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Summary: Ventilator‐associated pneumonia commonly occurs in critically ill patients. Clinical suspicion results in overuse of antibiotics, which in turn promotes antimicrobial resistance. Detection of volatile organic compounds in the exhaled breath of critically ill patients might allow earlier detection of pneumonia and avoid unnecessary antibiotic prescription. We report a proof of concept study for non‐invasive diagnosis of ventilator‐associated pneumonia in intensive care (the BRAVo study). Mechanically ventilated critically ill patients commenced on antibiotics for clinical suspicion of ventilator‐associated pneumonia were recruited within the first 24 h of treatment. Paired exhaled breath and respiratory tract samples were collected. Exhaled breath was captured on sorbent tubes and then analysed using thermal desorption gas chromatography–mass spectrometry to detect volatile organic compounds. Microbiological culture of a pathogenic bacteria in respiratory tract samples provided confirmation of ventilator‐associated pneumonia. Univariable and multivariable analyses of volatile organic compounds were performed to identify potential biomarkers for a ‘rule‐out’ test. Ninety‐six participants were enrolled in the trial, with exhaled breath available from 92. Of all compounds tested, the four highest performing candidate biomarkers were benzene, cyclohexanone, pentanol and undecanal with area under the receiver operating characteristic curve ranging from 0.67 to 0.77 and negative predictive values from 85% to 88%. Identified volatile organic compounds in the exhaled breath of mechanically ventilated critically ill patients show promise as a useful non‐invasive ‘rule‐out’ test for ventilator‐associated pneumonia.

Objective: It is very important to determine infections and etiologic organisms in intensive care unit, in order to take necessary precautions and treat them successfully. Infections developing in intensive care units, result in very high morbidity, mortality and massive increases in hospitalization costs. In this study, it has been aimed to determine frequency, general properties and etiology of lower respiratory tract, urinary tract and blood stream infections developed in intensive care unit and compare these data with the national data.Material and Methods: Between January 2016 and December 2019, 178 infections, developed in an intensive care unit having 51 adult patient beds, were evaluated, retrospectively. Lower respiratory tract, urinary tract and bloodstream infections and causative organisms were investigated. Patients aged under 18, who had immunosupressive diseases and who had infections developed after surgical interventions were excluded.Results: Eigthyfive female, 86 male patients were enrolled, mean age was 72.5±14 years. Infection rate for a thousand hospitalization days in lower respiratory tract infections was 4.5, urinary tract infections was 0.3 and bloodstream infections was 0.2. Rate of ventilator-associated pneumonia was higher than Turkish National Data. Urinary tract and blood stream infections rate were less than expected (p, Amaç: Yoğun bakımdaki hastane enfeksiyonlarının önlenmesi ve etkili tedavisi için etyolojik etkenlerin saptanması önemlidir. Yoğun bakımda gelişen enfeksiyonların mortalitesi, morbiditesi ve maliyetleri yüksektir. Bu çalışmada yoğun bakımda gelişen alt solunum yolu, üriner sistem ve kan dolaşımı enfeksiyonlarının genel özellikleri, etkenlerinin tiplerinin saptanması ve enfeksiyon hızlarının ulusal verilerle karşılaştırılması