Bacteriological Profile Of Nosocomial Pneumonia Patients In A Superspeciality Hospital.

Background: To ascertain the bacteriological profile of patients with nosocomial pneumonia in endotracheal cultures and correlation with blood cultures. Methodology: 559 endotracheal aspirates were collected using mucous traps from 180 patients of suspected nosocomial pneumonia patients over 2 years. The samples were processed and a colony count of 104cfu/ml was taken as the cut-off to differentiate between pathogens and colonizers. Identification and sensitivity of bacterial isolates was done with the help of Vitek 2. Blood for culture was processed as per standard techniques. Results & Conclusion: Klebsiella sp.(33%) was the commonest bacteria isolated, followed by Acinetobacter baumanii, Pseudomonas sp., Escherichia coli and Staphylococcus aureus. 25% of Acinetobacter spp. and 40% of Pseudomonas spp were pandrug resistant. Mostly non-fermenters were sensitive to Tigecycline and Colistin. Enterobacteriaceae showed highest resistance for Cephalosporins and Cotrimoxazole but were mostly sensitive to Tigecycline. Staphylococcus aureus was uniformly sensitive to Linezolid and Teicoplanin. Blood cultures were positive in 52 (9.3%) patients of which pulmonary origin bacteremia was present in 33 patients while non-pulmonary origin bacteremia was present in 19 patients. The pulmonary care bundle along with rational use of antibiotics will go a long way to improve treatment outcome, patient morbidity and mortality.

Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre‑antibiotic era.

The rise in super bugs causing Ventilator‑Associated Pneumonia (VAP) is a major cause of mortality and morbidity despite recent advances in management owing to the looming ‘antibiotic apocalypse’. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU) and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV) for ≥48 hrs. Endotracheal aspirates (ETA) from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP), while Nonfermenting Gram negative bacilli (NFGNB) were significantly associated with late onset VAP (LOVAP). Most of the isolates were multi drug resistant (MDR) super bugs. With limited treatment options left for this crisis situation like the pre‑antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

Antibiotic Sensitivity Pattern of Gram Negative Bacilli Isolated from the Lower Respiratory Tract of Ventilated Patients in the Intensive Care Unit.

The causative organisms vary according to the patients’ demographics in the ICU, methods of diagnosis, the durations of hospital and ICU stay. It is necessary to study different etiological organisms and their antimicrobial susceptibility pattern for generating local antibiotic policy. Aims: To study the causative organisms and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to ICU. Methods and Material: Endotracheal aspirates from 200 patients admitted to the ICU were cultured, identified and antimicrobial susceptibility testing was performed by standard methods. Results: From 200 specimens, 69(34.5%) were culture positive. Total 96 isolates were recovered, from these 92 (96.87%) isolates were gram negative bacilli (GNB). In 34.78% specimens, two isolates were recovered. The most common Gram- negative organism being Acinetobacter spp. (31.25%) followed by Klebsiella spp. (21.87%), E-coli (21.87%) and Pseudomonas Spp. (17.7%). All GNBs were 100% sensitive to polymyxin B and colistin and resistant to piperacillin, ceftazidime and cotrimoxazole. 50% E-coli and 38% of Klebsiella pneumoniae strains were ESBL (extendedspectrum b-lactamase) producers. Conclusions: This study demonstrates the trend in antimicrobial susceptibility pattern of gram negative bacilli in intensive care unit. It is the most important for specific treatment of ventilator associated pneumonia patients and to generate local data periodically to decide empiric antimicrobial therapy.

Uso de cultivo cuantitativo de aspirado endotraqueal para el diagnóstico de neumonía asociada a ventilación mecánica en pediatría: estudio prospectivo, analítico / Evaluation of quantitative cultures of endotracheal aspirates for pediatric ventilator-associated pneumonia diagnosis: analytic, prospective study

Introduction: Ventilator-associated pneumonia (VAP) is difficult to diagnose because of the absence of a gold standard. Aim: To evaluate the use of quantitative cultures of endotracheal aspirates for diagnosis of pediatric VAP and to obtain acceptable sensitivity and specificity cutoff points. Patients and Methods: Prospective, analytic study which included patients under 15 years, who were connected to mechanical ventilation at Hospital Luis Calvo Mackenna's intensive care units. They were classified as cases or controls according to NNIS criteria. Results: During a period of 21 months we recruited a total of 43 patients with a mean age of 16 months. We obtained endotracheal aspirated samples to perform quantitative cultures. Most frequently isolated pathogens were Staphylococcus aureus (34,5 percent) and non-fermentative Gram-negative bacilli (24,1 percent). We obtained a sensitivity of 88 percent, specificity of 70 percent, PPV of 82 percent, and NPV of 79 percent for samples greater than 10(6) CFU. Conclusions: Quantitative culture of endotracheal aspirates is a reliable method for diagnosing pediatric VAP when the value is greater than 10(6) CFU.

