Microbiome and Antimicrobial Sensitivity Pattern of Endotracheal Secretions in Mechanically Ventilated Patients in ICUs in a Tertiary Care Hospital

Abstract

BACKGROUND Mechanical ventilation is a life-saving procedure for most patients in ICUs. But it has a risk of acquiring respiratory tract infections resulting in high morbidity and mortality. If not treated early, it may lead to ventilator-associated pneumonia (VAP). Early diagnosis and appropriate antibiotic therapy at right time in the right dosage is essential for better clinical outcome. The objectives of the study were to analyse the microbiomes of endotracheal samples and their antimicrobial susceptibility pattern in mechanically ventilated patients in ICUs and to frame an institution based local antibiotic policy especially for them. METHODS A retrospective study was conducted in a tertiary care hospital and sample data was collected which included all adult patients who were mechanically ventilated for various co-morbid conditions in ICUs from January 2019 to December 2019. All the samples were processed for microscopy, culture and antimicrobial susceptibility pattern. RESULTS Among 848 endotracheal samples, 673 (79.4 %) samples were culture positive and 175 (20.6 %) samples were sterile. Most common organism was Acinetobacter spp (N=240) followed by Klebsiella spp (N=225) and Pseudomonas spp (N=97). In our study, polymicrobial infections were 186(21.7 %). Sixty-eight percent of organisms were multidrug-resistant. Carbapenem resistance was 58 %. CONCLUSIONS The most common complication of mechanical ventilation is an endotracheal infection which in turn leads to prolonged stay in hospital, morbidity and mortality. It is essential to know about the local microbiome and its antibiotic susceptibility pattern. KEY WORDS Microbiome-human, Antibiogram, Endotracheal Intubation.