hedeflendi.Gereç ve Yöntemler: Ocak 2016 ile Aralık 2019 tarihleri arasında özel bir hastanedeki 51 yataklı erişkin üçüncü basamak karma yoğun bakım biriminde saptanan 178 hastane enfeksiyonu retrospektif olarak değerlendirildi. Hastalardaki enfeksiyon etkenlerinin sıklığı incelendi. Postoperatif cerrahi alan enfeksiyonu saptanan hastalar, immün suprese olanlar ile 18 yaşından küçük hastalar çalışmaya dahil edilmedi.Bulgular: Çalışmaya dahil edilen hastaların 85'i kadın 86'sı erkekti. Hastaların ortalama yaşı 72,6±14,2 idi. Bin hasta yatışındaki enfeksiyon hızları; alt solunum yolu enfeksiyonda 4,5, üriner sistem enfeksiyonunda 0,3 ve kan dolaşımı enfeksiyonunda 0,2 olarak saptandı. Ventilatör ilişkili pnömoni hızı öngörülen ulusal değerden yüksek, üriner ve kan dolaşımı enfeksiyon hızları ise öngörülen ulusal değerden daha düşük saptandı (p

Aim: It remains unclear whether immunosuppressive treatments such as corticosteroids and IL-6 receptor blockers have an effect on the development of ventilator-associated pneumonia (VAP). The aim of this study was to investigate the effect of immunosuppressive therapy on the development of VAP in critically ill patients with COVID-19. Material and Method: Two hundred thirty five patients with critically ill patients with COVID-19, who were treated in the intensive care unit (ICU) and received mechanical ventilator support, were evaluated retrospectively. VAP development, secondary infections, microorganisms isolated, and resistance patterns were compared between the groups that received and did not receive immunosuppressive therapy, and also the groups that did not receive immunosuppressive therapy, received only corticosteroid, received only tocilizumab, and received corticosteroid plus tocilizumab were compared in the subgroup analysis. Results: In the immunosuppressive treatment group, VAP development (40.2% vs. 21.2%; p=0.001), secondary infection development (48.4% vs. 29.2%; p=0.003), at least one drug resistant bacteria growth (46.7% vs. 27.4%; p=0.001), extensively-drug resistant (XDR) microorganism growth (89.8% vs. 72.7%; p=0.033) were higher than the group that did not receive immunosuppressive treatment. VAP (53.3%; p=0.004), secondary infection (73.3%; p=0.0002), the growth of bacteria resistant to at least one drug (70%; p=0.0003) were highest in the corticosteroid plus tocilizumab group in the subgroup analysis. In addition, XDR (95.5% vs. 72.7%; p=0.032) and pan-drug resistant (PDR) microorganism growth (31.8% vs. 9.1% p=0.032) were higher in the corticosteroid plus tocilizumab group than the no immunosuppressive therapy group. There was no difference between the groups in terms of mortality (p>0.05). Conclusion: Immunosuppressive therapy has been found to potentially enhance the risk of VAP and secondary infections in critically ill patients with COVID-19 pneumonia as well as the growth of bacteria resistant to at least one drug, the length of stay in hospital and ICUs. In addition, it has been evaluated that there may be an increase in the growth of XDR and PDR microorganisms when corticosteroid and tocilizumab are used together. Although there was no difference in mortality, using immunosuppressive therapy may require careful use of targeted antibiotics and longer-term antimicrobial therapy.

