ANTIMICROBIAL RESISTANCE PATTERN OF BACTERIAL ISOLATES FROM VENTILATOR ASSOCIATED PNEUMONIA PATIENTS IN ICU ALONG WITH RISK STRATIFICATION
Main Article Content
Keywords
Ventilator associated pneumonia, Multi drug resistance , Quantitative culture
Abstract
Background: Ventilator associated pneumonia (VAP) is one of the key challenges for critical care physicians. The study was done to identify the risk factors in patients developing VAP, the bacteriological profile and resistance pattern of the infective bacteria in our intensive care units (ICUs), and formulate empirical antibiotic policy.
Methods: This prospective study was carried out over 1 year period in a Medical College in Kolkata. Out of 60 samples collected from patients admitted to ICU and requiring mechanical ventilation for more than 48 hours and suspected of having Ventilator associated events (VAE). Semi-quantitative culture of Deep tracheal aspirate (DTA) was processed
Results: In the present study of 60 respiratory samples in the form of tracheal aspirate -50(83%) showed growth and 10 (17%) showed no growth. In the study, 98% of isolates were gram negative bacilli and Acinetobacter baumannii was the commonest isolate. Common co-morbidities include Cerebrovascular accident, puerperal sepsis, trauma, diabetic coma, and neurosurgery post-operative complications. Duration of ventilation and history of previous antibiotic use emerged as significant risk factors in the development of VAE in the ICU. Conclusion: VAP is associated with significant morbidity and mortality not only due to VAP but the underlying critical illness in the patients. Microbiological data should be used for formulating antibiotic policy of the institution. The pitfall in using empiric antibiotics for suspicion of VAP is the potential for antibiotic overuse, the emergence of resistance, and unnecessary adverse effects.
References
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24. Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia:Role of colonizers and value of routine endotracheal aspirate cultures. Int J Infect Dis [Internet]. 2010;14(8):e723–9
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26. Saravu K, Preethi V, Kumar R, Guddattu V, Shastry AB, Mukhopadhyay C. Determinants of ventilator associated pneumonia and its impact on prognosis: A tertiary care experience. Indian J Crit Care Med [Internet]. 2013 Nov [cited 2016 Sep 25];17(6):337–42.
27. Manchanda V, Sanchaita S, Singh N. Multidrug resistant acinetobacter. J Glob Infect Dis [Internet]. 2010 Sep [cited 2016 Apr 24];2(3):291–304.
28. Meduri GU, Beals DH, Maijub AG, Baselski V. Protected bronchoalveolar lavage. A new bronchoscopic technique to retrieve uncontaminated distal airway secretions. Am Rev Respir Dis [Internet]. 1991 Apr [cited 2016 Jun 26];143(4 Pt 1):855–64.
29. Ranjan N, Chaudhary U, Chaudhry D, Ranjan KP. Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality. Indian J Crit Care Med [Internet]. 2014 Apr [cited 2016 Oct 5];18(4):200–4.
30. Mukhopadhyay C, Bhargava A, Ayyagari A. Role of mechanical ventilation & development of multidrug resistant organisms in hospital acquired pneumonia. Indian J Med Res [Internet]. 2003 Dec [cited 2016 Oct 2];118:229–35.
31. Ranjan N, Ranjan K, Chaudhary U, Chaudhry D. Antimicrobial resistance in bacteria causing ventilator-associated pneumonia in a tertiary care hospital: one year prospective study. Int J Res Med Sci [Internet]. 2014 [cited 2016 Oct 7];2(1):228.
32. WHO | Antimicrobial resistance: global report on surveillance 2014 [Internet]. [cited 2021 Mar 6]. Available from: https://www.who.int/drugresistance /documents/ Surveillance report/en/
33. Tanwar J, Das S, Fatima Z, Hameed S. Multidrug resistance: An emerging crisis. Vol. 2014, Interdisciplinary Perspectives on Infectious Diseases. Hindawi Limited; 2014.
