Pattern and incidence of ventilator associated pneumonia among mechanically ventilated patients

Background: Initial empirical therapy of ventilator-associated pneumonia (VAP), which is based on organisms recovered, can be modified based on the knowledge of local microbiological data, patient characteristics, and sensitivity pattern of expected pathogens at the institution. Aim of this study was conducted to observe the regional the incidence of VAP among mechanically ventilated patients.Methods: All the patients who conformed to the inclusion criteria of the study, and who were in the ICU settings and put on ventilatory support, underwent vigorous aseptic precautions and later on developed VAP were taken into the study.Results: Total 374 admitted patients were needed mechanically ventilation. Among 31 developed LRTI. The Overall incidence rate of VAP was computed to be 8.2% with highest rate among patients of age group 31-50 years. The incidence rates of VAP were found highest for Acinetobacter (54.8%) with second highest mortality (47%) whereas maximum mortality (66.66%) was caused by Klebsiella, the second most common incidence of VAP. Twenty-one patients developed early VAP whereas remaining 10 subjects developed late VAP. Mortality was higher between early VAP (57.14%) compared to the late VAP cases (30%). Majority of organisms were sensitive to Cefoperazone + Sulbactum (29), Imipenem (24) and Meropenem (22).Conclusions: Despite advances in diagnostic and treatment modalities of VAP, its management still continues to be a challenge for clinicians. The findings emerging out of this investigation will help in initial selection of antibiotics for the empiric treatment of VAP. Later on, therapy can be modified based on the knowledge of pattern and profile of VAP patients along with sensitivity pattern of expected pathogens.

Strategies for appropriate antibiotic use in intensive care unit

The comsumption of antibiotics is high, mainly in intensive care units. Unfortunately, most are inappropriately used leading to increased multi-resistant bacteria. It is well known that initial empirical therapy with broad-spectrum antibiotics reduce mortality rates. However the prolonged and irrational use of antimicrobials may also increase the risk of toxicity, drug interactions and diarrhea due to Clostridium difficile. Some strategies to rational use of antimicrobial agents include avoiding colonization treatment, de-escalation, monitoring serum levels of the agents, appropriate duration of therapy and use of biological markers. This review discusses the effectiveness of these strategies, the importance of microbiology knowledge, considering there are agents resistant to Staphylococcus aureus andKlebsiella pneumoniae, and reducing antibiotic use and bacterial resistance, with no impact on mortality.

Acute bacterial meningitis caused by Streptococcus pneumoniae resistant to the antimicrobian agents and their serotypes

The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from April 2001 to august 2002 have been evaluated. One hundred S. pneumoniae have been isolated, of which 15% were resistant to penicillin, 1% to cephalosporin and 0% to vancomycin. The serotypes most found were 14 (19%), 3 and 23F (10% each). When only the resistant serotypes were analyzed, the most prevalent was the 14 with 44%. The risk factors found in relation to the S. pneumoniae resistance were: age under one year old (p=0.01) and previous use of antibiotic (p=0.046). The resistance rates found, which were moderate to penicillin, low to cephalosporin and neutral to vancomycin, suggest the isolated use of a 3rd generation cephalosporin as an initial empirical therapy for the treatment of acute bacterial meningitis with a communitarian background.

Optimizing Pharmacodynamic Target Attainment Using the MYSTIC Antibiogram: Data Collected in North America in 2002

ABSTRACT The OPTAMA Program is intended to examine typical antimicrobial regimens used in the treatment of common nosocomial pathogens and the likelihood of these regimens attaining appropriate pharmacodynamic exposure in different parts of the world. A 5,000-subject Monte Carlo simulation was used to estimate pharmacodynamic target attainment for meropenem, imipenem, ceftazidime, cefepime, piperacillin-tazobactam, and ciprofloxacin against Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Standard dosing regimens from North America were used. Pharmacokinetic parameter variability was derived from existing healthy volunteer data, and MIC data came from the 2002 MYSTIC Program. Ciprofloxacin displayed the lowest target attainment against all bacterial species (41 to 46% for A. baumannii, 53 to 59% for P. aeruginosa, and 80 to 85% for the Enterobacteriaceae). Increasing the dose to 400 mg every 8 h did not significantly increase target attainment against nonfermenters. Piperacillin-tazobactam target attainments were similar to that of ceftazidime against all pathogens. Higher doses of both compounds were needed to achieve better target attainments against P. aeruginosa. Overall, meropenem, imipenem, and cefepime attained the highest probabilities of attainment against the Enterobacteriaceae (99 to 100%). The carbapenems appear to be the most useful agents against A. baumannii (88 to 92%), and these agents, along with higher doses of any of the β-lactams, would be the most appropriate choices for empirical therapy for P. aeruginosa infection. Given the lack of agreement between percent susceptibility and probability of target attainment for certain antimicrobial regimens, a methodology employing stochastic pharmacodynamic analyses may be a more useful tool for differentiating the most-optimal compounds and dosing regimens in the clinical setting of initial empirical therapy.