Swagnik Roy 1 , Bibhas Saha Dalal 2 , Saurabh Mitra 3 , Barun Saha Dalal 4 , Rajat Dasgupta 5
BACKGROUND The development of nosocomial infections mostly ventilator-associated pneumonia due to prolonged stay in the ICUs varies grossly in different outcomes including increased morbidity and mortality. The American Thoracic Society (ATS) guidelines recommend that quantitative cultures can be performed on ETA or samples collected either bronchoscopically or nonbronchosopically.1 More importantly, recent small trials have repeatedly shown that there is no advantage of bronchoscopic cultures over quantitative endotracheal aspirate.2,3,4 Detection of causative organisms and their antibiotic MIC determination is absolutely necessary to initiate the specific antibiotic with appropriate dose thereby reducing the adverse effects of inadequate antibiotic treatment on the patient prognosis. MATERIALS AND METHODS The prospective study was carried out during the period from August 2012 to January 2015 in Department of Microbiology from the samples those were received as a routine culture from VAP suspected patients from the ICU. There were 373 samples from which 123 were culture positives. Inclusion criteria were all the patients 18 years and more age group who were intubated in mechanical ventilator and others were excluded in the study. Clinical Pulmonary Infection Score (CPIS) was given to each patient included in the study on daily basis. CPIS of greater than six was used as diagnostic criteria for VAP.5 Clinically diagnosed ventilator-associated pneumonia were observed and clinical parameters were recorded from their medical records and bedside charts. All patients with clinical and radiological signs suggestive of pneumonia on admission. Endotracheal aspirate was collected by using a 22-inch Romsons suction catheter. Chest vibration or percussion for 10 mins. was used. Only 1 ETA sample was collected from each patient and was immediately taken to the laboratory for processing. RESULTS Klebsiella pneumonia was isolated 39.02%, Pseudomonas aeruginosa was isolated 17.07%, Acinetobacter baumanni was isolated 30.08%, E. coli 8.10% and E. aerogenes 5.60%. CONCLUSION Most of the isolates were from Enterobacteriaceae family and very drug-resistant variety. Antibiotic stewardship was done following this study to control the ventilator-associated pneumonia. Empiric antibiotic protocol was formulated and it was very effective.