34. Akhtar N. Hospital acquired infections in a medical intensive care unit. J Coll Physicians Surg Pak [Internet]. 2010 Jun [cited 2016 Oct 11];20(6):386–90.
35. Fatima A, Naqvi SB, Khaliq SA, Perveen S, Jabeen S. Antimicrobial susceptibility pattern of clinical isolates of Pseudomonas aeruginosa isolated from patients of lower respiratory tract infections. Springerplus [Internet]. 2012 Dec
36. Gonlugur U, Bakici MZ, Akkurt I, Efeoglu T. Antibiotic susceptibility patterns among respiratory isolates of Gram-negative bacilli in a Turkish university hospital. BMC Microbiol [Internet]. 2004 Aug 22 [cited 2016 Oct 11];4:32.
37. Gladstone P, Rajendran P, Brahmadathan KN. Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory infections in the intensive care units. Indian J Med Microbiol [Internet]. 2005 Jul [cited 2016 Oct 11];23(3):189–91.
38. Küçükates E, Kocazeybek B. High resistance rate against 15 different antibiotics in aerobic gram-negative bacteria isolates of cardiology intensive care unit patients. Indian J Med Microbiol [Internet]. [cited 2016 Oct 11];20(4):208–10.
39. Walkty A, DeCorby M, Nichol K, Karlowsky JA, Hoban DJ, Zhanel GG. In vitro activity of colistin (polymyxin E) against 3,480 isolates of gram-negative bacilli obtained from patients in Canadian hospitals in the CANWARD study, 2007-2008. Antimicrob Agents Chemother [Internet]. 2009 Nov [cited 2016 Oct 11];53(11):4924–6.
40. Yayan J, Ghebremedhin B, Rasche K. Antibiotic Resistance of Pseudomonas aeruginosa in Pneumonia at a Single University Hospital Center in Germany over a 10-Year Period. PLoS One [Internet]. 2015 [cited 2016 Oct 11];10(10):e0139836.
2. Jakribettu RP, Boloor R. Characterisation of aerobic bacteria isolated from endotracheal aspirate in adult patients suspected ventilator associated pneumonia in a tertiary care center in Mangalore. Saudi J Anaesth [Internet]. 2012 Apr [cited 2016 May 24];6(2):115–9.
3. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and health care associated pneumonia. Am J Respir Crit Care Med [Internet]. 2005 Feb 15 [cited 2016Aug 16];171(4):388–416.
4. Arango MV, Martí AT, Ordeñana JI, Lerma FÁ, Joaquinet NC. Diagnostic Value ofQuantitative Cultures of Endotracheal Aspirate in Ventilator-Associated Pneumonia????:A Multicenter Study. 2003;39(9).
5. Ferrer M, Difrancesco LF, Liapikou A, Rinaudo M, Carbonara M, Li Bassi G, et al.Polymicrobial intensive care unit-acquired pneumonia: prevalence, microbiology and outcome. Crit Care [Internet]. 2015 Dec 23 [cited 2016 May 24];19(1):450.
6. Raoof S, Baumann MH. Ventilator-Associated Events: The New Denition. Am J Crit Care [Internet]. 2014 Jan 1 [cited 2016 Aug 15];23(1):7–9. Available from: http://ajcc.aacnjournals. org/cgi/ doi/10.4037/ajcc2014469
7. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL LA. Harrison's Principles of Internal Medicine.19th ed. New York: McGraw Hill; In 2015.
8. Corrêa R de A, Luna CM, Anjos JCFV dos, Barbosa EA, Rezende CJ de, Rezende AP, et al. *. J Bras Pneumol [Internet]. 2014 Dec [cited 2016 Aug 17];40(6):643–51.
9. Collee JG, Fraser AG, Marmion BP, Simmons A editors. Mackie & McCartney Practical Medical Microbiology. 12th ed. India: Elsevier; 2012.; 2012.
