ABSTRACT
Background: Respiratory infections among critically ill Patient are associated with high morbidity and mortality. Mechanically ventilated patients are at a high risk of acquiring respiratory infections due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria. Irrational use of antibiotics increases the emergence of drug – resistant bacteria. Objectives: The aim of study was to investigate the bacterial isolates in the endotracheal aspirates of mechanically ventilated patients in ICU and see the antimicrobial resistance pattern of bacterial isolates. Methods: Analysis of E.T aspirates of 459 patients over a period of 1 year (Aug 14 to Aug 15) was done. Aspirates were cultured on Blood and MacConkey agar isolation and identification was done using conventional techniques and biochemical reactions. Antibiotic sensitivity testing was done by Kirby-Bauer disc diffusion method as per CLSI guidelines. Results: Out of 459 Samples 365 was found to be positive. Acinetobacter sp (44.65%) was the most common isolate followed by Klebsiella sp (18.63%), Pseudomonas sp (11.23%), Candida (10.46%), Escherichia Coli (7.94%), COPS (3.28%), CONS (2.46%), Enterococci (0.82%), and Citrobacter (0.54%). The gram-negative bacilli were mostly sensitive to Tigecycline, Colistin, Imipenem, Meropenem, Amikacin and Piperacillin/Tazobactam. Gram positive Cocci were mostly sensitive to Vancomycin, Linezolid and Gentamicin. Conclusion: The isolation and antimicrobial resistance pattern of the microorganisms is necessary for their effective management. Endotracheal intubation is one of the major risk factors in causing iatrogenic infections to patients. A local antibiogram for each hospital, based on bacteriological patterns and susceptibility is essential to initiate empirical therapy.
ABSTRACT
Background: Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia occurring in patients who are mechanically ventilated for more than 48 hours. VAP is the most common nosocomial infection occurring in the intensive care units and its incidence varies from 8% to 28%. AIMS & OBJECTIVES- This study was done to determine the bacteriological profile and antibiotic sensitivity pattern of the isolates obtained from the endotracheal aspirates of the clinically suspected patients of VAP in ICU. Materials & Methods: The study was conducted in the department of general medicine of the Haridev Joshi Hospital, Dungarpur, Rajasthan, India. The present study included 52 patients who had serum bilirubin > 3 mg%. So, after excluded patient the study group included 45 patients. All patients were underwent a set of investigations, including conjugated and unconjugated bilirubin, and serum AST and ALT levels. All the patients with cerebral malaria underwent detailed ultrasonography to check the size and echo-texture of the liver. Results: A total of 45 patients with malaria were included in the study. The mean serum bilirubin level was 11.23+6.8 mg %, mean AST levels was 298.42+242.21 IU/l and mean ALT levels was 382.21+298.12 IU/l. 17 patients were diagnosed having cerebral malaria. The patients with cerebral malaria were directed to undergo USG abdomen. Enlarged size if liver was seen 14 patients. Conclusion: Within the limitations of our study we conclude that significant hepatitis findings are seen in patients with cerebral malaria. Required supportive and anti-malarial treatment should be provided to the patients with specially taking care of the hepatic health.
ABSTRACT
BACKGROUND: Distal airway bacterial colonization occurs more frequently in patients with endotracheal tubes or tracheostomy of intensive care units (ICU) care. In general, bronchoscopic samples are considered more accurate than transtracheal aspirates. In this study, we evaluated the consistency and clinical significance between bronchoscopic samples and transtracheal aspirates (TTA) in severe pneumonia under mechanical ventilation. METHODS: We investigated the consistency between bronchoscopic samples and transtracheal aspirates among patients with endotracheal tubes or tracheostomy, retrospectively. Fiberoptic bronchoscopy was performed in 212 patients with mechanical ventilation via endotracheal tube or tracheostomy between January 1st, 2004 and December 31th, 2008 in ICU at Ewha Womans University Hospital. We evaluated consistency in terms of true pathogen according to the arbitrary ICU days progress. RESULTS: Among the 212 enrolled patients, 113 (53%) had consistency between bronchoscopic samples and transtracheal aspirates. When evaluated alteration trends in consistency according to ICU stay, the consistency was maintained for 5 to 9 ICU days with statistical significance (p< 0.05) since adjusting for age, sex, and combined risk factors. Consistency in sampling status between the endotracheal tube and tracheostomy was also evaluated, however, there was no statistical significance (OR 1.9 vs. 1, 95% CI = 0.997-3.582, p = 0.051). CONCLUSIONS: Shorter hospital stay (within 9 days of ICU stay) had higher probability of consistency between bronchoscopic samples and TTA samples. TTA may be as confident as bronchoscopic samples in patients of pneumonia under mechanical ventilation with shorter ICU stays, especially less than 10 days.