Evaluation of Bacteria Isolated from Endotracheal Aspirates of Patients in Intensive Care Units: A Single-Centre Retrospective Study

Öz

Aim: This study aims to analyze the bacteriological profile and antibiotic susceptibility patterns of isolates from endotracheal aspirates (ETAs) of intensive care units (ICUs) patients to provide data for combating ventilator-associated pneumonia (VAP) and other nosocomial infections. Material and Method: A retrospective study of ETA samples from ICU patients (January-December 2022) was conducted. Bacteria were identified and tested for antibiotic susceptibility according to EUCAST criteria. Results: Among 263 isolates, predominant gram-negative bacteria were Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella spp., gram-positive bacteria included Staphylococcus epidermidis and Staphylococcus aureus. High resistance was noted in Acinetobacter baumannii to ciprofloxacin (96.4%) and piperacillin-tazobactam (97.3%). Staphylococcus epidermidis showed resistance to oxacillin (66.6%) but none to vancomycin or linezolid. Conclusion: The prevalence of multidrug-resistant pathogens in ETA cultures emphasises the importance of improved surveillance, antimicrobial stewardship and infection control in ICUs.

Anahtar Kelimeler

• ventilator-associated pneumonia
• endotracheal aspirates
• antibiotic resistance

Kaynakça

1. 1. Pickens C, Wunderink R. Methicillin-resistant staphylococcus aureus hospital-acquired pneumonia/ventilator-associated pneumonia. Seminars in Respiratory and Critical Care Medicine. 2022;43(02):304–309.
2. 2. Hasan J, Nessa S, Rabbani R. Comparative evaluation of linezolid and teicoplanin in the treatment of ventilator-associated mrsa pneumonia: a single-center experience. International Journal of Infection. 2020;7(3).
3. 3. Sharma A, Thakur A, Thakur N, Kumar V, Chauhan A, Bhardwaj N. Changing Trend in the Antibiotic Resistance Pattern of Klebsiella Pneumonia Isolated From Endotracheal Aspirate Samples of ICU Patients of a Tertiary Care Hospital in North India. Curēus 2023.
4. 4. Büyüktuna SA, Hasbek M, Çelik C, Ünlüsavuran M, Avcı O, Baltacı S, et al. Yoğun Bakım Ünitesinde Gelişen Klebsiella pneumoniae Enfeksiyonları: Karbapenem Direnci ve Hasta Mortalitesi ile İlgili Risk Faktörler. Mikrobiyoloji Bülteni2020;54:378–391.
5. 5. Fanning J, Panigada M, Bassi GL. Nosocomial Pneumonia in the Mechanically Ventilated Patient. Seminars in Respiratory and Critical Care Medicine. 2022;43:426–439.
6. 6. Feng D-Y, Zhou Y-Q, Zou X-L, Zhou M, Zhu J-X, Wang Y-H, et al. Differences in microbial etiology between hospitalacquired pneumonia and ventilator-associated pneumonia: a single-center retrospective study in Guang Zhou Infection and Drug Resistance. 2019;Volume 12:993–1000.
7. 7. Eggimann P, Revelly J-P. Should Antibiotic Combinations Be Used to Treat Ventilator-Associated Pneumonia? Seminars in Respiratory and Critical Care Medicine. 2006;27:068–081.
8. 8. Şafak B, Çiftçi I-H, Kıyıldı N, Aktepe O-C, Çetinkaya Z, Altındiş M Ventilatör ilişkili pnömoni tanısında endotrakeal aspirat kültürleri:2004–2006 yılları sonuçları. 2007;21(2):81–85.

