从机械通气患者的气管导管分泌物和气管抽吸物中分离出的革兰氏阴性杆菌的细菌学特征和抗生素图谱:一项医院横断面研究

K. Snehitha, S. Swapna, P. Kamala
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引用次数: 0

摘要

目的:非医院感染已成为住院病人死亡率和发病率的严重威胁。危重病人的主要风险因素是过度使用气管插管(ET)和气管插管等侵入性装置。生物膜的形成和随后的脱落有助于肺部定植,并可能导致呼吸机相关肺炎(VAP)[1]:本研究的对象是微生物实验室从 2022 年 9 月至 2023 年 8 月的一年时间里从维萨卡帕特南安得拉医学院各重症监护室(内科、外科和儿科)收到的 ET 管头和气管吸出物。根据标准协议共处理了 116 份样本,并按照 CLSI 指南在穆勒-欣顿琼脂上采用柯比-鲍尔盘扩散法进行了抗生素敏感性检测(AST):结果:共处理了 116 份样本。其中,76/116 例为急诊插管尖端样本,40/116 例为气管抽吸样本,男性样本(69/116 例)多于女性样本(47/116 例)。在总共 116 份样本中,72 份(62%)培养呈阳性,44 份(38%)无菌。在 72 个培养阳性样本中,最常见的病原体是醋杆菌属(31/72,43%),其次是克雷伯菌属(20/72,28%)、假单胞菌属(13/72,18%)和大肠埃希菌(8/72,11%)。共发现 11 种(11/72,15%)对多种药物耐药的 GNB。分离出的对多种药物耐药的 GNB 包括醋杆菌(6/72)、克雷伯氏菌(3/72)和假单胞菌(2/72)。美罗培南是最易耐药的抗生素,其次是哌拉西林-他唑巴坦:大多数分离菌株对碳青霉烯类和 BLBLI 复方药物敏感。当存在多重耐药菌时,微生物的持续存在和对治疗的反应减弱更为常见。因此,基于细菌学特征和 AST 的局部联合抗生素疗法对于启动经验性治疗至关重要,这将最大限度地减少细菌定植并预防 VAP 的发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
BACTERIOLOGICAL PROFILE AND ANTIBIOGRAM OF GRAM-NEGATIVE BACILLI ISOLATED FROM ENDOTRACHEAL TUBE SECRETIONS AND TRACHEAL ASPIRATES FROM PATIENTS ON MECHANICAL VENTILATION: A HOSPITAL-BASED CROSS-SECTIONAL STUDY
Objective: Nosocomial infections have become a serious threat to mortality and morbidity among hospitalized patients. Major risk factor among critically ill patients is excessive use of invasive devices like Endotracheal tube (ET) and tracheal intubation. The development of biofilm and their subsequent dislodgement aids in lung colonization and may cause Ventilator-associated pneumonia (VAP) [1]. Methods: Present study was conducted on ET tube tips and Tracheal aspirates received in microbiological laboratory from various ICU’s (Medical, surgical and pediatric) in Andhra Medical College, Visakhapatnam over a period of one year from September 2022 to August 2023. A total of 116 samples were processed according to standard protocols and Antibiotic Susceptible Testing (AST) was performed by Kirby-Bauer disc diffusion method on Mueller-Hinton agar as per CLSI guidelines. Results: In total, 116 samples were processed. ET tube tips were 76/116 and tracheal aspirates were 40/116, with males (69/116) outnumbered females (47/116). Out of a total of 116 samples, 72 (62%) were culture-positive and 44 (38%) were sterile. Acinetobacter spp. was the most common pathogen among 72 culture positives (31/72, 43%), followed by Klebsiella spp. (20/72, 28%), Pseudomonas spp. (13/72, 18%) and Escherichia coli (8/72, 11%). A total of 11 (11/72, 15%) GNB were found as multi-drug resistant. The multi-drug resistant GNB isolated were Acinetobacter (6/72), Klebsiella (3/72) and Pseudomonas (2/72). Meropenem is the most susceptible antibiotic, followed by Piperacillin-Tazobactam. Conclusion: It was concluded from this study that most commonly isolated pathogen was Acinetobacter spp. Most of these isolates were sensitive to Carbapenem and BLBLI combination drugs. Microbial persistence and impaired response to the treatment were more frequent, when multi-drug resistant organisms were present. Hence a local combined antibiotic approach, based on bacteriological profile and AST is essential to initiate empirical therapy which will minimize the bacterial colonization and prevent the incidences of VAP.
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