Risk Factors for Carbapenem Resistance Section in Gram Negative Nosocomial Pneumonia: A Single Centre Prospective Cohort StudyCorrespondence Address :
Dr. Renoy Henry,
Anjiparambil P.C Road, Ponnurunny-682019, Kochi, Kerala, India.
Introduction: Gram Negative Bacilli (GNB) account for about 70% of Hospital Acquired Pneumonia (HAP), Ventilator Acquired Pneumonia (VAP) and Healthcare Associated Pneumonia (HCAP). Increasing use of carbapenems lead to infections caused by GNBs with therapeutically challenging ExtendedSpectrum Beta-Lactamases (ESBLs).
Aim: To assess the risk factors and clinical outcomes associated with HAP, VAP and HCAP caused by Carbapenem Resistant (CR) GNB at a Tertiary Care Centre.
Materials and Methods: The present study was a prospective cohort study which was conducted from February 2015 to September 2016 that included 66 patients with Broncho Alveolar Lavage (BAL) cultures for GNB. Clinical, demographic and microbiological data (including antibiotic sensitivity) along with overall mortality, occurrence of sepsis and length of stay were collected for each patient. Data were analysed using OpenStat 30.0 along with relevant descriptive statistics. Comparison of outcomes between CR and Carbapenem Sensitive (CS) group were studied along with the concordance between initial antibiotics and BAL culture sensitivity.
Results: Overall prevalence of CR in the cohort was 54.54%. The most common organism to be ESBL positive was Klebsiella pneumoniae (45.45%). Exposure to previous antibiotics was a risk factor for CR (p=0.017). Mortality was higher (50%) in CR group than in CS group (23.3%; p=0.026). There were 45.8% of the cases having lack of concordance of initial antibiotics that died in comparison to 16.7% who had an appropriate initial antibiotic therapy (p=0.030).
Conclusion: There is a high prevalence of CR in nosocomial pneumonia. Judicious use of antibiotics is the need of the hour and can be implemented by an Antibiotic Stewardship program.
Antibiotic resistance, Extended-spectrum beta-lactamases, Healthcare associated pneumonia
Date of Submission: Sep 11, 2020
Date of Peer Review: Oct 05, 2020
Date of Acceptance: Dec 25, 2020
Date of Publishing: Feb 01, 2021
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA
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• Plagiarism X-checker: Sep 14, 2020
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ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
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- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)