Ventilator Associated Pneumonia in the ICU: Microbiological Profile

Abstract

Ventilator-associated pneumonia (VAP) refers to pneumonia which occurs in people who required mechanical ventilation through an endotracheal or tracheostomy tube for at least 48hours. The study includes patients of pneumonia who were on mechanical ventilation for more than 48hours and admitted to the intensive care unit (ICU). During the study period 48 patients developed VAP out of which 51 isolates were recovered of which 66.7% were male and 33.3% were female. The incidence of early onset VAP was 19% while late onset VAP was 81%. Acinetobacter species followed by Pseudomonas aeruginosa were the most common organisms causing early onset VAP. However, Acinetobacter spp. followed by Klebsiella spp. were the common organisms causing late onset VAP. Acinetobacter spp. was overall the most common isolate (66%) having 100% resistance to ampicillin, amikacin, ciprofloxacin, cefotaxime and cefepime. Pseudomonas spp. showed 100% resistance to gentamicin, ceftazidime and piperacillin. ESBL (Extended spectrum β lactamase) production was detected in 22% of the isolates with Enterobacter spp being the most common producer (50%). 80% of the isolates were carbapenemase producers, 74% showed MBL (Metallo β lactamase) production and 40% were AmpC producers. VAP due to multidrug resistant organisms (MDRO) is one of the most dreadful complications that can occur in the critical care setting. Various strategies such as strict infection control measures, judicious prescribing of antibiotics, antibiotic resistance surveillance programs and antibiotic cycling are crucial in controlling infections due to these bacteria in patients admitted to ICU.