9. 9. Dede B, Kadanalı A, Karagoz G, Comoglu S, Bektaşoğlu M, İrvem A Yoğun bakım ünitemizden gönderilen derin trakeal aspirat kültürlerinin değerlendirilmesi. 2014;54(1):15–20.
10. 10. Sagmak-Tartar A, Ozer AB, Ulu R, Akbulut A. Microbiological Evaluation of the Pathogens Isolated From the Endotracheal Aspirate Samples of the Patients Followed in the Intensive Care Units: A One-Year Retrospective Analysis. Klimik Dergisi. 2018;:56–60.
11. 11. Ameet H, Ankita A, Kumar G. Study of microbiological profile of ventilator associated pneumonia. Paripex Indian Journal Of Research. 2024;48–49.
12. 12. Karakeçe E, Demiray T, Erdoğan F, Çiftci İH. Endotrakeal aspirat örneklerinden izole edilen gram-negatif etkenler. ACU Sağlık Bil Derg. 2014(3):200–203.
13. 13. Raikod BRP, Awati A, Kinhal SV, Saraf N. Incıdence Of Pneumonıa In Crıtıcally Ill Patıents On Ventılator In Basaveshwar Teachıng And General Hospıtal. Journal of Evolution of Medical and Dental Sciences. 2014;3:13374–13379.
14. 14. Golia S, T SK, L VC. Microbial Profile of Early and Late Onset Ventilator Associated Pneumonia in The Intensive Care Unit of A Tertiary Care Hospital in Bangalore, India. Journal of Clinical and Diagnostic Research 2013.
15. 15. Tsubosa Y, Sato H, Bando E, Ota Y, Tanuma A, Ohmagari N. Relationship between the pathogens of postoperative pneumonia after an esophagectomy for thoracic esophageal cancer and the aggregate length of preoperative hospital stay. Esophagus2010;7:81–86.
16. 16. Sader HS, Farrell DJ, Flamm RK, Jones RN. Antimicrobial susceptibility of gram-negative organisms isolated from patients hospitalised with pneumonia in US and European hospitals: Results from the SENTRY Antimicrobial Surveillance Program, 2009–2012. International Journal of Antimicrobial Agents. 2014;43:328–334.
17. 17. Tunçoğlu E, Yenişehirli G, Bulut Y. Klinik örneklerden izole edilen Pseudomonas aeruginosa suşlarında antibiyotik direnci, ANKEM Derg. 2009;23(2):54–8.
18. 18. Mohamed ER, Aly SA, Halby HM, Ahmed SH, Zakaria AM, El-Asheer OM. Epidemiological typing of multidrugresistant Klebsiella pneumoniae, which causes pediatric ventilator-associated pneumonia in Egypt. Journal of Medical Microbiology/Journal of Medical Microbiology. 2017;66:628–634.
19. 19. Adukauskiene D, Ciginskiene A, Adukauskaite A, Koulenti D, Rello J. Clinical Features and Outcomes of VAP Due to Multidrug-Resistant Klebsiella spp.: A Retrospective Study Comparing Monobacterial and Polybacterial Episodes. Antibiotics. 2023;12:1056.
20. 20. Duran H, Çeken N, Atik TK. Bacteria Isolated from Endotracheal Aspirate Samples and Antibiotic Resistance Rates:5-year Analysis:5-year Retrospective Analysis. Türkiye Klinikleri Tıp Bilimleri Dergisi. 2021;41:327–334.
21. 21. Saha B, Bal M, S. Emergence of multi-drug resistant clinical strains of staphylococcus aureus. International Journal ofNatural Sciences,. 2016;1–6.
22. 22. Fatima S, Uddin M, Rao P, Rao S. Role of multidrug-resistant pathogens in ventilator-associated pneumonia in a tertiary care hospital in india. Avicenna Journal of Clinical Microbiologyand Infection. 2022;9(2):49–54.
23. 23. Elnasser Z, Obeidat H, Bani-Salem M, Amarin Z, Banni-Issa A, Kaplan N. Is methicillin-resistant staphylococcus aureus a common pathogen in ventilation-associated pneumonia?. Medicine. 2021;100(20).
24. 24. Afzal M, Vijay AK, Stapleton F, Willcox M. The Relationship between Ciprofloxacin Resistance and Genotypic Changes in S. aureus Ocular Isolates. Pathogens. 2022;11:1354.
25. 25. Jagadeesan U, Manavalan J, Sri Nsk R, Banaji N. Minimum inhibitory concentration levels of mupirocin by e-test among staphylococcus aureus isolates and their antimicrobial susceptibility pattern. International Journal of Pharmacy and Pharmaceutical Sciences 2023:24–27.