Microbiological profile, antibiotic resistance and clinical outcome of ventilator-associated pneumonia in intensive care unit

Abstract

Background: Increased in case of ventilator-associated pneumonia (VAP) and mortality due to increased bacterial resistance are evident in clinical practice, but studies have not yet been conducted and evidence is still scarce. Therefore, the goal of improving antibiotic treatment and care during VAP based on the profile of microorganisms and drug resistance commonly found in the ICU of hospital in Mongolia became the basis for conducting this study. Aim: To investigate the relationship between the prevalence of VAP recorded in the ICU, profile of microorganisms, and resistance to drugs and other clinical parameters. Materials and Methods: This is single-centred, retrospective study that included 47 patients with ventilator-associated pneumonia and treated at the Intensive Care Unit of Mongolian-Japan hospital of MNUMS from 1 April 2022 to 5 March 2024. Results: A total of 47 cases were included in our study, 29 (61.7%) were cured and 18 (38.2%) died. Chronic liver disease (p=0.004), use of 2 antibiotics before admission (p=0.017), and treated at another hospital before admission (p=0.011) were significantly higher in the death group. WBC on day of respiratory specimen (11.3 vs 18.2, p=0.02), WBC on day 7 after specimen (9.57 vs 15.7, p=0.014), SOFA score (4.69 vs 11.77, p=0.006) there were differences between the 2 groups. Also, there were significant differences in the 7th day after respiratory specimen RDW-CV% (p<0.001), PCT (p=0.019), CRP (p<0.001), and PaO2/FiO2 ratio (p<0.001) the deceased group. . Acinetobacter baumannii 29.8%, Candida 29.7%, Enterococcus 10.6%, Klebsiella pneumoniae 6.4%, and Pseudomonas aeruginosa 4.3% were the common microorganisms of VAP in the ICU. 31.9% of total cases were pandrug resistant and 36.1% were multidrug resistant. Acinetobacter baumannii was pandrug resistant in 78.5% and ciprofloxacin had the lowest value of MIC=3.22±1.36. Conclusion: In total cases with VAP, 31.9% of cases were pandrug-resistant and 36.1% were multidrug-resistant. Acinetobacter baumannii was the causative agent at high risk for late onset VAP, and 78.5% were pandrug resistant. Chronic liver disease and use of ≥2 antibiotics in the last 3 months each increased the risk of death from VAP by 2 times. Late onset VAP prolongs ICU length of stay and total hospital length of stay by an average of 20 days compared with early onset VAP.