Bu tez çalışması Batman Üniversitesi Bilimsel Araştırma Projeleri Koordinatörlüğü tarafından BTÜBAP-2022-YL-08 nolu proje ile desteklenmiştir., Bu çalışmada, siyah sarımsak ile kekiğin zatürre patojen bakterileri üzerine antimikrobiyal ve antioksidatif sinerjik etkileri araştırılmıştır. Çalışmamızda su ve etil alkol ekstrelerinin antimikrobiyal aktivitelerini belirmek için agar kuyu difüzyon, minimum inhibisyon konsantrasyonu (MIC) ve minimum bakterisidal konsantrasyonu (MBC) testleri yapılmıştır. Bu şekilde toplam fenolik, flavonoid, ve antioksidan kapasite (DPPH-2,2-diphenyl-1-picrylhydrazyl, CUPRAC-Cupric Reducing Antioxidant Capacity, FRAP-Fluorescence recovery after photobleaching) belirlenmiştir. Agar kuyu difüzyon testinde beyaz sarımsağın (BS) su ekstraktında (SE) en yüksek etki gösterdiği bakteri Staphylococcus aureus (34.64 mm zon çapı) iken, BS etil alkol(EE) ekstraktı uygulanan bakterilerde en yüksek Pseudomonas aeruginosa ve Klebsiella pneumoniae (30.48mm zon çapı) olduğu görülmüştür. Siyah sarımsak su ekstraktı (SSSE) uygulanan bakterilerde sadece Staphylococcus aureus (9.44 mm zon çapı) üzerinde etkili olurken, siyah sarımsak etil alkol ekstraktının (SSEE’nin) en etkili olduğu bakteri Pseudomonas aeruginosa (18.17mm zon çapı aralığı) olduğu belirlenmiştir. Kekiğin su ekstraktının (KSE) en etkili olduğu bakteri Klebsiella pneumoniae (23.50mm zon çapı) iken, etil alkol ekstraktının (KEE) en etkili olduğu bakteri ise Pseudomonas aeruginosa (20.62 mm zon çapı) olarak tespit edilmiştir. BS+KSE en etkili olduğu bakteri Klebsiella pneumoniae (22.34mm zon çapı) iken, BS+KEE’nin (23.79mm zon çapı) en etkili olduğu bakteri yine Klebsiella pneumoniae olduğu verisine ulaşılmıştır. SS+KSE’nin sadece Pseudomonas aeruginosa bakterisine etkili (8.52 mm zon çapı) iken, SS+KEE’nin en etkili olduğu bakteri Acinetobacter baumannii (38.50 mm zon çapı) olarak tespit edilmiştir. MBC testi verilerine göre, BSSE (0.012 mg/mL) tüm bakteri izolatlarında etkili iken, MIC testi için en etkili olduğu bakteri Staphylococcus aureus (0.094 mg/mL) olarak bulunmuştur. MBC testinin BSEE (0.012 mg/mL) Pseudomonas aeruginosa hariç diğer tüm bakterilerde etki gösterirken, MIC BSEE’nin (0.023 mg/mL) en etkili olduğu bakteri Staphylococcus aureus bilgisi elde edilmiştir. MBC testinin SSSE’de (0,188 mg/mL) en etkili olduğu bakteri Pseudomonas aeruginosa iken, MIC SSSE’de (0.750 mg/mL) sadece Klebsiella pneumoniae bakterisine etki etmiştir. MBC testinin SSEE (0.012 mg/mL) tüm bakteri izolatlarında etkili iken, MIC SSEE’nin (0.047 mg/mL) en etkili olduğu bakteri Staphylococcus aureus olarak bulunmuştur. MBC testinin KSE‘de (0.375 mg/mL) en etkili olduğu bakteriler Pseudomonas aeruginosa, Staphylococcus aureus ve Acinetobacter baumannii iken, MIC KEE’nin hiçbir bakteri izolatında etkili olmadığı görülmüştür. MBC testinin KEE’de (0.375 mg/mL) tüm bakterilerde etkili iken, MIC KEE’nin (0.023 mg/mL) en etkili olduğu bakteri Staphylococcus aureus olduğu verisine ulaşılmıştır. MBC testinin BS+KSE (0.012 mg/mL) en etkili olduğu bakteriler Klebsiella pneumoniae ve Staphylococcus aureus iken, MIC BS+KSE (0.375 mg/mL) en etkili olduğu bakteri Staphylococcus aureus tespiti yapılmıştır. MBC testinin BS+KEE (0,012 mg/mL) en etkili olduğu bakteriler Klebsiella pneumoniae ve Staphylococcus aureus iken, MIC BS+KEE (0.023 mg/mL) en etkili olduğu bakteriler Staphylococcus aureus ve Acinetobacter baumannii olduğu bilgisine ulaşılmıştır. MBC testinin SS+KSE (0.012 mg/mL) en etkili olduğu bakteri Staphylococcus aureus iken, MIC SS+KSE (0.188 mg/mL) sadece Staphylococcus aureus bakterisinde etkili olmuştur. MBC testinin SS+KEE (0.012 mg/mL) en etkili olduğu bakteriler Staphylococcus aureu ve Acinetobacter baumannii iken, MIC SS+KEE (0.023 mg/mL) en etkili olduğu bakteriler Pseudomonas aeruginosa ve Staphylococcus aureus olduğu tespit edilmiştir. Biyokimyasal testlerde araştırılan ekstraktlar