Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia

Objective To compare the ventilator-free days (VFDs) at day 28 and the short-term outcomes in neonates with and without ventilator-associated pneumonia (VAP and non-VAP groups). Study Design We performed a cohort study in a Thai neonatal intensive care unit between 2014 and 2020 to identify the VFDs in VAP and non-VAP neonates. Univariate and multivariate analyses were performed. Results The incidences of VAP rates were 5.76% (67/1,163 neonates) and 10.86 per 1,000 (92/8,469) ventilator days. The medians (interquartile ranges) of gestational age and birth weight in the VAP vs non-VAP groups were 31 (27–35) vs 34 (30–38) weeks, and 1,495 (813–2,593) vs 2,220 (1,405–2,940) grams (p < 0.001 both), respectively. The medians (interquartile ranges) of VFDs at 28 days in the VAP and non-VAP groups were 5 (0–16) and 24 (20–26) days (<i>p</i> < 0.001). From the univariate analysis, the lower VFDs, longer ventilator days, and higher rates of moderate to severe bronchopulmonary dysplasia (BPD), postnatal steroids for BPD, length of stay, and daily hospital cost in the VAP group were significantly higher than in the non-VAP group. From the multivariate analysis, the VAP group had significantly lower VFDs (regression coefficient = -10.99, standard error = 1.11, <i>p</i> < 0.001) and higher BPD (adjusted risk ratio 18.70; 95% confidence interval 9.17–39.5, <i>p</i> < 0.001) than the non-VAP group. <b>Conclusion</b> Neonatal VAP lead to lower VFDs and a higher frequency of BPD. A multimodal strategy with a VAP prevention bundle care should be used in indicated cases to reduce the occurrence of neonatal VAP.

Rescuing Tetracycline Class Antibiotics for the Treatment of Multidrug-Resistant Acinetobacter baumannii Pulmonary Infection

Within intensive care unit settings, multidrug-resistant (MDR) Acinetobacter baumannii is a major cause of ventilator-associated pneumonia, and hospital-associated outbreaks are becoming increasingly widespread. Antibiotic treatment of A. baumannii infection is often compromised by MDR strains resistant to last-resort β-lactam (e.g., carbapenems), polymyxin, and tetracycline class antibiotics.

Nghiên cứu mức độ kháng kháng sinh của các vi khuẩn gram âm không lên men gây viêm phổi ở bệnh nhân thở máy

TÓM TẮT Đặt vấn đề: Viêm phổi liên quan thở máy là bệnh lý nhiễm khuẩn bệnh viện rất thường gặp trong đơn vị hồi sức tích cực. Có nhiều vi khuẩn gây viêm phổi liên quan thở máy, trong đó các vi khuẩn Gram âm không lên men như Acinetobacterbaumannii, Pseudomonasaeruginosa,.. là những vi khuẩn gây bệnh hàng đầu và có mức độ kháng kháng sinh cao. Phương pháp: Một nghiên cứu mô tả cắt ngang được thực hiện ở các chủng vi khuẩn Gram âm không lên men phân lập được từ các mẫu đờm của bệnh nhân thở máy trên 48 giờ điều trị tại các khoa Hồi sức tích cực - Ngoại khoa Bệnh viện Hữu nghị Đa khoa Nghệ An năm từ 1/2020 đến 6/2021. Kết quả: Phân lập được 120 chủng Vi khuẩn Gram âm không lên men, trong đó, Acinetobacter baumannii 85 chủng, Pseudomonas aeruginosa 31 chủng. Acinetobacter baumannii có mức độ đề kháng trên 70% với tất cả các kháng sinh thử nghiệm, trong đó kháng cao nhất với Ceftriaxone 96,9%. Pseudomonas aeriginosa kháng với tất cả các kháng sinh thử nghiệm, kháng cao nhất với Gentamycin 80,0%, kháng thấp nhất với Piperacillin/Tazobactam 32,3%. Kết luận: Vi khuẩn không lên men là những tác nhân chính gây viêm phổi liên quan thở máy, phổ biến nhất là Acinetobacter baumannii và Pseudomonas aeruginosa. Những vi khuẩn này kháng cao với các kháng sinh thử nghiệm, trong đó, A. baumannii kháng trên 70% các kháng sinh thử nghiệm, P. aeruginosa kháng tất cả kháng sinh thử nghiệm với mức độ khác nhau tử 32,3 - 80,0%. ABSTRACT ANTIBIOTIC RESISTANCE OF NON - FERMENTABLE GRAM - NEGATIVE BACTERIA CAUSING PNEUMONIA IN PATIENTS WITH MECHANICALLY VENTILATION Background: Ventilator - associated pneumonia is a very common nosocomial infection in the intensive care unit. Many bacteria cause ventilator - associated pneumonia, in which non - fermentative Gram - negative bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, etc., are the leading pathogens and have high antibiotic resistance. Methods: A cross sectional descriptive study was conducted on non - fermentative bacteria strains causing ventilator - associated pneumonia which were isolated at the Surgical Intensive Care Unit Department of Nghe An General Friendship Hospital from January 2020 to June 2021. Results: A total of 120 strains of non - fermenting Gram - negative bacteria were isolated. Of these, 85 strains were Acinetobacter baumannii, 31 strains was Pseudomonas aeruginosa. Acinetobacter baumannii has a resistance rate of more than 70% with all tested antibiotics, of which the highest resistance is to Ceftriaxone 96.9%. Pseudomonas aeriginosa was resistant to all tested antibiotics, with the highest resistance to Gentamycin80.0%, the lowest resistance to Piperacillin/Tazobactam 32.3%. Conclusion: Non - fermentative bacteria are the main pathogens of ventilator - associated pneumonia. The most common pathogens were Acinetobacter baumannii and Pseudomonas aeruginosa. These bacteria were highly resistant to the tested antibiotics. In which, A. baumannii resisted over 70% of the tested antibiotics, and P. aeruginosa resisted all tested antibiotics with varying degrees from 32.3 to 80.0%. Keywords: Ventilation associated pneumonia, VAP, P. aeruginosa, A. baumannii.

