Incidence of ventilator associated pneumonia and drug-resistant bacterial preponderance: a fact to ponder

Background: Management of ventilator-associated pneumonia (VAP) in critically ill patients is a challenge to intensivists. This study aimed at identifying microbial factors and infection control practices that influenced incidence of VAP in a tertiary care hospital.Methods: Incidence of VAP among patients admitted to the intensive care units (ICU) from January to December 2016 was estimated. A one year period of study was divided into 3 segments of January to April, May to August, and September to December. Isolation rates of Gram Negative Bacteria (GNB) from respiratory samples and their extensively drug resistance (XDR) pattern were also analyzed.Results: A total of 14 patients had developed VAP. Incidence of VAP in the 1st, 2nd and 3rd segments of the year was 25.3, 15.2 and 4.1/1000 ventilator days respectively. Acinetobacter baumannii was the causative agent in all patients (100%). Among all GNB isolated the rate of Acinetobacter baumannii was 83%, 64%, 59% during the 3 segments of the year. XDR strains were 76%, 62% and 55%. Interventional factors like improvement in infection control practices which included hand hygiene, cohorting of MDR/XDR infected patients and environmental surveillance was noted.Conclusions: The VAP incidence declined in the later part of the year than the earlier (25.3 Vs 4.1/1000 ventilator days), with a notable decrease in the isolation of Acinetobacter baumannii (p value-0.005) and XDR organisms (p value-0.01). Directly proportionate association of VAP incidence with microbial factors were noted. Infection control measures to curtail MDR organisms should be an important component in the management of patients on ventilators

Escherichia coli in hospitalised patients

Background Extended spectrum betalactamase (ESBL)-producing organisms are a major cause of hospital-acquired infections. ESBL-producing Escherichia coli (E. coli) have been recovered from the hospital environment. These drug-resistant organisms have also been found to be present in humans as commensals. The present investigation intended to isolate ESBL-producing E. coli from the gut of already infected patients; to date, only a few studies have shown evidence of the gut microflora as a major source of infection. Aims This study aimed to detect the presence of ESBL genes in E.coli that are isolated from the gut of patients who have already been infected with the same organism. Methods A total of 70 nonrepetitive faecal samples were collected from in-patients of our hospital. These in-patients were clinically diagnosed and were culture-positive for ESBL-producing E. coli either from blood, urine, or pus. Standard microbiological methods were used to detect ESBL from clinical and gut isolates. Genes coding for major betalactamase enzymes such as blaCTX-M, blaTEM, and blaSHV were investigated by polymerase chain reaction (PCR). Results ESBL-producing E. coli was isolated from 15 (21 per cent) faecal samples of the 70 samples that were cultured. PCR revealed that out of these 15 isolates, the blaCTX-M gene was found in 13 (86.6 per cent) isolates, the blaTEM was present in 11 (73.3 per cent) isolates, and blaSHV only in eight (53.3 per cent) isolates. All 15 clinical and gut isolates had similar phenotypic characters and eight of the 15 patients had similar pattern of genes (blaTEM, blaCTX-M, and blaSHV) in their clinical and gut isolates. Conclusion Strains with multiple betalactamase genes that colonise the gut of hospitalised patients are a potential threat and it may be a potential source of infection