arasında, en yüksek fenolik madde miktarı değerleri KSE 1.184 mgGAE/mL, en yüksek flavonoid madde miktarı değerleri KSE 0.129 mg rutin eşdeğeri/mL olduğu görülmüştür. Antioksidan testlerde ise, en yüksek DPPH radikal giderme aktivitesi değerleri BS+KEE kombinasyonunda 0.198 mg Troloks eşdeğeri/mL, en yüksek CUPRAC aktivitesi değerleri KSE 4.318 mg Troloks eşdeğeri/mL ve en yüksek FRAP aktivitesi değerleri KSE 2.633 mg Troloks eşdeğeri/mL olarak tespit edilmiştir. Yapılan araştırma sonucunda, zengin biyokimyasal ve antioksidatif özellikleri belirlenen tıbbi bitkilerin, yalnız ve birlikte kullanımının patojen pnömoni izolatlarına karşı antimikrobiyal özellikleri yorumlanmıştır. Bu tıbbi bitkilerin pnömoni kökenli hastalarda kullanılan ilaçları destekleyici olarak kullanılması faydalı olabileceği kanısına varılmıştır., In this study, antimicrobial and antioxidative synergistic effects of black garlic and thyme on pneumonia pathogenic bacteria were investigated. In our study, agar well diffusion, minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC) tests were performed to determine the antimicrobial activities of water and ethyl alcohol extracts. In this way, total phenolic, flavonoid, and antioxidant capacity (DPPH-2,2-diphenyl-1-picrylhydrazyl, CUPRAC (Cupric Reducing Antioxidant Capacity), FRAP-(Fluorescence recovery after photobleaching) were determined. Staphylococcus aureus (34.64 mm zone diameter) was the bacteria in which white garlic (WG) showed the highest effect in water extract (WE) in the agar well diffusion test, while Pseudomonas aeruginosa and Klebsiella pneumoniae (30.48 mm zone diameter) had the highest effect in bacteria applied WG ethyl alcohol extract (EE) has been found. While black garlic water extract (BGWE) was effective only on Staphylococcus aureus (9.44 mm zone diameter) in bacteria applied, it was determined that black garlic ethyl alcohol extract (BGEE) was the most effective bacteria Pseudomonas aeruginosa (18.17 mm zone diameter range). The most effective bacterium was Klebsiella pneumoniae (23.50 mm zone diameter), while water extract (TWE) of thyme was most effective, while Pseudomonas aeruginosa (20.62 mm zone diameter) was determined to be the most effective bacterium by ethyl alcohol extract (TEE). While the bacteria that WG+TWE was most effective was Klebsiella pneumoniae (22.34mm zone diameter), the bacteria that WG+TEE (23.79mm zone diameter) was most effective was again Klebsiella pneumoniae. While BG+TWE was effective only against Pseudomonas aeruginosa bacteria (8.52 mm zone diameter), the bacteria that BG+TEE was most effective was Acinetobacter baumannii (38.50 mm zone diameter). According to MBC test data, WGWE (0.012 mg/mL) was effective in all bacterial isolates, while Staphylococcus aureus (0.094 mg/mL) was found to be the most effective bacteria for MIC test. While MBC test was effective on all bacteria except WGEE (0.012 mg/mL) Pseudomonas aeruginosa, Staphylococcus aureus information was obtained for which MIC WGEE (0.023 mg/mL) was the most effective. While Pseudomonas aeruginosa was the most effective bacteria in MBC test in BGWE (0.188 mg/mL), it only affected Klebsiella pneumoniae bacteria in MIC BGWE (0.750 mg/mL). While BGEE (0.012 mg/mL) of the MBC test was effective in all bacterial isolates, the bacteria that MIC BGEE (0.047 mg/mL) was most effective was found to be Staphylococcus aureus. While the bacteria that the MBC test was most effective in TWE (0.375 mg/mL) were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii, MIC TEE was not found to be effective in any bacterial