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ISSN 1527-3172 (Electronic)

2013, Number 2

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MEDICC Review 2013; 15 (2)

Nosocomial ventilator-associated pneumonia in Cuban Intensive Care Units: bacterial species and antibiotic resistance

Medell M, Hart M, Duquesne A, Espinosa F, Valdés R

Language: English
References: 46
Page: 26-29
PDF size: 132.63 Kb.


ABSTRACT

Introduction: Nosocomial pneumonia associated with use of mechanical ventilators is one of the greatest challenges confronted by intensivists worldwide. The literature associates several bacteria with this type of infection; most common in intensive care units are Acinetobacter baumannii, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and some of the Enterobacteriaceae family.
Objetive: To identify the causal agents of nosocomial ventilator-associated pneumonia in patients receiving mechanical ventilation in the intensive care units of Havana's Hermanos Ameijeiras Clinical-Surgical Teaching Hospital in 2011, and to characterize their antibiotic resistance.
Methods: A cross-sectional descriptive study was conducted using hospital administrative data of quantitative cultures from positive tracheal aspirates for January through December, 2011. Records were analyzed from 77 intensive care unit patients who developed nosocomial ventilator-associated pneumonia. Variables examined were age and sex, and pathogens identified from culture of tracheal aspirate and related antibiotic susceptibility.
Results: Species most frequently isolated were: Acinetobacter baumannii in 53 patients (68.8%), Pseudomonas aeruginosa in 34 patients (44.2%), other species of Pseudomonas in 15 patients (19.5%), and Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli in 12 patients each (15.6%). Some patients presented more than one pathogen in concurrent or successive infections. Antimicrobial susceptibility testing found high percentages of resistance to antibiotics in all these pathogens. Least resistance was found to colistin.
Conclusions: The prevalence of antibiotic resistance in bacteria causing nosocomial ventilator-associated pneumonia is of concern. Colistin is the drug of choice among the antibiotics reviewed, but sensitivity to other antibiotics should be assessed to search for more appropriate broad-spectrum antibiotics for treating nosocomial ventilator-associated pneumonia. Our results also suggest the need to strengthen infection control efforts, particularly in intensive care units, and to reassess compliance with quality control procedures. Multidisciplinary research involving microbiologists, epidemiologists, internists and intensivists is needed to fully understand the etiological and resistance patterns observed.


REFERENCES

  1. Hechavarria JC, Suárez R, Armaignac G, del Pozo C. Infección nosocomial en la Unidad de Cuidados Intensivos. MEDISAN. 2001;5(4):12–7. Spanish.

  2. Yu VL, Singh N. Excessive antimicrobial usage causes measurable harm to patients with suspected ventilator-associated pneumonia. Intensive Care Med. 2004 May;30(5):735–8.

  3. Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med. 2010 May 13;362(19):1804–13.

  4. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002 Apr 1;165(7):867–903.

  5. Diaza E, Lorente L, Valles J, Rello J. Neumonía asociada a la ventilación mecánica. Med Intensiva. 2010 Jun–Jul;34(5):318–24. Spanish.

  6. Tao L, Hu B, Rosenthal VD, Zhang Y, Gao X, He L. Impact of a multidimensional approach on ventilator- associated pneumonia rates in a hospital of Shanghai: Findings of the International Nosocomial Infection Control Consortium. J Crit Care. 2012 Oct;27(5):440–6.

  7. Comunidad Científi ca Internacional de Control de Infecciones Nosocomiales [Internet]. Buenos Aires: Comunidad Científi ca Internacional de Control de Infecciones Nosocomiales; c2008 [cited 2012 Nov 1]. Available from: http://www.inicc .org/espanol/contacto.php. Spanish.

  8. Ortiz G, Fonseca N, Molina F, Garay M, Lara A, Dueñas C. Epidemiología de la neumonía asociada a ventilador en 39 unidades de cuidados intensivos de Colombia (2007-2009). Informe año 2010. Acta Colombiana Cuidado Intens. 2011;11(1):12–9. Spanish.

  9. Kübler A, Duszynska W, Rosenthal VD, Fleischer M, Kaiser T, Szewczyk E, et al. Device-associated infection rates and extra length of stay in an intensive care unit of a university hospital in Wroclaw, Poland: International Nosocomial Infection Control Consortium’s (INICC) fi ndings. J Crit Care. 2012 Feb;27(1):105.e5–10.

  10. Ramírez M, Fernández B, Cruz A, Jardines E, Bermúdez Y. Comportamiento de las infecciones nosocomiales en Unidad de Cuidados Intensivos en un quinquenio (2005–2009). MediSur. 2011;9(5):40–6. Spanish.