10. Clinical & Laboratory Standards Institute: CLSI Guidelines [Internet]. [cited 2021 Mar 6]. Available from: https://clsi.org/
11. Varley Bsc A, Frca M, Williams H, Bch M, Fletcher FS, Frcpe F. Antibiotic resistance in the intensive care unit.
12. Bhattacharya S, Mondal A. Clinical microbiology in the intensive care unit: Strategic and operational characteristics. Indian J Med Microbiol [Internet]. 2010 [cited 2016 Apr 20];28(1):5.
13. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med [Internet]. 1996 May [cited 2016 Aug 18];153(5):1711–25
14. Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian J Crit Care Med [Internet]. 2015 Jan [cited 2016 Oct 2];19(1):14–20.
15. Singh AK, Sen MR, Anupurba S, Bhattacharya P. Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU. J Commun Dis [Internet]. 2002 Dec [cited 2016 Oct 2];34(4):257–63.
16. Goel N, Chaudhary U, Aggarwal R, Bala K. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the Intensive care unit. Indian J Crit Care Med [Internet]. 2009 [cited 2016 Oct 2];13(3):148–51.
17. Rajasekhar T, Anuradha K, Suhasini T, Lakshmi V. The role of quantitative cultures of non-bronchoscopic samples in ventilator associated pneumonia. Indian J Med Microbiol [Internet]. 2006 Apr [cited 2016 Oct 11];24(2):107–13.
18. Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator associated pneumonia in a tertiary care hospital: a nine months' prospective study. Ann Thorac Med [Internet]. 2007 Apr [cited 2016 Oct 4];2(2):52–7.
19. Ranjan N, Chaudhary U, Chaudhry D, Ranjan KP. Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality. Indian J Crit Care Med [Internet]. 2014 Apr [cited 2016 Oct 4];18(4):200–4.
20. Goel N, Chaudhary U, Aggarwal R, Bala K. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the Intensive care unit. Indian J Crit Care Med [Internet]. 2009 [cited 2016 Oct 4];13(3):148–51.
21. Gadani H, Vyas A, Kar AK. A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesth [Internet]. 2010 Nov [cited 2016 Apr 20];54(6):535–40.
22. Vora CS, Karnik ND, Gupta V, Nadkar MY, Shetye J V. Clinical Prole of Patients Requiring Prolonged Mechanical Ventilation and their Outcome in a Tertiary Care Medical ICU. J Assoc Physicians India. 2015;63.
23. Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator associated pneumonia in a tertiary care hospital: a nine months' prospective study. Ann Thorac Med [Internet]. 2007 Apr [cited 2016 May 3];2(2):52–7.
24. Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia:Role of colonizers and value of routine endotracheal aspirate cultures. Int J Infect Dis [Internet]. 2010;14(8):e723–9
25. Di Pasquale M, Ferrer M, Esperatti M, Crisafulli E, Giunta V, Li Bassi G, et al. Assessment of severity of ICU-acquired pneumonia and association with etiology. Crit Care Med [Internet]. 2014 Feb [cited 2016 May 24];42(2):303–12.
26. Saravu K, Preethi V, Kumar R, Guddattu V, Shastry AB, Mukhopadhyay C. Determinants of ventilator associated pneumonia and its impact on prognosis: A tertiary care experience. Indian J Crit Care Med [Internet]. 2013 Nov [cited 2016 Sep 25];17(6):337–42.
27. Manchanda V, Sanchaita S, Singh N. Multidrug resistant acinetobacter. J Glob Infect Dis [Internet]. 2010 Sep [cited 2016 Apr 24];2(3):291–304.
28. Meduri GU, Beals DH, Maijub AG, Baselski V. Protected bronchoalveolar lavage. A new bronchoscopic technique to retrieve uncontaminated distal airway secretions. Am Rev Respir Dis [Internet]. 1991 Apr [cited 2016 Jun 26];143(4 Pt 1):855–64.
29. Ranjan N, Chaudhary U, Chaudhry D, Ranjan KP. Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality. Indian J Crit Care Med [Internet]. 2014 Apr [cited 2016 Oct 5];18(4):200–4.