isolate. While the MBC test was effective in TEE (0.375 mg/mL) in all bacteria, it was found that Staphylococcus aureus was the most effective bacteria in MIC TEE (0.023 mg/mL). While the bacteria Klebsiella pneumoniae and Staphylococcus aureus were the most effective in MBC test with WG+TWE (0.012 mg/mL), the bacteria Staphylococcus aureus was detected for which MIC WG+TWE (0.375 mg/mL) was the most effective. While the bacteria that MBC test WG+TEE (0.012 mg/mL) is the most effective are Klebsiella pneumoniae and Staphylococcus aureus, MIC WG+TEE (0.023 mg/mL) is the most effective bacteria Staphylococcus aureus and Acinetobacter baumannii. Staphylococcus aureus was the most effective bacteria in MBC test BG+TWE (0.012 mg/mL), while MIC BG+TWE (0.188 mg/mL) was effective only on Staphylococcus aureus bacteria. Staphylococcus aureus and Acinetobacter baumannii were found to be the most effective bacteria in MBC test BG+TEE (0.012 mg/mL), while Pseudomonas aeruginosa and Staphylococcus aureus were found to be the most effective bacteria with MIC BG+TEE (0.023 mg/mL). Among the extracts investigated in biochemical tests, the highest phenolic content values were found to be TWE 1.184 mg GAE/mL, and the highest flavonoid content values were TWE 0.129 mg routine equivalent/mL. In antioxidant tests, the highest DPPH radical scavenging activity values were determined as 0.198 mg Trolox equivalent/mL in the WG+TEE combination, the highest CUPRAC activity values were found to be 4.318 mg Trolox equivalent/mL for TWE and the highest FRAP activity values for TWE were 2.633 mg Trolox equivalent/mL. . As a result of the research, the antimicrobial properties of medicinal plants, whose rich biochemical and antioxidant properties were determined, against pathogen pneumonia isolates were interpreted when used alone or together. It has been concluded that the use of these medicinal plants as a supplement to the drugs used in patients with pneumonia may be beneficial.

VAP due to multidrug-resistant (MDR) bacteria is a frequent infection among patients in ICUs. Patient characteristics and mortality in mono- and polybacterial cases of VAP may differ. A single-centre, retrospective 3-year study was conducted in the four ICUs of a Lithuanian referral university hospital, aiming to compare both the clinical features and the 60-day ICU all-cause mortality of monobacterial and polybacterial MDR Klebsiella spp. VAP episodes. Of the 86 MDR Klebsiella spp. VAP episodes analyzed, 50 (58.1%) were polybacterial. The 60-day mortality was higher (p < 0.05) in polybacterial episodes: overall (50.0 vs. 27.8%), in the sub-group with less-severe disease (SOFA < 8) at VAP onset (45.5 vs. 15.0%), even with appropriate treatment (41.7 vs. 12.5%), and the sub-group of extended drug-resistant (XDR) Klebsiella spp. (46.4 vs. 17.6%). The ICU mortality (44.0 vs. 22.5%) was also higher in the polybacterial episodes. The monobacterial MDR Klebsiella spp. VAP was associated (p < 0.05) with prior hospitalization (61.1 vs. 40.0%), diabetes mellitus (30.6 vs. 5.8%), obesity (30.6 vs. 4.7%), prior antibiotic therapy (77.8 vs. 52.0%), prior treatment with cephalosporins (66.7 vs. 36.0%), and SOFA cardiovascular ≥ 3 (44.4 vs. 10.0%) at VAP onset. Patients with polybacterial VAP were more likely (p < 0.05) to be comatose (22.2 vs. 52.0%) and had a higher SAPS II score (median [IQR] 45.0 [35.25–51.1] vs. 50.0 [40.5–60.75]) at VAP onset. Polybacterial MDR Klebsiella spp. VAP had distinct demographic and clinical characteristics compared to monobacterial, and was associated with poorer outcomes.