Nutritional Status Disorders and Selected Risk Factors of Ventilator-Associated Pneumonia (VAP) in Patients Treated in the Intensive Care Ward—A Retrospective Study

Introduction: The development of pneumonia in patients treated in intensive care wards is influenced by numerous factors resulting from the primary health condition and co-morbidities. The aim of this study is the determination of the correlation between nutritional status disorders and selected risk factors (type of injury, epidemiological factors, mortality risk, inflammation parameters, age, and gender) and the time of pneumonia occurrence in patients mechanically ventilated in intensive care wards. Material and method: The study included 121 patients with injuries treated in the intensive care ward who had been diagnosed with pneumonia related to mechanical ventilation. The data were collected using the method of retrospective analysis of patients’ medical records available in the electronic system. Results: Ventilator-associated pneumonia (VAP) occurred more frequently in patients over 61 years of age (40.4%), men (67.8%), after multiple-organ injury (45.5%), and those with a lower albumin level (86%), higher CRP values (83.5%), and leukocytes (68.6%). The risk of under-nutrition assessed with the NRS-2002 system was confirmed in the whole study group. The statistical analysis demonstrated a correlation between the leukocytes level (p = 0.012) and epidemiological factors (p = 0.035) and the VAP contraction time. Patients infected with Staphylococcus aureus had 4% of odds for the development of late VAP in comparison to Acinetobacter baumannii (p < 0.001), whereas patients infected by any other bacteria or fungi had about four times lower odds of the development of late VAP in comparison to Acinetobacter baumannii (p = 0.02). Patients with results in APACHE from 20 to 24 and from 25 to 29 had 13% and 21%, respectively, odds of the development of late VAP in comparison to patients with APACHE II scores ranging from 10 to 19 (respectively, p = 0.006; p = 0.028). Conclusions: The development of VAP is impacted by many factors, the monitoring of which has to be included in prophylactics and treatment.

BACTERIAL AND SENSITIVITY PATTERN OF PATHOGENS CAUSING VENTILATOR-ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

Highlight:1. Antimicrobial resistance bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. 2. Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to the non-VAP group. 3. The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. Cefoperazone-sulbactam, meropenem and amikacin were more than 70% sensitive against these bacteria.Abstract:Background: Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit (ICU). Antimicrobial resistant bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. Objective: This study aimed to analyze the pattern and sensitivity among pathogens that caused VAP in ICU. Materials and Methods: The study was conducted retrospectively by extracting the data of bacterial isolates from sputum specimens in the Laboratory of Clinical Microbiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia and confirming the clinical data on patients suffering from VAP in ICU ward. The study started from January until December 2017. Results: The total 148 pathogens were isolated, 18 of them were diagnosed as VAP, and 130 were not VAP. The most predominant isolates in the VAP group were Acinetobacter baumannii as many as 38 (9%) followed by Pseudomonas aeruginosa 22 (2%), E. coli 16 (7%), and Klebsiella pneumoniae 11 (1%). The pathogens showed a sensitivity rate above 70% to cefoperazone-sulbactam (SCF), meropenem (MEM) and amikacin (AK). Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to non-VAP group. Conclusion: The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. The pathogens had sensitivity rate above 70% to cefoperazone-sulbactam, meropenem, and amikacin.

Prevention of ventilator-associated pneumonia by noble metal coating of endotracheal tubes: a multi-center, randomized, double-blind study

Background Ventilator-associated pneumonia (VAP) causes increased mortality, prolonged hospital stay and increased healthcare costs. Prevention of VAP in intensive care units (ICUs) is currently based on several measures, and application of noble metal coating on medical devices has been shown to inhibit the bacterial adherence of microorganisms to the surface. The objective of this study was to evaluate the potential benefit of noble metal coating of endotracheal tubes for the prevention of VAP. Methods This was a multi-center, randomized, controlled, double-blind, prospective study including ventilated patients from nine ICUs from four hospital sites in Belgium. Patients were randomly intubated with identical appearing noble metal alloy (NMA) coated (NMA-coated group) or non-coated (control group) endotracheal tubes (ETT). Primary endpoint was the incidence of VAP. Secondary endpoints were the proportion of antibiotic days during ICU stay and tracheal colonization by pathogenic bacteria. Results In total, 323 patients were enrolled, 168 in the NMA-coated group and 155 in the control group. During ventilation, VAP occurred in 11 patients (6.5%) in the NMA-coated group and in 18 patients (11.6%) in the control group (p = 0.11). A higher delay in VAP occurrence was observed in the NMA-coated group compared with the control group by Cox proportional hazards regression analysis (HR 0.41, 95% CI 0.19–0.88, p = 0.02). The number of antibiotic days was 58.8% of the 1,928 ICU days in the NMA-coated group and 65.4% of the 1774 ICU days in the control group (p = 0.06). Regarding tracheal colonization, bacteria occurred in 38 of 126 patients in the NMA-coated group (30.2%) and in 37 of 109 patients in the control group (33.9%) (p = 0.57). Conclusions This study provides preliminary evidence to support the benefit of noble metal coating in the prevention of VAP. A confirmatory study in a larger population would be valuable. Trial registration: Clinical trial number: NCT04242706 (http://www.clinicaltrials.gov)