Pradeep M.S.S

Abstract

Introduction: Hospital-acquired pneumonia (HAP) is defined as an infection in patients admitted in hospital for more than 48hours, and ventilator associated pneumonia (VAP) can be defined as infection occurring in patients admitted in ICU after 48hrs endotracheal intubation and mechanical ventilation. VAP has a mean of 7.3/1000 ventilator days for medical ICU patients and 13.2/1000 ventilator days for surgical ICU patients. The crude mortality rates for HAP are approximately 10% and are higher for VAP, ranging from 20% to 60%. The culture of endotracheal (ET) aspirates will help know the etiological agent and formulate the antibiotic policy for early treatment. Objectives: To isolate the bacterial pathogens of ET secretions from patients with VAP and know their antibiotic susceptibility pattern. Results: In the present study, out of 102 endotracheal secretions from cases of VAP, 88 samples (86.27%) were culture positive, and the remaining 14 samples (13.73%) were culture negative. Out of the 88 positive cultures, 62 samples (60.78%) showed growth of single isolates, and 26 samples (25.49%) showed multiple isolates. Out of the 114 isolates, 18 isolates (15.8%) were gram positive organisms, and 96 isolates (84.2%) were gram negative organisms. Of the gram positive isolates, the predominant organism was Methicillin resistant (MRSA) (55.56%), followed by Methicillin sensitive (MSSA) (22.22%) and (22.22%). Out of the gram negative isolates, the predominant organism was (36.46%), followed by Acinetobacter spp (25%), (23.96%), (12.5%), (1.04%), and Proteus mirabilis (1.04%). In the present study, Gram positives isolates showed the highest susceptibility to vancomycin and linezolid (100%), and gram negative isolates showed the highest susceptibility to polymyxin B (100%) and meropenem (47.92%). Conclusion: The study gives insight into the bacterial pathogens and their antibiotic susceptibility patterns of isolates from endotracheal secretions of mechanically ventilated patients to prevent the mortality and morbidity of mechanical ventilation and VAP, helping in formulating an antibiotic policy for appropriate empirical therapy.   Keywords: Gram positive organisms, Gram negative organisms, Mechanical ventilation, ventilator associated pneumonia (VAP), Antibiotic susceptibility testing

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Abstract

Introduction: Enterococci are gram positive cocci encountered in various human infections.The most striking feature of enterococci is their relative and absolute resistance to variety of antibiotics.Vancomycin resistant enterococci (VRE) were first described in late 1980 and the incidence of nosocomial infections by VRE being 11.9% in Asia Pacific and 35.5% in U.S. Daptomycin is a lipopeptide antibiotic with bactericidal activity . Objective: To study the daptomycin susceptibility in enterococci isolated in urinary samples. Results: A total of 76 strains of enterococci were isolated during the study period.25 (33%) were identified as E.faecium and 51 (67%) as E.faecalis. Most of the Enterococcal isolates (82.8%) were resistant to Norfloxacin followed by 71% being resistant to tetracycline and 76% of isolates were sensitive to nitrofurantoin. Most of the E.faecium isolates were multidrug resistant. Of the 76 Enterococci isolated only 2(2.63%) were VRE and both the VRE strains isolated were E.faecium. There was no resistance to linezolid including the VRE strains. All the isolates 76 (100%) were sensitive to daptomycin including the VRE strains. Conclusions: Our study mainly focused on susceptibility of enterococcal isolates in urinary samples to daptomycin which has bactericidal activity against gram positive organisms including multidrug resistant strains. This study shows growing concern for increasing antibiotic resistance in enterococcal isolates and treatment of these infections with daptomycin is invited as there are only few reports of daptomycin non susceptible enterococci (DNSE). Keywords: Enterocooci, Urinary tract infections, Drug resistance, VRE, Daptomycin.

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