Department of Clinical Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
School of Optometry and Vision Science, University of New South Wales, Australia.
Biomed Res Int. 2021 May 28;2021:8817700. doi: 10.1155/2021/8817700. eCollection 2021.
Emerging threat of drug resistance among pathogens causing ventilator-associated pneumonia (VAP) has resulted in higher hospital costs, longer hospital stays, and increased hospital mortality. Biofilms in the endotracheal tube of ventilated patients act as protective shield from host immunity. They induce chronic and recurrent infections that defy common antibiotics. This study intended to determine the biofilm produced by pathogens causing VAP and their relation with drug resistance.
Bronchoalveolar lavage and deep tracheal aspirates ( = 70) were obtained from the patients mechanically ventilated for more than 48 hours in the intensive care units of Tribhuvan University Teaching Hospital, Kathmandu, and processed according to the protocol of the American Society for Microbiology (ASM). Antibiotic susceptibility testing was done following Clinical and Laboratory Standards Institute (CLSI) 2017 guidelines. Biofilm formation was determined using the microtiter plate method described by Christensen and modified by Stepanovoic et al.
Significant microbial growth was seen in 78.6% of the total samples with 52.7% monomicrobial, 45.5% polymicrobial, and 1.8% fungal infection. Among the 71 isolates obtained, bulk was gram-negative ( = 64, 90.1%). (31.0%) was the predominant isolate followed by complex (16.9%), (16.9%), (15.5%), (7.0%), (5.6%), (2.8%), (1.4%), complex (1.4%), and (1.4%). Of the total isolates, 56.3% were biofilm producers. Multidrug-resistant (MDR) organisms, extended-spectrum -lactamase (ESBL), and metallo--lactamase (MBL) producers were preeminent among the biofilm producers. The highest producer of biofilm was (19.7%). Among gram-negative biofilm producers, 42.2% were MDR, 21.9% were ESBL producers, and 7.8% were MBL producers.
Gram-negative nonfermenter bacteria account for the bulk of nosocomial pneumonia. MDR, ESBL, and MBL production was preponderant among the biofilm producers. The rampant spread of drug resistance among biofilm producers is summoning novel interventions to combat multidrug resistance.
导致呼吸机相关性肺炎（VAP）的病原体的耐药性出现了新的威胁，这导致了更高的医院成本、更长的住院时间和更高的医院死亡率。呼吸机患者的气管内导管中的生物膜充当了宿主免疫的保护屏障。它们会引发慢性和复发性感染，使常见抗生素无法发挥作用。本研究旨在确定引起 VAP 的病原体产生的生物膜及其与耐药性的关系。
从在加德满都特里布万大学教学医院接受机械通气超过 48 小时的患者中获得支气管肺泡灌洗和深气管抽吸物（=70），并按照美国微生物学会（ASM）的方案进行处理。根据临床和实验室标准协会（CLSI）2017 指南进行抗生素敏感性测试。使用 Christensen 描述的微量滴定板法并经 Stepanovoic 等人修改来确定生物膜形成。
总样本中有 78.6%显示出显著的微生物生长，其中 52.7%为单微生物感染，45.5%为多微生物感染，1.8%为真菌感染。在获得的 71 株分离株中，大部分为革兰氏阴性菌（=64，90.1%）。铜绿假单胞菌（31.0%）是主要分离株，其次是鲍曼不动杆菌（16.9%）、肺炎克雷伯菌（16.9%）、洋葱伯克霍尔德菌（15.5%）、大肠埃希菌（15.5%）、奇异变形菌（7.0%）、肺炎链球菌（5.6%）、流感嗜血杆菌（2.8%）、金黄色葡萄球菌（1.4%）、铜绿假单胞菌（1.4%）和鲍曼不动杆菌（1.4%）。在总分离株中，56.3%为生物膜产生菌。多药耐药（MDR）、产超广谱β-内酰胺酶（ESBL）和产金属β-内酰胺酶（MBL）的生物体是生物膜产生菌中的主要耐药菌。生物膜产生量最大的是铜绿假单胞菌（19.7%）。在革兰氏阴性生物膜产生菌中，42.2%为 MDR，21.9%为 ESBL 产生菌，7.8%为 MBL 产生菌。
革兰氏阴性非发酵菌是医院获得性肺炎的主要病原体。生物膜产生菌中存在多药耐药、产 ESBL 和产 MBL 的情况。生物膜产生菌中耐药性的广泛传播正在呼唤新的干预措施来对抗多药耐药性。
