Role of endotracheal tube culture or aspirate culture in identifying mechanically ventilated patients at risk for ventilator-associated pneumonia in neonatal intensive care unit at a tertiary care centre
Keywords:Ventilator associated pneumonia, Endotracheal tube aspirate, Neonatal intensive care unit
Background: Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection in Neonatal intensive care units (NICU). The standard methods of diagnosis are not popular because of their invasive nature and cost. Endotracheal aspirate (ETA) is a relatively easy and non-invasive method. The aim of the study was to document the role of routine endotracheal aspirate culture performed in predicting causative organism and selecting effective antibiotic therapy in the event of subsequent ventilator-associated pneumonia.
Methods: This study was conducted in the NICU of a medical college over ten months (September 2019 to June 2020). Newborns up to 28 days of life admitted in NICU and mechanically ventilated for more than 48 hours were enrolled in this prospective observational study (cross-sectional study). After 48 hours of ventilation, ET aspirate is collected and sent for culture and sensitivity testing in the microbiology lab. A Chi-square test was applied. P value<0.05 was considered statistically significant.
Results: A total of 50 patients were included in this study, of which 15 patients developed VAP. Among the 6 VAP pathogens in this study, 94.12% were gram negative bacilli and 5.88% were gram positive cocci. Acinetobacter baumanii (52.80%) was the most predominating causative organism, followed by Klebsiella, Pseudomonas and E. coli (11.76%), followed by coagulase-negative staphylococcus and Enterobacter cloacae (5.88%).
Conclusions: Acinetobacter baumanii was the most common organism isolated. Endotracheal tube aspirate cultures help in the early identification of patients at risk for developing VAP.
CDC. Pneumonia (Ventilator-associated [VAP] and non-ventilatorassociated Pneumonia [PNEU]) Event, 2022. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf. Accessed on 13 September 2022.
Sodhi MK, Kumar GAD, Singh K, Kumar A, Malhotra S, Neki NS. Incidence, Clinical and Microbiological Pattern of Ventilator Associated Pneumonia (VAP) In Neonatal Intensive Care Unit in Amritsar, India. Int J Current Res Med Sci. 2018;4(2):21-30.
Zwet WC, Kaiser AM, Elburg RM, Berkhof J, Fetter WP, Parlevliet GA, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect. 2005;61(4):300-11.
Geslain G, Guellec I, Guedj R, Guilbert J, Jean S, Valentin C, et al. Incidence and risk factors of ventilator-associated pneumonia in neonatal intensive care unit: a first French study. Minerva Anestesiol. 2018;84(7):829-35.
Labenne M, Poyart C, Rambaud C, Goldfarb B, Pron B, Jouvet P, et al. Blind protected specimen brush and bronchoalveolar lavage in ventilated children. Crit Care Med. 1999;27(11):2537-43.
Gauvin F, Dassa C, Chaïbou M, Proulx F, Farrell CA, Lacroix J. Ventilator-associated pneumonia in intubated children: comparison of different diagnostic methods. Pediatr Crit Care Med. 2003;4(4):437-43.
Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev. 2007;20(3):409-25.
Luyt CE, Bréchot N, Trouillet JL, Chastre J. Antibiotic stewardship in the intensive care unit. Crit Care. 2014;18(5):480.
Weber CD. Applying Adult Ventilator-associated Pneumonia Bundle Evidence to the Ventilated Neonate. Adv Neonatal Care. 2016;16(3):178-90.
Alaiyan A, Binmanee A. Neonatal Ventilator-Associated Pneumonia: An Under diagnosed Problem in the Neonatal Intensive Care. J Pediatric Neonatal Care. 2017;7(3):0028.
Hamaguchi S, Seki M, Yamamoto N, Hirose T, Matsumoto N, Irisawa T, et al. Case of invasive nontypable Haemophilus influenzae respiratory tract infection with a large quantity of neutrophil extracellular traps in sputum. J Inflamm Res. 2012;5:137-40.
Marquette CH, Georges H, Wallet F, Ramon P, Saulnier F, Neviere R, et al. Diagnostic efficiency of endotracheal aspirates with quantitative bacterial cultures in intubated patients with suspected pneumonia. Comparison with the protected specimen brush. Am Rev Respir Dis. 1993;148(1):138-44.
Köksal N, Hacimustafaoğlul M, Celebi S, Ozakin C. Nonbronchoscopic bronchoalveolar lavage for diagnosing ventilator-associated pneumonia in newborns. Turk J Pediatr. 2006;48(3):213-20.
Tripathi S, Malik GK, Jain A, Kohli N. Study of Ventilator Associated Pneumonia in Neonatal Intensive Care Unit. Internet J Med Upd. 2010;5(1):12-9.
Azab SF, Sherbiny HS, Saleh SH, Elsaeed WF, Elshafiey MM, Siam AG, et al. Reducing ventilator-associated pneumonia in neonatal intensive care unit using "VAP prevention Bundle": a cohort study. BMC Infect Dis. 2015;15:314.
Gupta MK, Mondkar J, Swami A, Hegde D, Goel S. Endotracheal Aspirate Microscopy, Cultures and Endotracheal Tube Tip Cultures for Early Prediction of Ventilator Associated Pneumonia in Neonates. Indian Pediatr. 2017;54(3):211-4.
Badr MA, Ali YF, Albanna EA, Beshir MR, Amr GE. Ventilator associated pneumonia in critically-ill neonates admitted to neonatal intensive care unit, zagazig university hospitals. Iran J Pediatr. 2011;21(4):418-24.