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Antibiotic susceptibility pattern of bacteria isolated from adult patients with ventilator associated pneumonia (VAP) in intensive care areas in a tertiary care hospital
journal of patient safety & infection control 3 ( 2 0 1 5 ) 70–117
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Department of Medicine (Infectious Disease Unit), Christian Medical College and Hospital, Ludhiana, Punjab, India 3 College of Nursing, Christian Medical College and Hospital, Ludhiana, Punjab, India 4 Christian Medical College and Hospital, Ludhiana, Punjab, India Introduction: Hand hygiene is recognized as the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of health care associated infections. Despite the relative simplicity of this procedure, compliance with hand hygiene among health care providers is low. Materials and methods: This cross-sectional observational study was conducted in a tertiary care 1000 bedded hospital situated in northern India. Verbal consent was obtained from health care workers. A self-structured questionnaire was distributed randomly containing a set of 25 questions regarding hand-hygiene knowledge. Results: The total of 100 health care workers consisting of 50 doctors and 50 nurses participated in the study. The study was analyzed using independent samples t-test. A p-value of <0.05was considered as significant and <0.01 was considered as highly significant. The mean knowledge score was 31 (62%) and 27.84 (55.68%)amongst the doctors and the nurses respectively. On uni-variant analysis, the doctors (31%) had better knowledge as compared to the nurses (22.4%) in the group with clinical experience of less than ten years. Amongst the group with clinical experienced of greater than 10 years, the nurses had better knowledge in hand hygiene practices (10.4 vs 6.6%) and prevention of nosocomial infections (7% vs 5.8%). Conclusion: The present study concludes, the knowledge of hand hygiene and prevention of nososcomial infections amongst the nurses increases with experience. Continuous medical education is required to re-enforce hand hygiene methods and thus a simple practices like hand hygiene can be helpful in preventing nosocomial infections. Conflicts of interest: The present study did not require funding either institutional or pharmaceutical. http://dx.doi.org/10.1016/j.jpsic.2015.10.117
P040 Antibiotic susceptibility pattern of bacteria isolated from adult patients with ventilator associated pneumonia (VAP) in intensive care areas in a tertiary care hospital M. Shaikh, Patwegar, A. De, S. Baveja Department of Microbiology, L.T.M. Medical College & General Hospital, Mumbai, India Introduction: Ventilator associated pneumonia (VAP) is a common complication of ventilator support for patients with acute respiratory failure and is associated with high morbidity and mortality. Present study was conducted on patients with suspected VAP, to find out the incidence of VAP, common organisms associated with it and their antibiotic susceptibility pattern.
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Method: Culture of endotracheal aspirates of all suspected cases of VAP, using a cut off value of – 105 CFU/ml was done and the organisms grown were identified by standard biochemical tests. Antibiotic susceptibility pattern of isolates were performed on Mueller Hinton agar by Kirby Bauer disc diffusion method, as per CLSI guidelines. Result: Out of 130 suspected cases of VAP, 40.8% cases were found to be VAP as per CPIS score (≥ 6). VAP was found to be more in males (60%) than in females. Maximum patients belonged to the age group of 21–40 years (42.31%) and were from Medical Intensive Care Unit (80%). Gram negative bacilli predominated (96.3%), over gram positive cocci. The commonest gram negative bacilli isolated were Acinetobacter species (70.37%), followed by Pseudomonas aeruginosa (14.81%). All gram negative bacilli showed high resistance to amikacin, piperacillin and ciprofloxacin & 100% resistance to amoxycillin-clavulanic acid and cefotaxime. Susceptibilty to colistin and tigecycline was 100% and 94.74% respectively for Acinetobacter species. Overall carbapenem resistance was 46%. Two MRSAs detected were 100% susceptible to vancomycin, linezolid and netilmycin. Mortality in VAP cases was 50.94%. Conclusions: VAP is an important nosocomial infection with increasing multidrug resistant bacteria. The commonest cause of VAP in this study was Acinetobacter species. Conflicts of interest: The authors have none to declare. http://dx.doi.org/10.1016/j.jpsic.2015.10.118
P041 Characterization of resistance mechanism amongst Gram-negative bacteria isolated from complicated urinary tract infection in tertiary care hospital R. Patkar, S. Baveja, A. De Department of Microbiology, L.T.M. Medical College, Mumbai, India Introduction: Production of extended-spectrum betalactamases (ESBLs), AmpCs and metallo beta-lactamases (MBLs) are the most common mechanisms of resistance in Gram negative bacteria. A prospective study was undertaken to detect ESBL, AmpC and MBL production in 100 Gram-negative isolates from complicated urinary tract infection (cUTI). Method: One hundred Gram-negative isolates from cUTI were subjected to phenotypic tests (double disk approximation for ESBL, three-dimensional test for AmpC and combined disk method for MBL) and genotypic test (multiplex PCR) for detection of ESBL, AmpC and MBL production. Result: Out of 100 isolates, 68 were positive by phenotypic methods, of which majority were ESBL & AmpC co-producers (38.2%), followed by ESBL producers (26.5%) and AmpC & MBL producers (13.2%). Of 68, Escherichia coli 42.1% and 50% of Klebsiella pneumoniae were ESBL producers. 28.6% of Pseudomonas aeruginosa and 50% of Acinetobacter species were MBL producers. 60% of Proteus species and 66.7% of Enterobacter species were ESBL & AmpC co-producers. Of 100 isolates, 64 were detected positive by genotypic method, of which 37.5% were ESBL producers, 26.6% were MBL producers and 20.3% were
