Document Type : Original Article
Authors
- . Mohan Bilikallahalli Sannathimmappa 1
- . Vinod Nambiar 2
- . Rajeev Aravindakshan 3
- . Nashwa M. Al‑Kasaby 4
1 Department of Microbiology and Immunology, College of Medicine and Health Sciences, National University of Science and Technology, Oman
2 Department of Microbiology and Immunology, College of Medicine and Health Sciences, National University of Science and Technology, Oman,
3 Department of Community Medicine, All India Institute of Medical Sciences, Andhra Pradesh, India
4 Department of Pathology, Sohar Hospital, Ministry of Health, Oman Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Abstract
BACKGROUND: Critically ill patients on mechanical‑ventilation are always at a higher risk of
acquiring ventilator‑associated respiratory infections. The current study was intended to determine
the antibiotic‑resistance pattern of bacteria recovered from the endotracheal (ET) specimens of
ventilated patients.
MATERIALS AND METHODS: This was a single‑centered, retrospective study carried out in a 400‑bed
tertiary care hospital in Oman. The data of profile and antibiotic resistance pattern of bacterial isolates
recovered from ET aspirates of ventilated patients during the period from January 2017 to August
2019 were retrieved from hospital database. The data were analyzed using the Statistical Package
for the Social Sciences (SPSS) software version 22 (IBM, Armonk, New York, USA). Descriptive
statistics were applied to find the frequencies and percentages. Charts and tables were constructed.
RESULTS: In total, 201 bacterial isolates recovered from ET secretions of 154 ventilated patients were
studied. The rate of isolation was predominant among males (65.6%) and in elderly people (50%).
Gram‑negative bacilli (GNB) were predominantly (88.6%) isolated. Acinetobacter baumannii (31.3%)
was the most common isolate and 86% of them were multidrug‑resistant strains. Klebsiella
pneumoniae (23.9%) and Pseudomonas aeruginosa (22.9%) were the other common GNB, whereas
Staphylococcus aureus was the most frequently isolated Gram‑positive bacteria. Gentamicin showed
good in vitro activity against S. aureus and all the GNB except A. baumannii reflecting good choice
for empirical therapy.
CONCLUSION: Gram‑negative bacteria were the predominant isolates in ET secretions of ventilated
patients. There was an alarmingly high rate of antimicrobial resistance among GNB. A rational use
of antibiotics, regular monitoring of antibiotic resistance and use of right combination of drugs, in
addition to refining of existing infection control practices are critical to control the emergence of
drug‑resistant strains.
Keywords
- Badulla WFS, Alshakka M, Mohamed Ibrahim MI. Antimicrobial
Resistance Profiles for Different Isolates in Aden, Yemen:
A Cross‑Sectional Study in a Resource‑Poor Setting. Biomed
Res Int. 2020; 2020:1810290. doi: 10.1155/2020/1810290. PMID:
32382529; PMCID: PMC7195635.
2. Friedrich AW. Control of hospital acquired infections and
antimicrobial resistance in Europe: the way to go. Wien
Med Wochenschr. 2019; 169(Suppl 1):25‑30. doi: 10.1007/
s10354‑018‑0676‑5. PMID: 30623278; PMCID: PMC6373234.
3. Heydarpour F, Rahmani Y, Heydarpour B, Asadmobini A.
Nosocomial infections and antibiotic resistance pattern in
open‑heart surgery patients at Imam Ali Hospital in Kermanshah,
Iran. GMS Hyg Infect Control. 2017; 12:Doc07. doi: 10.3205/
dgkh000292. PMID: 28584733; PMCID: PMC5447783.
4. KumariHB, NagarathnaS, ChandramukiA. Antimicrobial resistance
pattern among aerobic gram‑negative bacilli of lower respiratory
tract specimens of intensive care unit patients in a neurocentre.
Indian J Chest Dis Allied Sci. 2007; 49 (1):19‑22. PMID: 17256562.
5. Malik MI, Malik M, Chaudhry A. Antimicrobial Susceptibility
pattern of Bacteria Isolated from Tracheal Secretions. Pak J Chest
Med 2018; 24 (2):72‑77.
6. Ahmad H, Sadiq A, Bhatti H, et al. Bacteriological Profile and
Antibiogram of Cultures Isolated from Tracheal Secretions.
Cureus 2019; 11 (6): e4965. doi: 10.7759/cureus. 4965
7. Tosi, M, Roat E, Biasi SD, Munari E, Venturelli S, Coloretti I,
et al. Multidrug resistant bacteria in critically ill patients: A step
further antibiotic therapy. J Emerg Crit Care Med 2018; 2:103.
DOI: : http://dx.doi.org/10.21037/jeccm0.2018.11.08.
