Ventilator associated pneumonia: bacterial agents and antibiogram at a Tertiary Care Centre in Kathmandu
DOI:
https://doi.org/10.3396/ijic.v21.23632Keywords:
VAP, VAC, MDR, ESBL, MBL, AmpC β lactamaseAbstract
The most common nosocomial infection seen in patients under mechanical ventilation is ventilator-associated pneumonia (VAP). This study is conducted to study rate of VAP, bacterial agents, and their antibiogram. This was a hospital based, observational cross–sectional study of all the patients who were mechanically ventilated in the intensive care unit at Nepal Medical College Teaching Hospital, Kathmandu during a period of one year. Endotracheal aspirates were processed for bacterial isolation and identification and their antibiotic susceptibility test. Significant bacterial growth was considered on the basis of significant gram stain and semi-quantitative culture obtained by endotracheal sampling.
Significant bacterial growth was found in 48(57.8%) endotracheal aspirates (n = 83) of which 4(8.3%) were from cases of VAP and 44(91.7%) from Ventilator associated condition (VAC).VAP rate among patients was 4.8%. Among four VAP cases, two endotracheal aspirates grew Klebsiella pneumoniae, one grew Acinetobacter calcoaceticus baumannii complex, and one grew both Pseudomonas aeruginosa and K. pneumoniae. All isolates of K. pneumoniae were MDR and ESBL producers where two of them were AmpC β-lactamase and MBL producers. The P. aeruginosa isolated was MDR and produced AmpC beta lactamase, MBL and ESBL. The isolated Acinetobacter calcoaceticus baumannii complex was also MDR. VAP is a commonly encountered complication in mechanically ventilated patients. The MDR pathogens associated with VAP and VAC call for special attention to care for the ventilated and need for strict adherence to infection control practices including VAP bundle care.
Downloads
References
1. Divatia JV, Pulinilkunnathil JG, Myatra SN. Nosocomial infections and ventilator-associated pneumonia in cancer patients. In: Nates JL, Price KJ, eds. Oncologic critical care. Cham: Springer International Publishing; 2020, pp. 1419–39.
2. Kobayashi H, Uchino S, Takinami M, Uezono S. The impact of ventilator-associated events in critically ill subjects with prolonged mechanical ventilation. Respir Care 2017; 62(11): 1379–86. doi: 10.4187/respcare.05073
3. Peña-López Y, Ramírez-Estrada S, Rello J. Ventilator-associated events: definitions and uses. In: Encyclopedia of respiratory medicine. Elsevier; 2022, pp. 523–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780128012383114825 [cited 13 January 2023].
4. Patro S, Sarangi G, Das P, Mahapatra A, Mohapatra D, Paty BP, et al. Bacteriological profile of ventilator-associated pneumonia in a tertiary care hospital. Indian J Pathol Microbiol 2018; 61(3): 375. doi: 10.4103/IJPM.IJPM_487_16
5. Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: incidence and risk factors. J Infect Dev Ctries 2009; 3(10): 771–7. doi: 10.3855/jidc.396
6. Akbiyik A, Hepçivici Z, Eşer I, Uyar M, Çetin P. The effect of oropharyngeal aspiration before position change on reducing the incidence of ventilator- associated pneumonia. Eur J Clin Microbiol Infect Dis 2021; 40(3): 615–22. doi: 10.1007/s10096-019-03789-4
7. Standard_Operating_Procedures_Bacteriology_1stEdition.pdf. Available from: https://main.icmr.nic.in/sites/default/files/guidelines/Standard_Operating_Procedures_Bacteriology_1stEdition.pdf [cited 30 March 2023].
8. Webber DM, Wallace MA, Burnham CAD. Stop waiting for tomorrow: disk diffusion performed on early growth is an accurate method for antimicrobial susceptibility testing with reduced turnaround time. J Clin Microbiol 2022; 60(5): e03007–20. doi: 10.1128/jcm.03007-20
9. Kalanuria A, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care 2014; 18(2): 208. doi: 10.1186/cc13775
10. Poulou A, Grivakou E, Vrioni G, Koumaki V, Pittaras T, Pournaras S, et al. Modified CLSI extended-spectrum β-lactamase (ESBL) confirmatory test for phenotypic detection of ESBLs among enterobacteriaceae producing various β-lactamases. J Clin Microbiol 2014; 52(5): 1483–9. doi: 10.1128/JCM.03361-13
11. Sachdeva R, Sharma B, Sharma R. Evaluation of different phenotypic tests for detection of metallo-β-lactamases in imipenem-resistant Pseudomonas aeruginosa. J Lab Physicians 2017; 9(4): 249–53. doi: 10.4103/JLP.JLP_118_16
12. Aryal SC, Upreti MK, Sah AK, Ansari M, Nepal K, Dhungel B, et al. Plasmid-mediated AmpC β-lactamase CITM and DHAM genes among gram-negative clinical isolates. Infect Drug Resist 2020; 13: 4249–61. doi: 10.2147/IDR.S284751
13. Yagi T, Wachino J, Kurokawa H, Suzuki S, Yamane K, Doi Y, et al. Practical methods using boronic acid compounds for identification of class C β-lactamase-producing Klebsiella pneumoniae and Escherichia coli. J Clin Microbiol 2005; 43(6): 2551–8. doi: 10.1128/JCM.43.6.2551-2558.2005
14. Chouhdari A, Shokouhi S, Bashar FR, Vahedian Azimi A, Shojaei SP, Fathi M, et al. Is a low incidence rate of ventilation associated pneumonia associated with lower mortality? A descriptive longitudinal study in Iran. Tanaffos 2018; 17(2): 110–16.
15. Mathai AS, Phillips A, Isaac R. Ventilator-associated pneumonia: a persistent healthcare problem in Indian intensive care units! Lung India Off Organ Indian Chest Soc 2016; 33(5): 512–16. doi: 10.4103/0970-2113.188971
16. Shrestha DK, Rajbhandari B, Pradhanang A, Sedain G, Shilpakar SK, Pradhan S. Ventilator-associated pneumonia in neurosurgical patients: a tertiary care center study. J Inst Med Nepal 2019; 41(2): 40–4. doi: 10.59779/jiomnepal.1042
17. Mishra D, Shah D, Shah N, Prasad J, Gupta P, Agrawaal K. Study of microbiological and antibiotic sensitivity pattern of ventilator associated pneumonia (VAP) in ICU of a tertiary care hospital in Nepal. J Fam Med Prim Care 2020; 9(12): 6171. doi: 10.4103/jfmpc.jfmpc_1430_20
18. Adhikari K, Basnyat S, Shrestha B. Prevalence of multidrug-resistant and extended-spectrum betalactamase producing bacterial isolates from infected wounds of patients in Kathmandu Model Hospital. Nepal J Sci Technol 2020; 19(1): 171–9. doi: 10.3126/njst.v19i1.29798
19. Bairy I, Dey A. 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. doi: 10.4103/1817-1737.32230
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Ritu Pandey, Ritu Amatya, Ram Prasad Adhikari, Laxmi Kant Khanal, Sushila Khadka
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to IJIC. Read the full Copyright- and Licensing Statement.