  11. Frómeta I, Izquierdo F, López M. Infecciones nosocomiales en un hospital del tercer nivel. Experiencia de 5 años. Rev Cubana Med. 2008 Jul–Sep;47(3). Spanish.

  12. Fica CA, Cifuentes DM, Hervé EB. Actualización del Consenso “Neumonía asociada a ventilación mecánica”. Primera parte. Aspectos diagnósticos. Rev Chilena Infect. 2011 Apr;28(2):130–51. Spanish.

  13. Medell M, Hart M, Marrero O, Espinosa F, Montes de Oca Z, Valdés R. Clinical and microbiological characterization of pneumonia in mechanically ventilated patients. Braz J infect Dis. 2012;16(5):442–7.

  14. Baker JJ, Lambert RL, Poulos KM, Feldman JI. Managing the cost of care: a predictive study to identify critical care patients at risk for nosocomial pneumonia. J Health Care Finance. 2000 Spring;26(3):73–82.

  15. Espinosa F, Hart M, Halley MC, Zamora R. Control multidisciplinario de la infección nosocomial en un hospital de nivel terciario. Rev Cubana Med. 2011;50(1):100–10. Spanish.

  16. Larrondo HM. Infección por bacilos Gram-negativos no fermentadores. Problemática en las unidades de cuidados intensivos. Rev Habanera Cienc Méd. 2011;9(5):78–82. Spanish.

  17. Tafur JD, Torres JA, Villegas MV. Mechanisms of antibiotic resistance in Gram negative bacteria. Infect. 2008 Jul–Sep;12(3):120–4.

  18. Hessen MT, Kaye D. Nosocomial pneumonia. Crit Care Clin. 1998 Apr;4(2):245–57.

  19. BIOMERIEUX [Internet]. Marcy l’Etoile (FR): bioMérieux S.A; c1996–2012. VITEK® 2 Compact; 2012 [cited 2012 Oct 12]; [about 2 screens]. Available from: http://www.biomerieux-diag nostics.com/servlet/srt/bio/clinical-diagnostics /dynPage?open=CNL_CLN_PRD&doc=CNL _PRD_CPL_G_PRD_CLN_64&pubparams .sform=1&lang=en

  20. Procedimientos de Microbiología. Hospital Hermanos Ameijeiras [Internet]. Havana: Hermanos Ameijeiras Hospital; c2012 [cited 2011 Dec]. Available from: http://www.hha.sld.cu. Spanish.

  21. Galen Lab. Softel. Empresa de Software Cubana. Ministerio de Informática y Comunicaciones [Internet]. Havana: Ministry of Education (CU); c2012 [cited 2012 Oct 12]; [about 2 screens]. Available from: http://www.ecured.cu/index.php/Softel. Spanish.

  22. Solución informática integral para la atención primaria de salud [Internet]. Havana: Softel; [date unknown] [cited 2012 Oct 12]. 28 p. Available from: http://www.di.sld.cu/Ofertas/presen taciones/Presentaci%C3%B3n%20sistemas%20 para%20APS.pdf. Spanish.

  23. Valentine SC, Contreras D, Tan S, Real LJ, Chu S, Xu HH. Phenotypic and molecular characterization of Acinetobacter baumannii clinical isolates from nosocomial outbreaks in Los Angeles County, California. J Clin Microbiol. 2008 Aug;46(8):2499–507.

  24. Liu SY, Lin JY, Chu C, Su LH, Lin TY, Chiu CH. Integron-associated imipenem resistance in Acinetobacter baumannii isolated from a regional hospital in Taiwan. Int J Antimicrob Agents. 2006 Jan;27(1):81–4.

  25. Naas T, Levy M, Hirschauer C, Marchandin H, Nordmann P. Outbreak of carbapenem-resistant Acinetobacter baumannii producing the carbapenemase OXA-23 in a tertiary care hospital of Papeete, French Polynesia. J Clin Microbiol. 2005 Sep;43(9):4826–9.

  26. Borer A, Gilad J, Smolyakov R, Eskira S, Peled N, Porat N, et al. Cell phones and Acinetobacter transmission. Emerg Infect Dis. 2005 Jul;11(7):1160–1.

  27. Giamarellou H, Antoniadou A, Kanellakopoulou K. Acinetobacter baumannii: a universal threat to public health? Int J Antimicrob Agents. 2008 Aug;32(2):106–19.

