Tuberc Respir Dis.  2012 Jul;73(1):32-37. 10.4046/trd.2012.73.1.32.

Bacterial Pathogens of Ventilator Associated Pneumonia in a Tertiary Referral Hospital

• Chi SY
• Kim TO
• Park CW
• Yu JY
• Lee B
• Lee HS
• Kim YI
• Lim SC
• Kwon YS

• KMID: 2050672
• DOI: http://doi.org/10.4046/trd.2012.73.1.32

Abstract

BACKGROUND
This study evaluates the bacterial pathogens of Ventilator-associated pneumonia (VAP) in a tertiary referral hospital.
METHODS
A total of 109 bacterial pathogens from 91 adult patients with VAP, who were admitted to the medical intensive care unit from January 2008 to December 2009, were examined. Clinical characteristics, bacterial pathogens, and resistance profiles were analyzed.
RESULTS
Staphylococcus aureus (44%) was the most frequently isolated. Acinetobacter baumanii (30%), Pseudomonas aeruginosa (12%), Stenotrophomonas maltophilia (7%), Klebsiella pneumoniae (6%), and Serratia marcescens (2%) were isolated from the transtracheal aspirates or bronchoalveolar lavage in patients with VAP. There was no significant difference of bacterial pathogens between early and late onset VAP. All isolated S. aureus were methicillin resistant S. aureus; the imipenem resistance rate of A. baumanii was 69%.
CONCLUSION
The two most frequent pathogens of VAP were S. aureus and A. baumanii. There were no pathogenic differences between early and late onset VAP.

Keyword

Pneumonia, Ventilator Associated; Staphylococcus aureus; Acinetobacter baumanii

MeSH Terms

Acinetobacter
Adult
Bronchoalveolar Lavage
Humans
Imipenem
Intensive Care Units
Klebsiella pneumoniae
Methicillin Resistance
Pneumonia, Ventilator-Associated
Pseudomonas aeruginosa
Referral and Consultation
Serratia marcescens
Staphylococcus aureus
Stenotrophomonas maltophilia
Tertiary Care Centers
Ventilators, Mechanical
Imipenem

Reference

1. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005. 33:2184–2193.

2. Bell RC, Coalson JJ, Smith JD, Johanson WG Jr. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med. 1983. 99:293–298.

3. Celis R, Torres A, Gatell JM, Almela M, Rodríguez-Roisin R, Agustí-Vidal A. Nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest. 1988. 93:318–324.

4. Chevret S, Hemmer M, Carlet J, Langer M. European Cooperative Group on Nosocomial Pneumonia. Incidence and risk factors of pneumonia acquired in intensive care units: results from a multicenter prospective study on 996 patients. Intensive Care Med. 1993. 19:256–264.

5. Craven DE, Steger KA. Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996. Semin Respir Infect. 1996. 11:32–53.

6. Cross AS, Roup B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med. 1981. 70:681–685.

7. Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis. 1989. 139:877–884.

8. Langer M, Mosconi P, Cigada M, Mandelli M. Intensive Care Unit Group of Infection Control. Long-term respiratory support and risk of pneumonia in critically ill patients. Am Rev Respir Dis. 1989. 140:302–305.

9. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. EPIC International Advisory Committee. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. JAMA. 1995. 274:639–644.

10. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002. 165:867–903.

11. Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis. 2010. 51:Suppl 1. S81–S87.

12. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol. 2000. 21:510–515.

13. Alcón A, Fàbregas N, Torres A. Hospital-acquired pneumonia: etiologic considerations. Infect Dis Clin North Am. 2003. 17:679–695.

14. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of healthcare-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest. 2005. 128:3854–3862.

15. Jeon K. Ventilator-associated pneumonia. Tuberc Respir Dis. 2011. 70:191–198.

16. Clinical and Laboratory Standards Institute. Document M100-S20. Performance standards for antimicrobial susceptibility testing: twentieth informational supplement. 2010. Wayne, PA: Clinical and Laboratory Standards Institute.

17. Chung DR, Song JH, Kim SH, Thamlikitkul V, Huang SG, Wang H, et al. High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. Am J Respir Crit Care Med. 2011. 184:1409–1417.

18. Luna CM, Aruj P, Niederman MS, Garzón J, Violi D, Prignoni A, et al. Appropriateness and delay to initiate therapy in ventilator-associated pneumonia. Eur Respir J. 2006. 27:158–164.

19. American Thoracic Society. Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005. 171:388–416.

20. Lee K, Kim MN, Kim JS, Hong HL, Kang JO, Shin JH, et al. Further increases in carbapenem-, amikacin-, and fluoroquinolone-resistant isolates of Acinetobacter spp. and P. aeruginosa in Korea: KONSAR study 2009. Yonsei Med J. 2011. 52:793–802.

21. Lee SW, Jo HS, Kim WJ. Clinical characteristics of intensive care unit patients with carbapenem resistant Acinetobacter baumannii isolated from sputum. Tuberc Respir Dis. 2006. 60:228–234.