Pattern of Aerobic Bacteria in Adult Patients Isolated from Endotracheal Tubes in Tertiary Care Center

Introduction: Nosocomial infections have been described as an important issue among intubated patients which leads to significant morbidity and mortality. The pattern of microbiological colonization and antibiotic resistance are much valuable in this regard. Objectives: The aim of present study was to determine the pattern of aerobic bacteria isolated from endotracheal tubes in adult patients and determination of their antimicrobial susceptibility patterns. Materials and Methods: Specimens were collected from tracheal tubes of patients with endotracheal aspiration and microbiological investigations were done. The isolated bacteria were identified by using standard cultural and biochemical tests. Then antibiotic susceptibility testing was performed on the isolates by disc diffusion method according to clinical and laboratory Standards Institute (CLSI) guideline. Results: Among 104 participants 68 (65.4%) were female and 36 (34.6%) were male. Most of the patients were in the age group of 71-80 years (48.0%). From 104 positive growths, both Gram positive and Gram negative organisms were found. Maximum samples showed growth of gram negative organism. Antimicrobial susceptibility testing revealed that the most resistant Gram negative isolate was Klebsiella with highest resistance against Vancomycin (40.4%) and which showed highest sensitive against Cefotetan, Cefoxitin and Norfloxain (39.4%). Conclusions: It may be concluded that this study indicates the emergence of antibiotic resistant infections in the studied hospital. So, there is a need to improve the effectiveness of integrated infection control programs to control and manage nosocomial infections caused by highly resistant organisms. KYAMC Journal. 2021;12(3): 153-160

Bacteriological profile and antimicrobial resistance pattern of ventilator associated pneumonia in tertiary care hospital

With an occurrence ranging from 6-52%, ventilator-associated pneumonia (VAP) is the most common ICU acquired infection, accounting for a significant portion of hospital-acquired infections (HAIs). VAP is pneumonia that develops after a period of more than 48 hours of mechanical ventilation or endotracheal intubation. To isolate and identify the potential pathogens causing VAP and to study their antimicrobial susceptibility patterns. Endotracheal aspiration (ETA) or bronchoalveolar lavage (BAL) were collected from patients on mechanical ventilation >48 hours. Bacterial isolates were identified based on culture colony characteristics and biochemical parameters. Antibiotic susceptibility profile was determined for these isolates by Kirby-Bauer disc diffusion method as per Clinical and laboratory Standards Institute (CLSI) 2020 guidelines and studied. The collected data was entered in Excel, and analyzed by using SPSS version 16. Among the isolates, the most common were (31.31%) and (31.31%). These were followed by (22.22%), (7.07%), (3.03%) and (3.03%) and (2.02%).Multi Drug Resistant (MDR) microbes causing VAP are on the increase. The patient population at risk will benefit by the application of the results of this study. The antibiotic resistance pattern of these isolates will aid clinicians in selecting the appropriate antimicrobial agents. Hence, it can lead to decreased mortality and morbidity due to life-threatening VAP.

406. Utility of Tracheal Aspirates in Guiding Antibiotic Use in Mechanically Ventilated Patients with COVID-19

Background In critically ill patients with COVID-19 it is difficult to determine the presence of bacterial co-infection. Many patients receive antibiotics until a bacterial infection can be ruled out. To minimize aerosolization of SARS-CoV-2, non-invasive sampling, such as endotracheal aspiration (ETA), is preferred over invasive techniques. The purpose of this study is to determine the diagnostic yield of ETA and effect of ETA on antibiotic management in patients with COVID-19. Methods This retrospective analysis included patients admitted to the intensive care unit (ICU) from March 1 to May 31, 2020 who tested positive for SARS-CoV-2. Patients who did not receive mechanical ventilation were excluded. Data were extracted from electronic medical records. When ETA was performed, records were manually reviewed to determine diagnostic yield and effect on antibiotic management. Diagnostic yield was defined as ETA result with a plausible respiratory pathogen in a quantity of moderate or many. Plausible respiratory pathogens exclude normal flora, yeast, coagulase-negative Staphylococcus sp and Enterococcus sp. The primary outcome is the frequency of initiation, change, no change, or discontinuation of antibiotics based on ETA results. Results 124 patients with COVID-19 were admitted to the ICU; 76 met inclusion criteria. The average age was 58 years and 75% were male. Hispanic or Latino ethnicity made up the majority of the patient population (63%). Antibiotics were administered to 97% of patients for a median of 11 days of therapy (IQR 7, 21). There were 100 ETAs performed on 55 patients for a diagnostic yield of 21%. ETA led to a change in antibiotic management 47% of the time it was performed. Antibiotic changes include de-escalation (29), discontinuation (7), escalation (6), and initiation (5). Conclusion The diagnostic yield of ETA in mechanically ventilated patients with COVID-19 was low. Furthermore, ETA results led to a change in antibiotics less than half of the time. The use of ETA to diagnose bacterial co-infection and guide antibiotic therapy in patients with COVID-19 should be weighed against the risk of using a more invasive sampling technique vs the benefit of potential for increased diagnostic yield. Another conclusion may be to forgo ETA if the result is unlikely to change management. Disclosures All Authors: No reported disclosures