30. Mukhopadhyay C, Bhargava A, Ayyagari A. Role of mechanical ventilation & development of multidrug resistant organisms in hospital acquired pneumonia. Indian J Med Res [Internet]. 2003 Dec [cited 2016 Oct 2];118:229–35.
31. Ranjan N, Ranjan K, Chaudhary U, Chaudhry D. Antimicrobial resistance in bacteria causing ventilator-associated pneumonia in a tertiary care hospital: one year prospective study. Int J Res Med Sci [Internet]. 2014 [cited 2016 Oct 7];2(1):228.
32. WHO | Antimicrobial resistance: global report on surveillance 2014 [Internet]. [cited 2021 Mar 6]. Available from: https://www.who.int/drugresistance /documents/ Surveillance report/en/
33. Tanwar J, Das S, Fatima Z, Hameed S. Multidrug resistance: An emerging crisis. Vol. 2014, Interdisciplinary Perspectives on Infectious Diseases. Hindawi Limited; 2014.
34. Akhtar N. Hospital acquired infections in a medical intensive care unit. J Coll Physicians Surg Pak [Internet]. 2010 Jun [cited 2016 Oct 11];20(6):386–90.
35. Fatima A, Naqvi SB, Khaliq SA, Perveen S, Jabeen S. Antimicrobial susceptibility pattern of clinical isolates of Pseudomonas aeruginosa isolated from patients of lower respiratory tract infections. Springerplus [Internet]. 2012 Dec
36. Gonlugur U, Bakici MZ, Akkurt I, Efeoglu T. Antibiotic susceptibility patterns among respiratory isolates of Gram-negative bacilli in a Turkish university hospital. BMC Microbiol [Internet]. 2004 Aug 22 [cited 2016 Oct 11];4:32.
37. Gladstone P, Rajendran P, Brahmadathan KN. Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory infections in the intensive care units. Indian J Med Microbiol [Internet]. 2005 Jul [cited 2016 Oct 11];23(3):189–91.
38. Küçükates E, Kocazeybek B. High resistance rate against 15 different antibiotics in aerobic gram-negative bacteria isolates of cardiology intensive care unit patients. Indian J Med Microbiol [Internet]. [cited 2016 Oct 11];20(4):208–10.
39. Walkty A, DeCorby M, Nichol K, Karlowsky JA, Hoban DJ, Zhanel GG. In vitro activity of colistin (polymyxin E) against 3,480 isolates of gram-negative bacilli obtained from patients in Canadian hospitals in the CANWARD study, 2007-2008. Antimicrob Agents Chemother [Internet]. 2009 Nov [cited 2016 Oct 11];53(11):4924–6.
40. Yayan J, Ghebremedhin B, Rasche K. Antibiotic Resistance of Pseudomonas aeruginosa in Pneumonia at a Single University Hospital Center in Germany over a 10-Year Period. PLoS One [Internet]. 2015 [cited 2016 Oct 11];10(10):e0139836.
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Aug 22, 2025
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Dr.Sayan Pal, & , D. C. (2025). ANTIMICROBIAL RESISTANCE PATTERN OF BACTERIAL ISOLATES FROM VENTILATOR ASSOCIATED PNEUMONIA PATIENTS IN ICU ALONG WITH RISK STRATIFICATION. Journal of Population Therapeutics and Clinical Pharmacology, 32(7), 884-890. https://doi.org/10.53555/whhke821
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Author Biographies
Dr.Sayan Pal
Assistant Professor, Department of Microbiology Santiniketan Medical College, Bolpur, West Bengal
Dr.Samatirtha Chandra
Associate Professor, Department of Microbiology Santiniketan Medical College, Bolpur, West Bengal
How to Cite
Dr.Sayan Pal, & , D. C. (2025). ANTIMICROBIAL RESISTANCE PATTERN OF BACTERIAL ISOLATES FROM VENTILATOR ASSOCIATED PNEUMONIA PATIENTS IN ICU ALONG WITH RISK STRATIFICATION. Journal of Population Therapeutics and Clinical Pharmacology, 32(7), 884-890. https://doi.org/10.53555/whhke821