Biofilm producer multi drug resistance alert bugs in ventilator associated pneumonia patients. Threat to antibiotic era and future concern

Abstract

Background Emerging threat of drug resistance among Bacteria causing ventilator-associated pneumonia (VAP) has resulted in higher hospital costs, longer hospital stays, and increased hospital mortality. Biofilms in the endotracheal tube of ventilated patients act as protective shield from host immunity for bacterial growth and emerge them as multidrug resistant. Aim To know the prevalence of various bacterial isolates causing VAP, ability to form biofilm and their antibiotic susceptibility pattern. Material & Methods This study was conducted in the department of Microbiology in collaboration with the Respiratory Medicine department for a period of one year (November 2018-19). Endotracheal aspirate (ETA) along with 1 cm tube tip from clinically confirmed VAP patients were processed as per the standard microbiological procedure for the detection of bacterial biofilm formation and their antimicrobial resistance pattern. Statistical Analysis: Data was statistically evaluated using SPSS-PC-20 version. ‘P’ value less than 0.05, considered statistically significant. Results 72 patients with CPIS score > 6 were clinically confirmed as VAP. Various Bacteria isolated were Klebsiella pneumoniae in 52 (53%), Escherichia coli 16 (16.3%), Pseudomonas aeruginosa 14 (14.2%), Acinetobacter spp. 8 (8.1%), Proteus mirabilis 6 (6.1%) and Pseudomonas luteola 2 (2%). All bacterial isolates were processed for their ability to form biofilm, 86 (87.7%) were biofilm producers (BFP) while 12 (12.2%) were biofilm non-producers (BFNP). Conclusion Bacterial etiology, prolonged intubation, biofilm formation, and drug resistance have ramification on outcome of VAP. Keywords: Ventilator associated pneumonia (VAP), CPIS score, Biofilm formation, Tissue culture plate method (TCP), Antimicrobial drug resistance (AMR)