Evidence-based, standard antibiotic therapy for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is a relevant unmet clinical need in the intensive care unit (ICU). We aimed to evaluate the effectiveness of first-line therapy with old and novel CRAB active antibiotics in monomicrobial VAP caused by CRAB. A prospective, observational study was performed in a mixed non-COVID-19 ICU. The primary outcome measure was clinical failure upon first-line targeted therapy. Features independently influencing failure occurrence were also investigated via Cox proportional multivariable analysis. To account for the imbalance in antibiotic treatment allocation, a propensity score analysis with an inverse probability treatment weighting approach was adopted. Of the 90 enrolled patients, 34 (38%) experienced clinical failure. Compared to patients who experienced a clinical resolution of VAP, those who had clinical failure were of an older age (median age 71 (IQR 64–78) vs. 62 (IQR 52–69) years), and showed greater burden of comorbidities (median Charlson comorbidity index 8 (IQR 6–8) vs. 4 (IQR 2–6)), higher frequency of immunodepression (44% vs. 21%), and greater clinical severity at VAP onset (median SOFA score 10 (IQR 9–11) vs. 9 (IQR 7–11)). Lower rates of use of fast molecular diagnostics for nosocomial pneumonia (8.8% vs. 30.3%) and of timely CRAB active therapy administration (65% vs. 89%), and higher rates of colistin-based targeted therapy (71% vs. 46%) were also observed in patients who failed first-line therapy. Overall, CRAB active iv regimens were colistin-based in 50 patients and cefiderocol-based in 40 patients, both always combined with inhaled colistin. According to the backbone agent of first-line regimens, clinical failure was lower in the cefiderocol group, compared to that in the colistin group (25% vs. 48%, respectively). In multivariable Cox regression analysis, the burden of comorbid conditions independently predicted clinical failure occurrence (Charlson index aHR = 1.21, 95% CI = 1.04–1.42, p = 0.01), while timely targeted antibiotic treatment (aHR = 0.40, 95% CI = 0.19–0.84, p = 0.01) and cefiderocol-based first-line regimens (aHR = 0.38, 95% CI = 0.17–0.85, p = 0.02) strongly reduced failure risk. In patients with VAP caused by CRAB, timely active therapy improves infection outcomes and cefiderocol holds promise as a first-line therapeutic option.

The aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation.Retrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes.94 patients were included, mean age was 51 (39-64) years; median total body surface area burned was 36 (25-54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3-8] vs. 2 [1-4], p0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not.Pulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome.

Biofilm formation on endotracheal tubes (ETT) is an important factor in the development of ventilator-associated pneumonia (VAP). This work aimed to investigate the effectiveness of colistin (COL) against the early stages of biofilm formation by Pseudomonas aeruginosa. Two strategies were used: pre-conditioning the adhesion surfaces with COL before biofilm formation and growing biofilms in its presence. The combined effect of treating P. aeruginosa 24-hours old biofilms with Ciprofloxacin (CIP) or colistin (COL) on clean and COL-conditioned surfaces was also assessed. Random deposition of COL residues altered the physico-chemical properties of the adhesion surfaces and impaired biofilm formation. Moreover, as a consequence of the reduced amount of biofilms attached to COL conditioned surfaces, adhered cells became more exposed to the subsequent action of CIP or COL, suggesting a combined outcome of prophylactic and therapeutic COL-based strategies. Results highlighted the promising use of COL to prevent the establishment of biofilms on ETT., This work was supported by the Portuguese Foundation for Science Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2020 unit BioTecNorte operation [NORTE-01-0145-FEDER-000004] funded by the European Regional Development Fund under the scope of Norte2020–Programa Operacional Regional do Norte. The authors also acknowledge COMPETE2020 FCT for the project POCI-01-0145-FEDER-029841 and for PhD Grant of Diana Alves (SFRH/BD/78063/2011)., info:eu-repo/semantics/publishedVersion

Background Ventilator-associated pneumonia (VAP) is one of the most frequently encountered causes of hospital-acquired infection and results in high morbidity among intubated patients. Few trials have investigated the efficacy of oral care with chlorhexidine (CHX) mouthwash for the prevention of VAP in the paediatric population. Objectives The objective of this study was to assess the efficacy of CHX mouthwash in the prevention of VAP and to determine risk factors for VAP in children aged 1 month to 18 years admitted to the paediatric intensive care unit (PICU). Methods This was a prospective, randomised, controlled, double-blind trial performed in the PICU. Patients were randomised into two groups receiving CHX (0.12%) (n = 88) or placebo (0.9% NaCl) (n = 86) and were followed up for VAP development. The main outcome measures were incidence of VAP, duration of hospital stay, duration of PICU stay, duration of ventilation, mortality, and the characteristics of organisms isolated in cases with VAP. Results: No difference was observed in the incidence of VAP and the type and distribution of organisms in the two groups (p > 0.05). In the CHX and placebo groups, we identified 21 and 22 patients with VAP, respectively. Incidence per 1000 ventilation days was 29.5 events in the CHX group and 35.1 events in the placebo group. Gram-negative bacteria were most common (71.4% in CHX vs. 54.5% in placebo). The use of 0.12% CHX did not influence hospital stay, PICU stay, ventilation, and mortality (p > 0.05). Multivariate analysis identified duration of ventilation as the only independent risk factor for VAP (p = 0.001). Conclusion The use of 0.12% CHX did not reduce VAP frequency among critically ill children. The only factor that increased VAP frequency was longer duration on ventilation. It appears that low concentration of CHX is not effective for VAP prevention, especially in the presence of multiresistant bacteria. ClinicalTrials.gov Identifier NCT04527276 .

