Dharnish Kumar Jha

Abstract

Introduction: Ventilator associated events (VAE) refer to new surveillance definition developed by Centre for Disease Control and prevention (CDC)/ National Healthcare Safety Network (NHSN) is in use since the year 2013, switching the focus of surveillance from ventilator associated pneumonia (VAP) to ventilator associated events (VAE). A number of studies have been conducted in the United States and other Western countries to evaluate its practicality. However, information on VAE in Asian countries is scarce. The purpose of this preliminary study was to illuminate the incidence and microbiological profile of VAEs in tertiary hospital in Nepal, as a first step in the effort to determine its practicality. The objective of the study was to determine the incidence, etiological agent and mortality of VAE in patients on mechanical ventilation in medical Intensive care unit (ICU) of a tertiary hospital. Materials and Methods: Patients admitted in ICU on Mechanical Ventilation were evaluated daily using the VAE surveillance criteria. At least 2 days of stable or decreasing ventilator settings followed by at least 2 days of increased ventilator settings was used as definition of VAE. Three tiered approach of VAE, namely Ventilator-Associated Condition (VAC), Infection-related Ventilator-Associated Complication (IVAC) and Possible VAP (PVAP) was used for the final classification of cases. Results: Of the 313 patients admitted to the ICU over the period of one year, 52 patients received MV for ?2 days and met baseline criteria for VAEs Surveillance. Out of 52 patients, 14(27%) developed VAC only, 13(25%) developed IVAC only and 25(48%) patients developed PVAP. Endotracheal aspirate culture was positive in 25 patients (48%). The organisms isolated were Acinetobacter baumanii complex 14(53.84%), Pseudomonas aeruginosa 7(26.92%), Klebsiella pneumoniae 4(15.38%), and Escherichia coli 1(3.84%). Polymicrobial growth was observed in one. Almost all the isolates 25 (96%) being multidrug resistant. Overall mortality rate in patients with VAE was 36.5% with highest mortality rate in PVAP (44%). Early onset PVAP was observed in 9 (36%) where as 16 (64%) had late- onset VAP. Conclusion: VAE mostly being health care associated event and prevalence of multidrug resistance in as observed in this study warrant clinician to practices infection control measures and rationale use of antimicrobials as effective measures for infection control.   Keywords: Intensive care unit, Mechanical ventilation, Ventilator associated event, Ventilator associated pneumonia.

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Abstract

Introduction: The emergence of resistance to multiple antimicrobial agents in pathogenic bacteria poses a significant public health threat because few or no effective antimicrobials are available for infectious diseases. Acinetobacter baumannii is a major cause of device-associated infections that pose a serious threat to critically ill patients. Resistance patterns are thought to result in very limited treatment options and high mortality. We examined the prevalence of Acinetobacter baumannii in endotracheal aspirates samples and explored their antibiotics susceptibility. Objective: To determine the value of routine endotracheal aspirate cultures performed prior to the onset of the likely onset of ventilator-associated pneumonia (PVAP) in predicting pathogenic microorganisms and susceptibility to their antibiotics. Materials and Methods: Patients admitted to the ventilatory intensive care unit were tested daily, and endotracheal aspirated (ET) specimens from suspected patients were sent to a microbiology laboratory for culture and sensitivity measurements. Results: Of the 52 patients, only twenty five (48%) developed PVAP. Endotracheal aspirate cultures were positive in all PVAP cases. The most commonly isolated bacteria was Acinetobacter baumannii 14 (56%), followed by Pseudomonas aeruginosa 6 (24%) and Klebsiella pneumoniae 4 (16%). Almost all isolates of Acinetobacter baumannii are multidrug resistant (MDR). ICU stays greater than 16 days were observed for the pathogen Acinetobacter baumannii. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is a widespread epidemic, leading to high mortality, long ICU stays, and a difficult case for ICU physicians. Further prospective studies are needed to tackle this threat. Keywords: Intensive care unit, Multidrug resistant, Endotracheal aspirate, Possible Ventilator associated pneumonia

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