Relationship between the composition of the digestive microbiota and the concentrations of opportunistic pathogens in intensive care patients

ObjectiveInfections caused by multidrug-resistant Gram-negative bacilli (MDR-GNB) are a major issue in intensive care. The intestinal and oropharyngeal microbiota being the reservoir of MDR-GNB. Our main objective was to assess the link between the composition of the intestinal and tracheal microbiota and colonization by MDR-GNB.MethodsWe performed a 2-month prospective, monocentric cohort study in the medical intensive care unit of our hospital. Patients ventilated >3 days and spontaneously passing faeces were included. A faecal sample and an endotracheal aspiration (EA) were collected twice a week. MDR-GNB but also Enterococcus faecium and yeasts (as potential dysbiosis surrogate markers) were detected by culture methods. The composition of the intestinal and tracheal microbiota was assessed by 16S profiling.ResultsWe collected 62 couples of faeces and EA from 31 patients, including 18 faeces and 9 EA positive for MDR-GNB. We did not observe a link between the diversity and the richness of the intestinal microbiota and the MDR-GNB intestinal relative abundance (RA). Conversely, we observed a negative link between the intestinal diversity and richness and the RA of Enterococcus spp. (p<0.001).ConclusionThe intestinal MDR-GNB RA was not associated to the diversity nor the richness of the intestinal microbiota, but that of Enterococcus spp. was.

Evaluation of Candida Score: a bedside scoring system for early antifungal therapy in non-neutropenic critically ill patients

Background: Invasive Candida infections are the most common invasive fungal infections. Multiple site colonization plays a major role. Further decrease in host immunity (e.g. neutropenia, diabetes mellitus etc.) aggravates local invasion and dissemination which finally leads to candidemia. Hence the study was done to evaluate “Candida Score” in non-neutropenic critically ill patients for early antifungal therapy.Methods: In this prospective observational cohort study, all critically ill patients having sepsis or septic shock on admission or during their stay in ICU stay were included in the study. The components of “Candida Score” like severe sepsis, total parenteral nutrition, surgery, and multifocal Candida colonization were as per Leone et al. Clinical sepsis was given score of 2 if present and 0 if absent. The other variables were given score 01 if present and 0 if absent. The score more than 2.5 is considered significant.Results: Out of 78 patients admitted in the ICU a total of 26 blood culture positives were reported. The prevalence of Candidemia (based on culture) was 23.1% (n=06). The strains isolated were Candida non albicans (n=4, 66.7%) and Canida albicans (n=2, 33.3%). Candida was isolated in different samples other than blood culture of 26(33.33%). The most common specimen with Candida isolation was from urine (n=14, 60.87%), followed by endotracheal aspiration and sputum (n=3, 13% each) and BAL fluid (n=1, 04.3%). Among the isolates Candida non albicans (n=12, 52.2%) was more prevalent than Candida albicans (n=11, 47.8%). The prevalence was maximum for the age group of 60 to 69 years (42.31%) followed by 70 to 79 yrs and 50-59 yrs. Among all patients, 14 patients were referred in our hospital and 12 of them had a prolonged ICU stay (>10 Days). The patients with the Candida score ≥2.5 were 06 in numbers, of which 66.7% were having score 3 followed by one each of having score 4 and 5. Out of these 06 patients 04 received antifungal treatment. One patient with Candida score more than 03 succumbed to death without having antifungal treatment.Conclusions: Early identification of invasive candidiasis with the use of “Candida Score” in critically ill patients may help to initiate antifungal interventions and even help the treating physician or intensivist to formulate the more effective treatment algorithms.

