Epidemiologic Study of Ventilator Associated Pneumonia in Neonatal Intensive Care Unit
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Abstract
Objective: To determine the bacterial pathogens and susceptibility patterns causing ventilator associated pneumonia (VAP) in neonatal intensive care unit (NICU)
Methods: Retrospective descriptive study, collected data from microbiology department and medical records of newborn diagnosed as VAP at Faculty of Medicine Vajira Hospital, Navamindradhiraj University since January 1, 2016 to October 31, 2020.
Results: Forty four of specimens from sputum were diagnosed with VAP. The major pathogens were gram negative bacteria (93.2%) which included S. maltophilia (36.4%), P. aeruginosa (34.1%), A. baumannii (9.1%), Acinetobacter spp. (6.8%), E. coli, K. pneumoniae and Klebsiella spp. (2.3% each equally). A gram positive bacterium was S. aureus 6.8% which sensitive to methicillin 100% . All S. maltophilia isolates were sensitive to ceftazidime, ciprofloxacin, imipenem and piperacillin/tazobactam. A.baumannii isolates were 100% sensitive to colistin and tigecycline, 50% sensitive to amikacin, cefoperazone/sulbactam, ceftazidime, ciprofloxacin, gentamicin, imipenem, meropenem and piperacillin/tazobactam. P. aeruginosa isolates were 100% sensitive to amikacin, cefoperazone/sulbactam, gentamicin and piperacillin/ tazobactam, 92.9% sensitive to ceftazidime and meropenem, 88.9%, 86.7% and 85.7% were sensitive to ciprofloxacin, imipenem and colistin, respectively. E. coli was ESBL 100% that all susceptible to amikacin, ceftazidime, carbapenems and piperacillin/tazobactam.
Conclusion: The bacterial pathogens causing VAP in NICU at Faculty of Medicine Vajira Hospital were S. maltophilia, P. aeruginosa, A. baumannii, Acinetobacter spp., E .coli. The empirical antibiotic of choice is piperacillin/tazobactam or ceftazidime or carbapenems. Combination with aminoglycosides or ciprofloxacin is crucial for severe case and cloxacillin for suspected S. aureus. In case of carbapenem resistant A. baumannii (CRAB) and not improve with other empirical antibiotics, consider tigecycline plus colistin.
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