Bacteriological profile in intubated and mechanically ventilated babies in NICU in Krishna Institue of Medical Sciences, Karad, Maharashtra, India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20184291Keywords:
Antibiotic sensitivity, Intubation, Hospital acquired infections, Neonatal intensive care unit, Neonatal care, Respiratory infectionsAbstract
Background: Infections are the most important and leading cause of mortality and morbidity among the patients admitted in ICU. Nosocomial infection is a critical issue among intubated patients which is responsible for significant morbidity and mortality of these patients. The objectives of this study were to characterize bacterial species from the respiratory tract of patients undergoing endotracheal intubation and to determine the sensitivity of organism to various antibiotics. To propose a suitable antibiotic therapy in intubated and mechanically ventilated babies according to cultures and antibiotic sensitivity obtained from ET tube of previously intubated and ventilated babies in NICU.
Methods: It was a cross sectional descriptive study conducted in the NICU settings of KIMS, Karad, from January 2016 to June 2016. 78 neonates were intubated for more than 48 hours were included in the study during this duration, among which 44 were considered as cases.
Results: Out of 44 samples,16 were sterile and 28 were positive for organisms.25 cases were started prophylactic antibiotics before intubation with inj. ampicillin and inj. gentamicin (27.3%), inj. piperacillin and inj. amikacin (15.9%), inj. vancomycin (9.1%), inj. meropenem (2.3%), of which 6 cases were sterile and 19 were positive for organisms. Antibiotic sensitivity to inj. colisitn (38.7%) followed by inj. tigecycline (13.6%), inj. levofloxacin (4.6%) and inj. tetracycline (2,3%) and inj. clindamycin (2.3%). In majority cases antibiotic sensitivity was obtained positive to 3 antibiotics.
Conclusions: From the present study we have come to a conclusion that analyzing ET culture was important as the sensitivity to the antibiotics obtained was different from those given prophylactically as a protocol. Hence this study will help us in implementing different antibiotics prophylactically with regard to the commonly obtained sensitivity pattern.
References
Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A. Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance. Infect Control Hosp Epidemiol. 2004;25:753-8.
Elward AM, Warren DK, Fraser VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatr. 2002;109:758-64.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. In: R. N. Olmsted, ed. APIC infection control and applied epidemiology: principles and practice. Mosby, St. Louis, MO; 1996:A1-A19.
Gaynes RP, Edwards JR, Jarvis WR, Culver DH, J. Tolson S, Martone WJ, and the National Nosocomial Infection Surveillance System. Nosocomial infections among neonates in high-risk nurseries in the United States. Pediatr. 1996;98:357–361.
Drews MB, Ludwig AC, Leititis JU, Daschner FD. Low birth weight and nosocomial infection of neonates in a neonatal intensive care unit. J Hosp Infect. 1995;30:65-72.
Hemming VG, Overall JC, Britt MR. Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance. N Engl J Med. 1976;294:1310-6.
Ford-Jones EL, Mindorff CM, Langley JM, Allen U, Navas L, Patrick ML, et al. Epidemiologic study of 4684 hospital-acquired infections in pediatric patients. Pediatr Infect Dis J. 1989;8:668-75.
Diaz E, Planas K, Rello J. Infection associated with the use of assisted-ventilation devices. Enfermedades infecciosas y microbiologia clinica. 2008;26(7):465-70.
Zaichkin J, Wiswell TE. The history of neonatal resuscitation Neonatal Netw. 2002;21(5):21-8.
Gadani H, Vyas A, Kar AK. A study of ventilator associated pneumonia: incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesthesia. 2010;54(6):535.
Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator associated pneumonia by bacteriologic analysis of bronchoscopic and non bronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Resp Dis. 1991;143(5)(1):1121-9.
Tandia K, Wadhwani JL, Sharma M. A clinical study of pattern of microbiological colonization of endotracheal tube aspirate on mechanically ventilated patients. IJSR. 2013;4(11):2319-7064.
Johanson WG, Pierce AK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli: the significance of colonization of the respiratory tract. Ann Int Med. 1972;77(5):701-6.
Amini M, Javanmard A, Davati A, Azimi G. Bacterial colonization in tracheal tubes of ICU patients. Iranian J Pathol. 2009;4:123-7.
Abdollahi A, Shoar S, Shoar N. Microorganisms’ colonization and their antibiotic resistance pattern in oro-tracheal tube. Iranian J Microbiol. 2013;5(2):102-7.
Hemming VG, Overall JC, Britt MR. Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance. N Engl J Med. 1976;294:1310-6.
Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatr. 2003;112:1283-9.
Nazal-Matunog CL, Rodriguez L, Mercy G, Alberto L, Adrian CP, Remedios C. Nosocomial Pneumonia in mechanically ventilated patients. Phil J Microbiol Infect Dis. 1993;22:11-6.
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R, CDC and healthcare infection control practices advisory committee. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. Morb Mortal Wkly Rep Recomm Rep. 2004;53:1-36.
Collard HR, Saint S, Matthay MA. Prevention of ventilator associated pneumonia: an evidence-based systematic review. Ann Intern Med. 2003;138:494-501
Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354:1851-8.
Pittet D, Dharan S, Touveneau S, Sauvan V, Perneger TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch. Intern Med. 1999;159:821-6.
Won SP, Chou HC, Hsieh WS, Chen CY, Huang SM, Tsou KI, et al. Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2004;25:742-6.
Slagle TA, Bifano EM, Wolf JW, Gross SJ. Routine endotracheal cultures for the prediction of sepsis in ventilated babies. Arch Dis Childhood. 1989;64(1):34-8.
Cook DJ, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingham L, et al. Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA. 1996;275:308-14.
Pássaro L, Harbarth S, Landelle C. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrobial Resistance and Infection Control. 2016;5:43.