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Department of Medicine (Infectious Disease Unit), Christian Medical College and Hospital, Ludhiana, Punjab, India 3 College of Nursing, Christian Medical College and Hospital, Ludhiana, Punjab, India 4 Christian Medical College and Hospital, Ludhiana, Punjab, India Introduction: Hand hygiene is recognized as the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of health care associated infections. Despite the relative simplicity of this procedure, compliance with hand hygiene among health care providers is low. Materials and methods: This cross-sectional observational study was conducted in a tertiary care 1000 bedded hospital situated in northern India. Verbal consent was obtained from health care workers. A self-structured questionnaire was distributed randomly containing a set of 25 questions regarding hand-hygiene knowledge. Results: The total of 100 health care workers consisting of 50 doctors and 50 nurses participated in the study. The study was analyzed using independent samples t-test. A p-value of <0.05was considered as significant and <0.01 was considered as highly significant. The mean knowledge score was 31 (62%) and 27.84 (55.68%)amongst the doctors and the nurses respectively. On uni-variant analysis, the doctors (31%) had better knowledge as compared to the nurses (22.4%) in the group with clinical experience of less than ten years. Amongst the group with clinical experienced of greater than 10 years, the nurses had better knowledge in hand hygiene practices (10.4 vs 6.6%) and prevention of nosocomial infections (7% vs 5.8%). Conclusion: The present study concludes, the knowledge of hand hygiene and prevention of nososcomial infections amongst the nurses increases with experience. Continuous medical education is required to re-enforce hand hygiene methods and thus a simple practices like hand hygiene can be helpful in preventing nosocomial infections. Conflicts of interest: The present study did not require funding either institutional or pharmaceutical. http://dx.doi.org/10.1016/j.jpsic.2015.10.117
P040 Antibiotic susceptibility pattern of bacteria isolated from adult patients with ventilator associated pneumonia (VAP) in intensive care areas in a tertiary care hospital M. Shaikh, Patwegar, A. De, S. Baveja Department of Microbiology, L.T.M. Medical College & General Hospital, Mumbai, India Introduction: Ventilator associated pneumonia (VAP) is a common complication of ventilator support for patients with acute respiratory failure and is associated with high morbidity and mortality. Present study was conducted on patients with suspected VAP, to find out the incidence of VAP, common organisms associated with it and their antibiotic susceptibility pattern.
85
Method: Culture of endotracheal aspirates of all suspected cases of VAP, using a cut off value of – 105 CFU/ml was done and the organisms grown were identified by standard biochemical tests. Antibiotic susceptibility pattern of isolates were performed on Mueller Hinton agar by Kirby Bauer disc diffusion method, as per CLSI guidelines. Result: Out of 130 suspected cases of VAP, 40.8% cases were found to be VAP as per CPIS score (≥ 6). VAP was found to be more in males (60%) than in females. Maximum patients belonged to the age group of 21–40 years (42.31%) and were from Medical Intensive Care Unit (80%). Gram negative bacilli predominated (96.3%), over gram positive cocci. The commonest gram negative bacilli isolated were Acinetobacter species (70.37%), followed by Pseudomonas aeruginosa (14.81%). All gram negative bacilli showed high resistance to amikacin, piperacillin and ciprofloxacin & 100% resistance to amoxycillin-clavulanic acid and cefotaxime. Susceptibilty to colistin and tigecycline was 100% and 94.74% respectively for Acinetobacter species. Overall carbapenem resistance was 46%. Two MRSAs detected were 100% susceptible to vancomycin, linezolid and netilmycin. Mortality in VAP cases was 50.94%. Conclusions: VAP is an important nosocomial infection with increasing multidrug resistant bacteria. The commonest cause of VAP in this study was Acinetobacter species. Conflicts of interest: The authors have none to declare. http://dx.doi.org/10.1016/j.jpsic.2015.10.118
P041 Characterization of resistance mechanism amongst Gram-negative bacteria isolated from complicated urinary tract infection in tertiary care hospital R. Patkar, S. Baveja, A. De Department of Microbiology, L.T.M. Medical College, Mumbai, India Introduction: Production of extended-spectrum betalactamases (ESBLs), AmpCs and metallo beta-lactamases (MBLs) are the most common mechanisms of resistance in Gram negative bacteria. A prospective study was undertaken to detect ESBL, AmpC and MBL production in 100 Gram-negative isolates from complicated urinary tract infection (cUTI). Method: One hundred Gram-negative isolates from cUTI were subjected to phenotypic tests (double disk approximation for ESBL, three-dimensional test for AmpC and combined disk method for MBL) and genotypic test (multiplex PCR) for detection of ESBL, AmpC and MBL production. Result: Out of 100 isolates, 68 were positive by phenotypic methods, of which majority were ESBL & AmpC co-producers (38.2%), followed by ESBL producers (26.5%) and AmpC & MBL producers (13.2%). Of 68, Escherichia coli 42.1% and 50% of Klebsiella pneumoniae were ESBL producers. 28.6% of Pseudomonas aeruginosa and 50% of Acinetobacter species were MBL producers. 60% of Proteus species and 66.7% of Enterobacter species were ESBL & AmpC co-producers. Of 100 isolates, 64 were detected positive by genotypic method, of which 37.5% were ESBL producers, 26.6% were MBL producers and 20.3% were