Bacteriological profile of ventilator-associated pneumonia in trauma intensive care unit of a tertiary care hospital

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is an important cause of increased morbidity, mortality, duration of hospital stay, and increased health-care costs. It is the second-most common hospital-acquired infection associated with high morbidity and mortality. Identification of the spectrum of causative organisms of VAP is imperative in the proper utilization of antimicrobials for VAP and the prevention of multidrug resistance (MDR) organisms. Aim and Objective: The spectrum of organisms responsible for VAP in the trauma center of our tertiary care hospital is not known and additionally, the ideal use of antimicrobials for proper treatment of these cases had to be formulated. This study was planned to identify the organisms and antimicrobial susceptibility patterns of bacteria causing VAP in patients admitted to trauma intensive care unit (ICU) of this tertiary care general hospital. Materials and Methods: In this study, 150 cases of VAP from a trauma ICU were included, who met the criteria of VAP as per the Clinical Pulmonary Infection Score. Endotracheal aspirate (ETA) samples were collected and processed for Gram stain; organisms were isolated and antibiotic sensitivity was performed by Kirby–Bauer method. Statistical analysis was performed using SSPI 23.0.0.0. Results: Our study showed predominantly Gram-negative bacilli (GNB) (70.6%) in the isolates, Gram-positive cocci in 4.67% of isolates, and 2% polymicrobial. The most common organism isolated was Klebsiella pneumoniae (44.08%), followed by Acinetobacter baumannii (17.77%). K. pneumoniae showed maximum resistance to cefotaxime (98.51%) and most sensitivity to colistin (13.43%). Maximum resistance was seen against cefotaxime (97.08%) and least against moxifloxacin (37.96%) and colistin (13.08%). K. pneumoniae had the highest MDR (47.6%), followed by A. baumannii (17.14%). Conclusion: VAP is a significant cause of mortality in ICU settings. The significant isolation of GNB in ETAs and the resistance pattern seen in our study shows that judicious and appropriate use of antimicrobials in this setting would be highly beneficial to prevent the emergence of MDR organisms and reduce mortality in cases of VAP.

Keywords

• antimicrobial sensitivity pattern
• multidrug resistance
• trauma intensive care unit
• ventilator-associated pneumonia