Patro Somi, Sarangi Gitanjali, Das Padma, Mahapatra Ashoka, Mohapatra Dharitri, Paty Bimoch Projna, Chayani Nirupama
Department of Microbiology, S.C.B. Medical College, Cuttack, Odisha, India.
Department of Microbiology, AIIMS, Raipur, Chhattisgarh, India.
Indian J Pathol Microbiol. 2018 Jul-Sep;61(3):375-379. doi: 10.4103/IJPM.IJPM_487_16.
Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection. The etiology of VAP and their antimicrobial susceptibility pattern varies with different patient populations and types of ICUs.
An observational cross-sectional study was performed over a period of 2 years in a tertiary care hospital to determine the various etiological agents causing VAP and to detect the presence of multidrug-resistant (MDR) pathogens in these VAP patients. Combination disk method, Modified Hodge test, ethylenediaminetetraacetic acid disk synergy test, and AmpC disk test were performed for the detection of extended-spectrum beta-lactamase (ESBL), carbapenemases, metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively.
The prevalence of VAP was 35%. Enterobacteriaceae (66.66%) and Staphylococcus aureus (20%) were common in early-onset VAP, while nonfermenters (50%) and Enterobacteriaceae (40.61%) were predominant from late-onset VAP. Nearly 60.87% of the bacterial pathogens were MDR. ESBL was produced by 21.74% of Enterobacteriaceae. AmpC β-lactamase was positive in 35.29% nonfermenters and 26.08% Enterobacteriaceae. MBL was positive in 17.64% nonfermenters and 17.39% Enterobacteriaceae. Among the S. aureus isolates, 75% were cefoxitin resistant. Prior antibiotic therapy (P = 0.001) and hospitalization of 5 days or more (P = 0.001) were independent risk factors for VAP by MDR pathogens. polymyxin B, tigecycline, and vancomycin were the most sensitive drugs for Gram-negative and positive isolates respectively from VAP.
SPSS for Windows Version SPSS 17.0 (SPSS Inc., Chicago, IL, USA) and Chi-square with Yates correction.
Late-onset VAP is increasingly associated with MDR pathogens. Treatment with polymyxin B, tigecycline, and vancomycin should be kept as last-line reserve drugs against most of the MDR pathogens.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）获得性感染中最常见的类型。VAP的病因及其抗菌药物敏感性模式因患者群体和ICU类型的不同而有所差异。
在一家三级护理医院进行了一项为期2年的观察性横断面研究，以确定引起VAP的各种病原体，并检测这些VAP患者中多重耐药（MDR）病原体的存在情况。分别采用复合纸片法、改良Hodge试验、乙二胺四乙酸纸片协同试验和AmpC纸片试验检测超广谱β-内酰胺酶（ESBL）、碳青霉烯酶、金属β-内酰胺酶（MBL）和AmpCβ-内酰胺酶。
VAP的患病率为35%。早发性VAP中肠杆菌科细菌（66.66%）和金黄色葡萄球菌（20%）较为常见，而晚发性VAP中以非发酵菌（50%）和肠杆菌科细菌（40.61%）为主。近60.87%的细菌病原体为多重耐药菌。21.74%的肠杆菌科细菌产生ESBL。35.29%的非发酵菌和26.08%的肠杆菌科细菌AmpCβ-内酰胺酶呈阳性。17.64%的非发酵菌和17.39%的肠杆菌科细菌MBL呈阳性。在金黄色葡萄球菌分离株中，75%对头孢西丁耐药。既往抗生素治疗（P = 0.001）和住院5天及以上（P = 0.
