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Updated: May 7, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Profile of infective microorganisms causing ventilator-associated pneumonia: A clinical study from resource limited
Bhaskar Thakuria1, Preetinder Singh, Sanjay Agrawal
1Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
Background:
Ventilator-associated pneumonia (VAP) is the most common cause of hospital acquired infection and death among patients admitted in ICU. Microorganisms responsible for VAP vary from place to place. Gram-negative bacteria (GNB) have emerged as a major group of pathogen causing VAP and over the years carbapenem group of antibiotics has emerged as one of the important antibiotics used in the critically ill patients. There have been reports of increased occurrence of infection by carbapenem-resistant bacteria in health care settings in recent times.
Aim:
The aim of the study was to assess the incidence of VAP, their microbiological profile with reference to carbapenemase producing GNB in the intensive care unit of a tertiary care hospital, their relation to initial emperical antibiotic therapy, sensitivity patterns, and outcome.
Materials And Methods:
This prospective study was carried out over the period of 1 year (July 2010-June 2011) on 100 randomly selected patients above the age of 18 years admitted in the emergency/ICU and requiring intubation and mechanical ventilation for more than 72 hours. The diagnosis of VAP was established on the basis of clinical and radiological parameters as per Centre of Disease Centres (CDC) guidelines. A baseline sample was obtained after initial endotracheal intubation. Thereafter, the culture sent on the first day of occurrence of clinical sign of VAP. Culture was done on blood agar and MacConkey agar. All imipenem-resistant strains were further confirmed by Modified Hodge test and combined disc for confirmation of respective carbapenemase.
Results:
Incidence of VAP was found to be 51%. GNB mainly Citrobacter 28 (52.83%) and Klebsiella pneumoniae 7 (13.21%), were the most commonly isolated pathogens. The prevalence of carbapenemase-producing GNB was alarmingly high 24/50 (48%). The entire carbapenemase producers showed high degree of cross resistance to antibiotics with some sensitivity to Polymyxin B (94 %) and Tigecycline (96%).
Conclusion:
High incidence of VAP and the potential carbapenemase-producing GNB are real threat in our ICU. The emergence of microorganisms known for its inherent resistance among most of the common first-line antibiotics calls for a alarm in all upcoming tertiary care hospitals.
Insights
Ventilator-associated pneumonia (VAP) incidence was 51%, with carbapenem-resistant Gram-negative bacteria (GNB) posing a significant threat. High resistance necessitates urgent attention to antibiotic strategies in intensive care units (ICUs).
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) is a leading cause of hospital-acquired infections and mortality in intensive care units (ICUs).
- Gram-negative bacteria (GNB) are primary pathogens in VAP, with increasing resistance to carbapenem antibiotics reported globally.
- Carbapenem-resistant GNB infections pose a growing challenge in healthcare settings.
Purpose of the Study:
- To determine the incidence of VAP and the microbiological profile of carbapenemase-producing GNB in a tertiary care ICU.
- To analyze the relationship between initial empirical antibiotic therapy and VAP outcomes.
- To assess antibiotic sensitivity patterns and patient outcomes in VAP cases.
Main Methods:
- A prospective study of 100 mechanically ventilated patients (≥18 years) over 12 months.
- VAP diagnosis based on CDC clinical and radiological criteria.
- Microbiological analysis of endotracheal aspirates, including Modified Hodge test for carbapenemase confirmation.
Main Results:
- VAP incidence was 51%, with Citrobacter and Klebsiella pneumoniae as dominant GNB pathogens.
- Prevalence of carbapenemase-producing GNB was high at 48%.
- Carbapenemase producers exhibited cross-resistance but remained sensitive to Polymyxin B (94%) and Tigecycline (96%).
Conclusions:
- High VAP incidence and carbapenemase-producing GNB represent a significant ICU threat.
- Emergence of resistant GNB strains necessitates urgent re-evaluation of empirical antibiotic strategies.
- Continuous surveillance and updated treatment guidelines are crucial for tertiary care hospitals.
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