ABSTRACT
Ventilator Associated Pneumonia (VAP) is an important infection most often encountered in mechanical ventilation (MV) patients in intensive care units in hospital. VAP occurs in approximately 9 - 27% of patients who are intubated. The morbidity and mortality associated with VAP is more inspite of recent advances in diagnosis and accurate management. Emergence of multidrug resistance among the pathogens causing VAP is also contributing to the outcome. We wanted to isolate the bacterial pathogens, study the antibiotic susceptibility pattern of the isolates and detect the presence of drug resistance in various pathogens.METHODSThis is a retrospective, cross sectional study done on samples received between 2016 to 2018 among patients on MV for >/= 48 hours. Endotracheal aspirates were collected from 85 patients with assumed VAP, clinical pulmonary infection score (CPIS) was noted and aerobic quantitative cultures were performed on all samples. VAP was diagnosed by count of pathogenic organisms isolated >/= 105 cfu/mL. Identification and antibiotic susceptibility of the isolates were done as per the standard laboratory procedures. Patients with characteristic features i.e. clinical and radiological signs of pneumonia on admission were excluded from the study.RESULTS50 cases were diagnosed as VAP by CPIS. Gender ratio was 30:20 (male to female) higher incidence 42% of VAP was seen in the age group of 46-60 years. Majority were Gram negative bacilli; 96%- Klebsiella 36%, Acinetobacter 26% E. coli 16%, Pseudomonas 14%, and Citrobacter 4% along with coagulase positive Staphylococcus in 4%. Of the 50 VAP patients, single organism was isolated in 92% and polymicrobial in 8%. Most of the isolates showed resistance to Amoxiclav, Cefepime, Cefixime and Meropenem.CONCLUSIONSGood compliance with VAP bundle adopted in critical care areas by the health care workers will reduce the incidence of VAP. Early and accurate diagnosis, appropriate empirical and specific antimicrobial use may significantly improve patient outcome.
ABSTRACT
Staphylococcus aureus is the most common pathogen in nosocomial infections (4-6,17,19). Nasal carriage of Staphylococcus aureus is now considered a well defined risk factor for subsequent infections in various groups of patients (5,8,12,19). Nasal carriage of the pathogen among hospital personnel is an important source of nosocomial infection (1.3.18). Very few dedicated studies have investigated the nasal carriage state among medical students (3,18,21). Incidence of Staphylococcus aureus in the nasal flora of medical students, with or without varying degrees of clinical exposures were determined in our study. Nasal cultures from these students demonstrated a significantly increasing rate of colonization of Staphylococcus aureus with increased clinical exposure and also a corresponding increase in Methicillin resistance.
ABSTRACT
As Robertson’s cooked meat medium (RCM) promotes the simultaneous multiplication of facultative anaerobes along with anaerobes, it may be interfered with the isolation rate of anaerobes. In the present study RCM was made selective to overcome this difficulty by the incorporation of Neomycin. The efficacy of modified RCM was evaluated by growing stock cultures of various anaerobes and aerobes well as by inoculating clinical specimen directly and comparing the results with routine RCM. Among the 160 stock cultures of aerobes 8 of the 28 neomycin resistant aerobes grew in N.RCM but none of the 132 neomycin sensitive aerobes. Out of the 150 clinical samples tested in the study,77 anaerobes and 97 aerobes were isolated from routine RCM whereas 89 anaerobes and 8 Neomycin resistant aerobes from NRCM (i.e. NRCM inhibited 91.7% of aerobes and gave an increased yield of 13.5% anaerobes).These findings suggest that NRCM can be employed to suppress the aerobes and at the same time to enhance the isolation of anaerobes.