventilator Associated Pneumonia in a Tertiary Care Hospital and their Antibiotic Resistance Pattern. Int J Med Microbiol Trop Dis. 2015; 1(1): 1-5. [View at Publisher] [Google Scholar]
38. Nordmann P, Poirel L. Emerging carbapenemases in Gram-negative aerobes. Clin Microbiol Infect. 2002; 8(6): 321-31. [View at Publisher] [DOI:10.1046/j.1469-0691.2002.00401.x] [PMID] [Google Scholar]
39. Lee K, Gyo Lee W, Uh Y, Yim Ha G, Cho J, Chong Y. VIM-and IMP-Type Metallo-β-lactamase-Producing Pseudomonas spp. and Acinetobacter spp. in Korean Hospitals. Emerg Infect Dis. 2003; 9(7): 868-71. [View at Publisher] [DOI] [PMID] [Google Scholar]
40. Patel A, Lakhani S, Khara R. Microbiological profile of Ventilator associated pneumonia at ICU of rural based teaching hospital. Int J Biol Med Res. 2015;6(1):4732-6. [Google Scholar]

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