8. Montravers P, Dufour G, Guglielminotti J, Desmard M, Muller C,
Houissa H, et al. Dynamic changes of microbial flora and
therapeutic consequences in persistent peritonitis. Crit Care.
2015; 19 (1):70. doi: 10.1186/s13054‑015‑0789‑9. PMID: 25887649;
PMCID: PMC4354758.
9. Ahmed NH, Hussain T, Biswal I. Antimicrobial resistance of
bacterial isolates from respiratory secretions of ventilated patients
in a multi‑specialty hospital. Avicenna J Med. 2015; 5 (3):74‑78. doi:
10.4103/2231‑0770.160233. PMID: 26229758; PMCID: PMC4510824.
10. Paterson DL. The epidemiological profile of infections
with multidrug‑resistant Pseudomonas aeruginosa and
Acinetobacter species. Clin Infect Dis. 2006; 43 (Suppl 2):S43‑48.
doi: 10.1086/504476. PMID: 16894514. - 11. Chandra D, Laghawe A, Sadawarte K, Prabhu T. Microbiological
Profile and Antimicrobial Sensitivity Pattern of Endotracheal Tube
Aspirates of Patients in ICU of a Tertiary Care Hospital in Bhopal.
Int J Curr Microbiol App Sci. 2017; 6(3): 891‑895. doi: https://doi.
org/10.20546/ijcmas. 20170.603.104
12. CLSI. Performance Standards for Antimicrobial Susceptibility
Testing. 27th ed. CLSI supplement M100. Wayne, PA: Clinical and
Laboratory Standards Institute; 2017.
13. Carter MW, Oakton KJ, Warner M, Livermore DM. Detection of
extended‑spectrum beta‑lactamases in klebsiellae with the Oxoid
combination disk method. J Clin Microbiol. 2000; 38 (11):4228‑32.
doi: 10.1128/JCM.38.11.4228‑4232.2000. PMID: 11060096; PMCID:
PMC87569.
14. Weber DJ, Rutala W, Mayhall CG. In: Fishman AP, Fishman JA,
Kaiser LR, SeniorRM, Elias JA, Elias J, et al., editors. Fishman’s text
book of pulmonary diseases and disorders. Nosocomial Respiratory
tract infection and Gram negative pneumonia. Ch. 143. 3rd ed.,
Vol. 2. New York: McGraw‑Hill Publication; 1998. p. 2213‑29.
15. Jamil SM, Faruq MO, Saleheen S, Biswas PK, Hossain MS,
Hossain SZ, et al. Microorganisms profile and their antimicrobial
resistance pattern isolated from the lower respiratory tract of
mechanically ventilated patients in the intensive care unit of a
tertiary care hospital in Dhaka. J Med 2016; 17:91‑4. DOI: 10.3329/
jom.v17i2.30071. Corpus ID: 62821887.
16. Chandra D, Laghawe A, Sadawarte K, Prabhu T. Microbiological
profile and antimicrobial sensitivity pattern of endotracheal tube
aspirates of patients in ICU of a tertiary care hospital in Bhopal.
Int J Curr Microbiol App Sci 2017; 6 (3):891‑895. doi: https://doi.
org/10.20546/ijcmas. 20170.603.104
17. Gupta P, Gupta S, Singh JB. Bacteriological profile and the
antibiotic susceptibility pattern of endotracheal secretions in ICU
of a tertiary care hospital. J. Evolution Med Dent Sci 2018; 7:2210‑3.
18. George P, Sequiera A. Antimicrobial sensitivity pattern among
organisms isolated from the endotracheal aspirates of patients with
ventilator associated pneumonia. J Clin Diag Res 2010; 4:3397‑3401.
19. Vishwanath S, Chawla K, Gopinathan A. Multidrug resistant
Gram‑negative bacilli in lower respiratory tract infections.
Iran J Microbiol. 2013; 5 (4):323‑327. PMID: 25848499; PMCID:
PMC4385155.
20. Mohebbi B, Tol A, Sadeghi R, Yaseri M, Akbari Somar N, Doyore
Agide F. The efficacy of social cognitive theory‑based self‑care
intervention for rational antibiotic use: a randomized trial. Eur J
Public Health. 2018 ;28 (4):735‑739. doi: 10.1093/eurpub/cky082.
PMID: 29788293.
21. Sannathimmappa MB, Nambiar V, Aravindakshan R, Al-Kasaby
NM. Stenotrophomonas maltophilia: An emerging opportunistic
nosocomial pathogen in a tertiary care hospital in Al Batinah
North Governorate, Oman. Sultan Qaboos Univ Med J. 2021;21(1):
e66-e71. doi: 10.18295/squmj.2021.21.01.009. PMID: 33777425;
PMCID: PMC7968916.
)