Jakribettu Ramakrishna Pai, Boloor Rekha
Department of Microbiology, Fr. Muller Medical College, Mangalore, Karnataka, India.
Saudi J Anaesth. 2012 Apr;6(2):115-9. doi: 10.4103/1658-354X.97022.
Despite advances in antimicrobial therapy, better supportive care modalities and use of a wide range of preventive measures, ventilator-associated pneumonia (VAP) continues to be an important cause of morbidity and mortality in intensive care unit (ICU). VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, to prevent mortality and morbidity. Inappropriate and inadequate antibiotic treatment causes emergence of drug resistance in pathogens and poor prognosis in patients. Early detection of pathogens causing VAP helps to control their spread by administration of suitable antibiotics and proper infection control measures. The study was conducted to know the pathogens causing VAP in Fr. Muller Medical College Hospital, Mangalore, and their susceptibility pattern.
A total of 100 patients, on mechanical ventilation for more than 48 h, who were suspected to have VAP were included in the study between December 2008 and November 2009. Their endotracheal aspirates (ETAs) were collected and processed. From 100 ETA, 138 isolates of count > 10(5) CFU/ mL were characterized and antibiogram was determined using standard antibiotics regime.
Incidence of VAP was found to be 44.2% among the mechanically ventilated patients. Klebsiella pneumoniae (34%) was the most common pathogen isolated, followed by Pseudomonas aeruginosa (20%). Among them, most of the K. pneumoniae and P. aeruginosa isolates were resistant to penicillins, cephalosporins, fluoroquinolones was observed but were sensitive to piperacillin/tazobactum, cefaperazone/sulbactum, and carbapenems. All isolates were sensitive to amikacin.
The present study shows prevalence of multidrug-resistant organisms in the study region. Klebsiella species was the most common pathogen isolated in ETA. Acinetobacter species were the most resistant pathogens prevailing in our ICU setup, leading to the increased mortality in the ventilated patients. Patients with chronic obstructive pulmonary disease is the most common predisposing factor for VAP in the study group.
尽管抗菌治疗取得了进展，支持性护理方式有所改善，且采取了多种预防措施，但呼吸机相关性肺炎（VAP）仍是重症监护病房（ICU）发病和死亡的重要原因。VAP需要快速诊断并开始适当的抗生素治疗，以预防死亡和发病。不适当和不足的抗生素治疗会导致病原体产生耐药性，并使患者预后不良。早期检测引起VAP的病原体有助于通过使用合适的抗生素和适当的感染控制措施来控制其传播。本研究旨在了解芒格洛尔弗·穆勒医学院医院中引起VAP的病原体及其药敏模式。
2008年12月至2009年11月期间，共有100例接受机械通气超过48小时且疑似患有VAP的患者纳入本研究。收集并处理他们的气管内吸出物（ETA）。从100份ETA中，对138株计数>10⁵CFU/mL的分离株进行了鉴定，并使用标准抗生素方案确定了抗菌谱。
在机械通气患者中，VAP的发生率为44.2%。肺炎克雷伯菌（34%）是分离出的最常见病原体，其次是铜绿假单胞菌（20%）。其中，大多数肺炎克雷伯菌和铜绿假单胞菌分离株对青霉素、头孢菌素、氟喹诺酮耐药，但对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和碳青霉烯类敏感。所有分离株对阿米卡星敏感。
本研究显示了研究区域内多重耐药菌的流行情况。克雷伯菌属是ETA中分离出的最常见病原体。不动杆菌属是我们ICU环境中最耐药的病原体，导致通气患者死亡率增加。慢性阻塞性肺疾病患者是研究组中VAP最常见的易感因素。