Introducción: La neumonía asociada a ventilación mecánica (NAVM) presenta una importante dificultad en su diagnóstico ya que no existe un patrón de referencia. Objetivo: Evaluar el uso del recuento cuantitativo de aspirado endotraqueal como método diagnóstico de NAVM en pediatría, obteniendo puntos de cortes con una sensibilidad y especificidad aceptables. Materiales y Métodos: Estudio analítico, prospectivo, que incluyó pacientes bajo 15 años de edad, conectados a ventilación mecánica en unidades de cuidados intensivos del Hospital Luis Calvo Mackenna. Se clasificaron en casos y controles según criterios de NNIS. Resultados: Durante 21 meses se enrolaron 43 pacientes cuya edad promedio fue de 16 meses. Se tomaron muestras de aspirado endotraqueal para cultivos cuantitativos. Los principales microorganismos aislados fueron Staphylococcus aureus (34,5 por ciento) y bacilos gramnegativos no fermentadores (24,1 por ciento). Para las muestras con recuento mayor 10(6) ufc se obtuvo una sensibilidad de 88 por ciento, especificidad de 70 por ciento, VPP de 82 por ciento y VPN de 79 por ciento. Discusión: El cultivo cuantitativo de aspiración endotraqueal constituye un método diagnóstico confiable para NAVM en pediatría cuando se obtienen recuentos mayores a 10(6) ufc.

Usefulness of Quantitative Endotracheal Aspirate Cultures in Intensive Care Unit Patients with Suspected Pneumonia

It is difficult to differentiate pathogens responsible for pneumonia or colonization in patients with an endotracheal tube or in patients that have undergone tracheostomy. We evaluated the clinical usefulness of quantitative endotracheal aspirates cultures and sought to determine the result threshold level for positivity. The authors performed this retrospective cohort study between December 1, 2004 and January 31, 2006. Forty-five suspected pneumonia patients admitted to an intensive care unit (ICU) with quantitative bronchoalveolar lavage (BAL) and endotracheal aspirate (EA) culture results were enrolled. Using a threshold of 10(5) cfu/mL, 10 of the 45 (22.2%) quantitative EA cultures were positive, as compared with 7 (15.6%) BAL cultures. When BAL culture findings were used as the reference, the sensitivity and specificity of quantitative EA cultures were 85.7% and 89.5%, respectively, at a threshold of 10(5) cfu/mL, and 85.7% and 94.7%, respectively, at a threshold of 10(6) cfu/mL. Of the 10 EA culture positive patients, 2 patients with a result of -10(5) cfu/mL were BAL culture negative. The quantitative EA culture is a useful non-invasive tool for the diagnosis of pneumonia pathogens. It is suggested that a threshold level of 10(6) cfu/mL is appropriate.

Chryseobacterium indologenes Isolated from Clinical Specimens / 대한임상미생물학회지

Chryseobacterium indologenes is a nonfastidious, oxidase-positive, gram-negative rod that does not ferment glucose. It is known to be associated with a variety of clinical infections. We report six cases of C. indologenes isolated from clinical specimens, which were seen at our institution over a 2-year period. These organisms were recovered from blood, pleural fluid, peritoneal fluid, bile, endotracheal aspirate, and sputum. We described clinical characteristics, treatment outcome, microbiological characteristics, and in vitro antibiotic susceptibility test.

A Comparative Study of Endotracheal Aspirates and Protected Specimen Brush in the Quantitative Cultures of the Ventilator-Associated Pneumonia / 결핵

BACKGROUND: Pneumonia is a frequent complication in patients undergoing mechanical ventilation. Quantitative culture of protected specimen brush(PSB) have shown satisfactory diagnostic accuracy for the diagnosis of ventilator-associated pneumonia. However PSB method is invasive, expensive, and require a bronchoscopic procedure. But endotracheal aspiration(EA) is simple and less expensive. The purpose of our study was to investigate the diagnosic value of EA quantitative cultures. METHOD: We studied 15 cases of ventilator-associated pneumonia(for >72h of mechanical ventilation) patients. Patients were divided into two diagnostic categories. Group I was the patients who were suspicious of clinical pneumonia, Group II was the patients for control. The obtained samples by EA and PSB were homogenized for quantitative culture with a calibrated loop method in all patients. RESULT: Using 103cfu/ml, 105cfu/ml as threshold in quantitative culture of PSB, EA respectively, we found that EA quantitative cultures represented a relatively sentive(70%) and relatively specific (60%) method to diagnose the ventilator-associated pneumonia. CONCLUSION: Although EA quantitative cultures are less specific than PSB for diagnosing ventilator-associated pneumonia. EA quantitative cultures correlated with PSB quantitative culture in patients with clinical pneumonia and may be used to treat these patients when bronchoscopic procedures are not available.