Detection of Carbapenemase Producing Drug Resistant Gram Negative Bacteria of Ventilator Associated Pneumonia Patients in Intensive Care Unit in Rajshahi Medical College Hospital

Abstract

Background: Carbapenem resistance is a major and on-going public health problem globally and locally. Ventilator associated pneumonia is a major cause of higher morbidity and mortality among hospitalized patients especially in intensive care unit despite of recent advances in diagnosis and treatment. It occurs mainly among gram negative pathogens. Objective: To isolate and identify Carbapenemase producing drug resistance gram negative bacteria with their antibiogram of VAP patients in Intensive care unit in Rajshahi medical college hospital. Materials and Method: A Cross-sectional type of descriptive study was done during the period of July 2017 to June 2018. Endotracheal aspirates were collected of VAP patients in intensive care unit of Rajshahi Medical College Hospital. The specimens were inoculated in blood agar, nutrient agar and MacConkey’s agar media and incubated aerobically at 37° C for 24 hours. The isolated bacteria were identified by their colony morphology, pigment production, haemolysis on blood agar plate, motility test, Gram staining and relevant biochemical tests. Susceptibility tests of the bacterial isolates were done by using the modified Kirby Bauer disk diffusion method on Mueller Hinton agar media. Carbapenemase producing bacteria were identified phenotypically by modified Hodge test. Results: Out of a total 80 samples, Culture yielded growth were 71(88.75%) and 09(11.25%) had yielded no growth. Among the culture positive isolates, Gram negative organisms were higher 57(80.30%) than gram positive 14(19.70%). P. Aeruginosa 24(33.8%) was the predominant organism followed by S. aureus 14(19.7%), Klebsiella spp. 11(15.5%), Acinetobacter spp. 10(14.1%) and E. Coli 8(11.3%). Among 57 isolated gram-negative bacteria 27 (49.7%) were carbapenemase producers. Conclusion: It may be concluded that, most of the isolated bacteria isolated from VAP are multidrug resistant and causes complicated life-threatening infections. Identification of the risk factors associated with carbapenem resistant bacterial infections is necessary to guide appropriate empirical antibiotic therapy, thus, reducing unfavorable outcomes and morbidity.