Etiology and resistance patterns of bacteria causing ventilator-associated pneumonia in a respiratory intensive care unit

Vlada V Injac; Uroš Batranović; Jovan Matijašević; Marija Vukoja; Mirjana Hadnadjev; Zoran Bukumirić; Goran Trajković; Slobodan Janković

doi:10.2298/VSP151216270I

Vlada V Injac Hemofarm AD, Research and Development Department, Belgrade, Serbia
Uroš Batranović Institute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Intensive Care Unit, Sremska Kamenica, Serbia
Jovan Matijašević Institute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Intensive Care Unit, Sremska Kamenica, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Marija Vukoja Institute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Center for Pathophysiology of Breathing and Sleep Medicine, Sremska Kamenica, Serbia
Mirjana Hadnadjev Institute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Center for Microbiology, Virology and Immunology, Sremska Kamenica, Serbia
Zoran Bukumirić University of Belgrade, Faculty of Medicine, Institute for Medical Statistics and Informatics, Belgrade, Serbia
Goran Trajković University of Belgrade, Faculty of Medicine, Institute for Medical Statistics and Informatics, Belgrade, Serbia
Slobodan Janković University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP151216270I

Keywords: pneumonia, cross infection, anti-bacterial agents, drug resistance, bacterial, respiration, artificial, mortality,

Abstract

Background/Aim. Ventilator-associated pneumonia (VAP) incidence, causative pathogens, and resistance patterns are different among countries and intensive care units (ICUs). In Europe, resistant organisms have progressively increased in the last decade. However, there is a lack of data from Serbian ICUs. The aims of this study were to evaluate etiology and antimicrobial resistance for pathogens causing VAP in ICU patients, to examine whether there were differences among pathogens in early-onset and late-onset VAP and to identify mortality in patients with VAP after 30 and 60 days of hospitalization. Methods. A retrospective cohort study was conducted in the respiratory ICU and all adult patients diagnosed with VAP from 2009 to 2014 were included. Results. Gram negative organisms were the major pathogens (80.3%). The most commonly isolated was Acinetobacter spp (59.8%). There was a statistically significant increase in the incidence of infection with Klebsiella pneumoniae (8.9% vs 25.6%; p = 0.019). Extensively drug-resistant strains (XDR) were the most common (78.7%). Late-onset VAP was developed in 81.1% of patients without differences among pathogens in comparison with early-onset VAP. Acinetobacter spp was susceptible to tigecycline and colistin with a significant increase in resistance to ampicillin/sulbactam (30.2% vs 58.6%; p = 0.01). Resistance rate of Pseudomonas aeruginosa and Klebsiella pneumoniae to carbapenems was 38% and 11%, respectively. In methicillin-resistant Staphylococcus aureus no resistance was observed against vancomycin and linezolid. There was no difference in mortality rate between patients with early-onset and late-onset VAP after 30 and 60 days of hospitalization. Conclusion. Gram negative organisms were the primary cause of bacterial VAP of which the most common was the XDR strain of Acinetobacter spp. Patients with early- and late-onset VAP had the same pathogens. There was no difference in mortality between this two group of patients during 60 days of hospitalization

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