Clinical and Microbiological Profile of Tracheal Aspirates in Chronic Kidney Disease Patients

Abstract

Introduction: Chronic Kidney Disease (CKD) is a chronic inflammatory state, which inturn suppresses the immune system. CKD patients are hence at more risk for nosocomial infections. Ventilator Associated Pneumonia (VAP) is one of the major nosocomial infections. If not treated early and appropriately, it increases hospital stay and expenses in turn increasing morbidity and mortality. In recent times, due to irrational and rampant use of antibiotics, there is an emergence of multidrug resistant strains of organisms which are difficult to treat. Aim: To study the clinical and microbiological profile of tracheal aspirate samples in CKD patients. Materials and Methods: It was a retrospective cross sectional study conducted in the renal Intensive Care Unit (ICU) of a Tertiary Care Centre, Institute of Nephrourology, Bengaluru over a period of two years from July 2018 to July 2020. Clinical and demographic data of patients who fulfilled the inclusion criteria was recorded. Tracheal aspirates were obtained by convenient sampling technique. The samples were cultured on Blood Agar (BA), chocolate agar, MacConkey agar and Sabouraud’s Dextrose Agar (SDA). Antibiotic sensitivity profiling was done by using Mueller Hinton agar. Statistical analysis was done using Statistical Package For The Social Sciences (SPSS) V23.0 software. Results: Sixty-nine samples were analysed over a period of two years. Males (66.66%) were in majority. Diabetes Mellitus (64%) was the most common associated risk factor. Among the total samples obtained, around 70% showed bacterial growth. Gram negative bacteria (92.4%) were the most commonly isolated microorganism. Among the Gram-negative bacteria, Acinetobacter baumanni (45.3%) was the most common followed by Klebsiella pneumoniae. Majority of the gram negative organisms were sensitive to Polymyxin B, colistin, tigecycline. Acinetobacter and Klebsiella showed resistance to 3rd generation cephalosporins, aminoglycosides and fluoroquinolones. Conclusion: There is emergence of extremely drug resistant gram negative organisms as the cause for VAP. They are dangerous and difficult to treat. They thus increase the hospital expenses by prolonging the hospital stay. Hence, the need of the hour is to formulate an appropriate antibiotic policy based on the population being treated and to follow strict infection control practices in ICU setup.