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3 - Ventilator-associated pneumonia rate and causative microorganisms in an anesthesia intensive care unit
Yakup Tomak, Ayşe Ertürk, Ahmet Şen, Başar Erdivanlı, Aysel Kurt
Objective: Pneumonia is the most common nosocomial infection encountered in intensive care units. Pneumonia mostly occurs in form of ventilator-associated pneumonia (VAP) which is a maor cause of mortality and morbidity. Therefore, VAP rate should be determined while employing well grounded infection prevention measures. Also causative microorganisms and their susceptibilities should be determined to guide the antibiotic therapy.
Methods: Intensive care unit patients were prospectively surveyed in terms of nosoxomial infections through active surveillance methods. Centers for Disease Control and Prevention (CDC) criterias were used in detecting nosocomial infections. İnfection rates and cathehterization rates were calculated according to guidelines of Turkish National İnfection Surveillance Control Group (UHESKB).
Results: A total of 252 patients treated for longer than 48 hours in Anesthesia Intensive care Unit during January 2011 and January 2012 were surveyed. We detected VAP in 24 patients, all of whom received mechanical ventilator support. Mechanical ventilator usage rate was 58% and VAP rate was 16.49 in 1000 patient-ventilator days. Cultures of endotracheal aspiration samples showed that 18 (75%) of cases contained a single microorganism whereas 6 (25%) of cases contained two or more microorganisms. Twenty-seven (79.4%) of these microorganisms were gram-negative bacteria, 5 (14.7%) were gram-positive bacteria and 2 (5.8%) were candida species. Most commonly cultured gram-negative bacteria were Acinetobacter spp. 10 (29.4%), Acinetobacter baumannii 6 (17.6%), Pseudomonas aeruginosa 4 (11.7%%), Pseudomonas spp. 4 (11.7%) and Klebsiella spp. 3 (8.8%). Gram-positive microorganisms were MRSA 2 (5.8%) and MRKNS 3 (8.8%). Susceptibility tests showed that Acinetobacter species were resistant to imipeneme by 90%, ciprofloxacine by 60%, amikasine by 57%, and were totally susceptible to seftazidim, netilmisin, kolitsin and tigesikline. Other gram-negative bacteria were susceptible to carbapenems by 100%, ciproflxacine by 85%.
Conclusion: Culture and susceptibility test results showed that ampirical antibiotherapy in our intensive care unit should be against gram-negative bacteria and concerning carbapeneme resistant Acinetobacter species, combination therapies should be employed.
Keywords: Infection control, imipenem, intensive care unit, anesthesia, adult, ventilator-associated pneumonia
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