Colonization and Antimicrobial resistance patterns of Potentially Pathogenic Micro-Organisms in tracheostomized patients
Article Sidebar
Main Article Content
Abstract
Introduction: Tracheostomy is one of the most common and ancient surgical procedure performed in the world but it is like a double-edged sword which not only facilitates respiration, but also impairs the natural resistant barrier, therebyaugmenting the colonization of other secondary pathogenic micro-organisms. Hence, it is important to know the patternof microbiological colonizers in tracheostomized patients, so that adequate empiric antimicrobial coverage can preventdevelopment of hospital acquired pneumonia. This study aims to identify various micro-organisms colonizing lower airway in tracheostomized patients.
Materials and Methods: An observational cross-sectional study was conducted in a tertiary based teaching hospital in North Bengal, India during July 2021 to July 2022. A total of 56 patients were included in the study.
Results: Positive Cultures on day 0 were found in 20.8% & 65.6% of patients in wards and ICUs respectively. Out of the positive cultures isolated on day 0, Staphylococcus aureus was the most common organism (80%) obtained from ward patients whereas, Acinetobacter baumannii was most common organism (47.61%) in ICU admitted patients. On day 7, positive cultures were found in 66.6% & 84.4% of admitted patients in wards and ICUs respectively. Staphylococcus aureus was again the most common organism obtained (56.25%) in wards whereas, Pseudomonas aeruginosa was the most common organism (44.44%) obtained in ICU admitted patients followed by Acinetobacter baumannii (33.33%).
Conclusion: Culture positivity rates were higher in patients who were previously intubated in Intensive care unit, which establishes the fact that any procedure which warrants airway manipulations, increases the chance of hospital acquired infections. Antibiotic resistance is very common in ICU admitted patients and has a tendency to increase over time. Hence, upscaling of antibiotics is recommended only after proper sensitivity check of the tracheal aspirates.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Ranes JL, Gordon SM, Chen P, Fatica C, Hammel J, Gonzales JP, Arroliga AC. Predictors of long-term mortality in patients with ventilator-associated pneumonia. Am J Med 2006;119(10):897.e13-899.e13
Holzapfel L, Chevret S, Madinier G, Ohen F, Demingeon G, Coupry A, Chaudet M. Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial. Crit Care Med 1993;21(8):1132-38
Cavaliere S, Bezzi M, Toninelli C, Foccoli P. Management of postintubation tracheal stenoses using the endoscopic approach. Monaldi Arch Chest Dis 2007;67(2):73-80
Heffner JE, Hess D. Tracheostomy management in the chronically ventilated patient. Clin Chest Med 2001;22(1):55-69
Pierson DJ. Tracheostomy from A to Z: historical context and current challenges. Respir Care 2005;50(4):473-5
McClelland RM. Tracheostomy: its management and alternatives. Proc R Soc Med 1972;65(4):401-404
Golzari SE, Khan ZH, Ghabili K, Hosseinzadeh H, Soleimanpour H, Azarfarin R, et al.Contributions of Medieval Islamic physicians to the history of tracheostomy. Anesth Analg 2013;116(5):1123-32
Goodall EW. On infectious diseases and epidemiology in the Hippocratic collection: (Section of the History of Medicine). Proc R Soc Med 1934;27(5):525-534
Jackson C. Tracheotomy. Laryngoscope 1909;19:285-90
Lassen HC. A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency. Lancet 1953;1(6749):37-41
Wunsch H, Linde-Zwirble WT, Angus DC, Hartman ME, Milbrandt EB, Kahn JM. The epidemiology of mechanical ventilation use in the United States. Crit Care Med 2010;38(10):1947-53
Needham DM, Bronskill SE, Sibbald WJ, Pronovost PJ, Laupacis A. Mechanical ventilation in Ontario, 1992-2000: incidence, survival, and hospital bed utilization of noncardiac surgery adult patients. Crit Care Med 2004;32(7):1504-9
Needham DM, Bronskill SE, Calinawan JR, Sibbald WJ, Pronovost PJ, Laupacis A. Projected incidence of mechanical ventilation in Ontario to 2026: preparing for the aging baby boomers. Crit Care Med 2005;33(3):574-9
Carson SS, Cox CE, Holmes GM, Howard A, Carey TS. The changing epidemiology of mechanical ventilation: a population-based study. J Intensive Care Med 2006;21(3):173-82
Mukundan, Aswin & Kamath, M & Baliga, Shrikala & Shenoy, Vijendra & Bhojwani, Kiran & Prasad, Vishnu. Bacterial flora of the lower respiratory tract during and after a week of the tracheostomy. International Medical Journal 2017;4:92-8
De Jong, A., Jung, B. & Jaber, S. Intubation in the ICU: we could improve our practice. Crit Care 18, 209 (2014). https://doi.org/10.1186/cc13776
Shanthi M, Sekar U. Multi-drug resistant Pseudomonas aeruginosa and Acinetobacter baumannii infections among hospitalized patients: risk factors and outcomes. The Journal of the Association of Physicians of India. 2009 Sep;57:636, 638-40, 645
Cader SHA, Shah FA, Nair SKGR. Tracheostomy colonisation and microbiological isolates of patients in intensive care units-a retrospective study. World J Otorhinolaryngol Head Neck Surg. 2020 Mar 29;6(1):49-52
Tara Havens, David Rosen, Katherine Rivera-Spoljaric. Airway Multidrug-Resistant Organisms in a Population of Tracheostomy and Chronic Ventilator-Dependent Children at a Tertiary Care Pediatric Hospital. Authorea. February 11, 2022
Raveendra, N., Rathnakara, S.H., Haswani, N. et al. Bacterial Biofilms on Tracheostomy Tubes. Indian J Otolaryngol Head Neck Surg (2021). https://doi.org/10.1007/s12070-021-02598-6
Tran GM, Ho-Le TP, Ha DT, Tran-Nguyen CH, Nguyen TSM, Pham TTN, Nguyen TA, Nguyen DA, Hoang HQ, Tran NV, Nguyen TV. Patterns of antimicrobial resistance in intensive care unit patients: a study in Vietnam. BMC Infect Dis. 2017 Jun 15;17(1):429