Cuidados para a prevenção de complicações em pacientes traqueostomizados

ABSTRACT Objective: to analyze the evidences of care for the prevention of complications in tracheostomized patients. Method: this is a bibliographical study, type integrative review, with analysis of articles published between 2000 and 2017, carried out in the databases MEDLINE, LILACS, CINAHL and BDENF. The sample was composed by 22 primary studies in English, Portuguese and Spanish. A critical evaluation of the studies was carried out through the level of evidence and classification in relation to the topics addressed. Results: it was verified the predominance of international productions published in English language and level of evidence VII. The care that involved tracheostomy aspiration, saline humidification, dressing replacement, skin and tube cleaning, and education of the health team, the patient, and the caregiver were identified. Conclusion: it was evidenced that factors related to endotracheal aspiration, tube and skin cleansing and health education represented the main strategies that minimize the risk of complications. It is hoped to contribute to the consolidation of evidence-based practice and to the management of care with safety, quality and effectiveness. Descriptors: Surgical Stomas; Tracheostomy; Postoperative Complications; Disease Prevention; Atención de Enfermería; Nursing Care; Nursing.RESUMO Objetivo: analisar as evidências de cuidados para a prevenção de complicações em pacientes traqueostomizados. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa, com análise de artigos publicados entre 2000 a 2017, realizada nas bases de dados MEDLINE, LILACS, CINAHL e BDENF. Compôs-se a amostra por 22 estudos primários nos idiomas inglês, português e espanhol. Realizou-se a avaliação crítica dos estudos por meio do nível de evidência e classificação em relação às temáticas abordadas. Resultados: verificou-se o predomínio de produções internacionais publicadas em idioma inglês e com nível de evidência VII. Identificaram-se os cuidados que envolveram a aspiração da traqueostomia, a umidificação com solução salina, a troca do curativo, a limpeza da pele e do tubo e a educação da equipe de saúde, do paciente e do cuidador. Conclusão: evidenciou-se que fatores relacionados à aspiração endotraqueal, à limpeza do tubo e da pele e à educação em saúde representaram as principais estratégias que minimizam o risco de complicações. Espera-se contribuir para a consolidação da prática baseada em evidências e para o gerenciamento do cuidado com segurança, qualidade e efetividade. Descritores: Estomas Cirúrgicos; Traqueostomia; Complicações Pós-Operatórias; Prevenção de Doenças; Cuidados de Enfermagem; Enfermagem.RESUMEN Objetivo: analizar las evidencias de cuidados para la prevención de complicaciones en pacientes traqueostomizados. Método: se trata de un estudio bibliográfico, tipo revisión integrativa, con análisis de artículos publicados entre 2000 a 2017, realizada en las bases de datos MEDLINE, LILACS, CINAHL y BDENF. La muestra se compone de 22 estudios primarios en Inglés, portugués y español. Se realizó la evaluación crítica de los estudios por medio del nivel de evidencia y clasificación en relación a las temáticas abordadas. Resultados: se verificó el predominio de producciones internacionales publicadas en idioma inglés y con nivel de evidencia VII. Se identificaron los cuidados que involucraron la aspiración de la traqueostomía, la humidificación con solución salina, el cambio del vendaje, la limpieza de la piel y del tubo y la educación del equipo de salud, del paciente y del cuidador. Conclusión: Se evidenció que factores relacionados a la aspiración endotraqueal, a la limpieza del tubo y de la piel y a la educación en salud representaron las principales estrategias que minimizan el riesgo de complicaciones. Se espera contribuir a la consolidación de la práctica basada en evidencias y para la gestión del cuidado con seguridad, calidad y efectividad. Descriptores: Estomas Quirúrgicos; Traqueostomía; Complicaciones Posoperatorias; Prevención de Enfermedades; Enfermería.