Ventilator Associated Pneumonia (VAP) with Multidrug Resistance (MDR) Pathogens in Elderly Patients: Risk Factors and Antibiotic Sensitivity Patterns of MRSA, ESBLs and MBL in Intensive Care Unit

Ventilator Associated Pneumonia (VAP) is defined as pneumonia that occurs 48 hours or more after endotracheal intubation or tracheostomy, caused by infectious agents not present or incubating at the time mechanical ventilation started1. High mortality and healthcare costs area associated with ventilator-associated pneumonia (VAP) due to Multidrug-Resistant (MDR) Pathogens. The data concerning the link between multidrug-resistance pathogens and outcomes remains controversial2. Therefore, we aimed to identify the relation of risk factors for ventilator-associated pneumonia (VAP) and mortality with the drug resistance profiles of Multidrug-Resistant (MDR) Pathogens with detection of MRSA, ESBLs and MBLs in intensive care unit. This study was conducted in the Department of Microbiology at ESIC MC and PGIMSR, Rajajinagar, Bengaluru from January 2017 to June 2018. A total of 38 isolates from 35 VAP patients were collected during the study. They were processed following standard laboratory protocol. Antibiogram was done using appropriate antibiotics by Kirby-Bauer disc diffusion method and the occurrence of MRSA, ESBLs and MBLs was seen. Males were most commonly affected, Acinetobacter spp. (40%), was most common organism isolated followed by Klebsiella pneumoniae (33.33%). For MDR isolates most sensitive drug was Cefoperazone-sulbactum (25%), followed by Piperacillin-tazobactam (8.3%), Piperacillin (8.3%) and Cefoperazone (8.3%). Whereas in non-MDR isolates Amikacin (77.7%) was most sensitive followed by Cefoperazone-sulbactum and Gentamicin (72.2% each). Most common mechanism of resistance among MDR isolates was found to be Carbapenemase production (53.3%) {4 by Acinetobacter spp, 2 by Klebsiella pneumoniae, 1 each by Pseudomonas aeruginosa and Escherichia coli}, followed by AmpC (18.2%) {4-Klebsiella pneumoniae& 2-Escherichia coli}, and ESBL (3.3% by Klebsiella pneumoniae). Among Carbapenemase Metallo-betalactamase production was seen in 37.5% of isolates. Diabetes mellitus (58.33%) was most common risk factor, followed by smoking (50%), and alcohol (41.7%). 88% of patients had leucocytosis with mean total leucocytosis count (TLC) of 17,348 cells/mm3 and 17% of patients were anaemic with mean Hb of 10.02g/dl and 41.7% of patients had pneumonic changes (consolidation) and 50% of patients had BL/UL alveolar or interstitial infiltration and 1 patient (8.33%) had consolidation with CA lung. Periodic analysis of Sputum culture and their antibiotic sensitivity report should be made to identify the changing trends in etiological and sensitivity patterns.