Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase producing gram-negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh

Tanzina Nusrat, Nasima Akter, Nor Azlina A Rahman, Brian Godman, Diana Thecla D. Rozario, Mainul Haque

Research output: Contribution to journalArticle

Abstract

Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), which accounts for 25% of all ICU infections. The development of resistance to antimicrobials is increasing and becoming a significant health problem worldwide increasing morbidity, mortality and costs. In hospitals, this adds to length of stay as well as mortality. Identifying the antibiotic resistance pattern in VAP is important as this can cause outbreaks in ICUs, responsible for increased mortality and morbidity or limiting therapeutic options. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research project was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school Hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. Method: Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. Results: Among the 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients’ age or gender. Among the 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among the 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E. coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and Genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin Conclusion: A positive culture was detected in 90% of VAP patients, but it was not associated with the patients’ age and gender. The most common bacteria identified as Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide guidance on the empiric management of VAP in the future in this hospital.
Original languageEnglish
Number of pages1
JournalHospital Practice
Early online date9 Apr 2020
DOIs
Publication statusE-pub ahead of print - 9 Apr 2020

Keywords

  • healthcare-associated infections
  • antibiotic resistance
  • intensive care unit
  • public medical school hospital
  • Bangladesh

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