  28. Karageorgopoulos DE, Falagas ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis. 2008 Dec;8(12):751–62.

  29. Cortiñas Sáenz M, Lizán García M, Jiménez- Vizuete JM, Moreno Cuesta J, Cuesta García J, Peyro R. Incidencia de las neumonías nosocomiales precoces y tardías asociadas a ventilación mecánica en una unidad de reanimación críticos polivalente. Rev Esp Anestesiol Reanim. 2007 Mar;54(3):147–54. Spanish.

  30. Kollef MH, Morrow LE, Niederman MS, Leeper KV, Anzueto A, Benz-Scott L, et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest. 2006 May;129(5):1210–8.

  31. Agbaht K, Díaz E, Muñoz E, Lisboa T, Gomez F, Depuydt PO, et al. Bacteremia in patients with ventilator-associated pneumonia is associated with increased mortality: a study comparing bacteremic vs nonbacteremic ventilator-associated pneumonia. Crit Care Med. 2007 Sep;35(9):2064–70.

  32. Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, et al. NASCENT Investigation Group. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008 Aug 20;300(7):805–13.

  33. Niederman MS, Mantovani R, Schock P, Papas J, Fein AM. Patterns and routes of tracheobronchial colonization in mechanically ventilated patients: the role of nutritional status in colonization of the lower airway by Pseudomonas species. Chest. 1989 Jan;95(1):155–61.

  34. Vallésa J, Mariscal D. Neumonía por Pseudomonas aeruginosa. Enferm Infecc Microbiol Clin. 2005;23(Suppl 3):30–6. Spanish.

  35. Ostos OL, Cifuentes Y, Hernández R, Muñoz L. Neumonía Nosocomial. NOVA. 2006 Jun– Dec;4(6):94–9. Spanish.

  36. Quintanilla JA, Orellana R, Alfaro C. Perfi l microbiológico de infecciones nosocomiales en la Unidad de Terapia Intensiva del Hospital Clínico Viedma. Gac Méd Bol. 2011;34(1):50–5. Spanish.

  37. Labaut N, Riera R, Pérez I, Castañeda Y. Neumonía asociada a la ventilación mecánica en una unidad de cuidados intensivos. MEDISAN. 2011;15(12):17–59. Spanish.

  38. Manning ML, Archibald LK, Bell LM, Banerjee SN, Jarvis WR. Serratia marcescens transmission in a pediatric intensive care unit: a multifactorial ocurrence. Am J Infect Control. 2001 Apr;29(2):115–9.

  39. López-Pueyo MJ, Barcenilla-Gaite F, Amaya- Villar R, Garnacho-Montero J. Multirresistencia antibiótica en unidades de críticos. Med Intensiva. 2011 Jan–Feb;35(1):100–10. Spanish.

  40. Speller DC. The clinical impact of antibiotic resistance. J Antimicrob Chemother. 1988 Nov;22(5):583–6.

  41. Kofteridis DP, Alexopoulou C, Valachis A, Maraki S, Dimopoulou D, Georgopoulos D, et al. Aerosolized plus intravenous colistin versus intravenous colistin alone for the treatment of ventilator-associated pneumonia: A matched case-control study. Clin Infect Dis. 2010 Dec 1;51(11):1238–44.

  42. Pérez-Pedrero MJ, Sánchez-Casado M, Rodríguez- Villar S. [Nebulized colistin treatment of multi-resistant Acinetobacter baumannii pulmonary infection in critical ill patients]. Med Intensiva. 2011 May;35(4):226–31. Spanish.

  43. Poirel L, Nordmann P. Carbapenem resistance in Acinetobacter baumanii: mechanisms and epidemiology. Clin Microbiol Infect. 2006 Sep;12(9):826– 36.

  44. Alarcón T, López-Brea M, García Peñuela E, Aznar E. Patrón de sensibilidad de aislamientos clínicos de Acinetobacter baumannii en Madrid vs. Hong Kong. Rev Esp Quimioter. 2006;19(1):45–50. Spanish.

  45. Hart M, Espinosa F, Halley MC, Martínez ML, Montes de Oca Z. Resistencia a antibióticos en cepas de Acinetobacter baumannii aisladas de enero a marzo del 2010 en el Hospital Clínico Quirúrgico “Hermanos Ameijeiras”. Rev Cubana Med. 2010;49(3):218–27. Spanish.

  46. González JG, Lescay M, Machado A, Pardo A, Ortiz M. Neumonía Nosocomial. Resultado de un año de trabajo en la UCI del Hospital Hermanos Ameijeiras. Rev Cub Med Int Emerg. 2002;1:32– 41. Spanish.




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