Objectives This study assessed the efficacy and safety of novel β-lactam/β-lactamase inhibitor combinations in adult patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). Methods PubMed, Web of Science, the Cochrane Library, Ovid MEDLINE, Embase and EBSCO databases were searched for randomized controlled trials (RCTs) published before September 13, 2020. Only RCTs comparing the treatment efficacy of novel β-lactam/β-lactamase inhibitor combinations with other antibiotics for HAP/VAP in adult patients were included in this integrated analysis. Results Three RCTs were included, and no significant difference in clinical cure rate of the test of cure (TOC) was observed between the novel β-lactam/β-lactamase inhibitor combination and comparators (odds ratio [OR], 1.01; 95% CI, 0.81-1.27; I2 = 35%). The 28-day all-cause mortality was 16.2% and 17.6% for patients receiving the novel β-lactam/β-lactamase inhibitor combination and those receiving comparators, respectively, and no significant difference was noted (OR, 0.90; 95% CI, 0.69-1.16; I2 = 11%). Compared with the comparators, the novel β-lactam/β-lactamase inhibitor combination was associated with a similar microbiological response (OR, 1.06; 95% CI, 0.73-1.54; I2 = 64%) and a similar risk of AEs (treatment-emergent AEs [TEAEs]: OR, 1.04; 95% CI, 0.83-1.30; I2 = 0%; serious AEs: OR, 1.14; 95% CI, 0.79-1.63; I2 = 68%; treatment discontinuation for TEAE: OR, 0.90; 95% CI, 0.62-1.31; I2 = 11%). Conclusions The clinical and microbiological responses of novel β-lactam/β-lactamase inhibitor combinations in the treatment of HAP/VAP were similar to those of other available antibiotics. These combinations also shared a similar safety profile to that of comparators.

Background: Ventilator-associated pneumonia (VAP) is a common and genuine complication in fundamentally sick patients accepting mechanical ventilation. Silver nitrate sol-gel (SN) has been proposed as a potential preventative measure against VAP. Be that as it may, the arrangement of SN with distinctive concentrations and pH values remains a basic factor influencing its effectiveness. Methods: Silver nitrate sol-gel was arranged with distinctive concentrations (0.1852%, 0.03496%, 0.1852%, and 0.01968%) and pH values (8.5, 7.0, 8.0, and 5.0) separately. The antimicrobial action of the silver nitrate and NaOH arrangements were assessed against Escherichia coli as a reference strain. The thickness and pH of the arrangements were measured, and biocompatibility tests were performed on the coating tube. The auxiliary changes in the endotracheal tube (ETT) tests after treatment were analyzed utilizing electron microscopy (SEM) and transmission electron microscopy (TEM). Results: The pH estimations of the diverse arrangements showed that the pH values shifted depending on the test conditions, with pH values extending from 5.0 to 8.5. The consistency estimations of the arrangements showed that the thickness values expanded as the pH values drew closer to 7.5 and diminished when the pH values went over 7.5. The antimicrobial action of the silver nitrate and NaOH arrangements were successful against Escherichia coli, with microbial checks decreasing in concentration (0.03496%, 0.1852% (pH: 8), and 0.01968%). The biocompatibility tests revealed tall cell reasonability rates, demonstrating that the coating tube was secure for therapeutic utilization and did not hurt typical cells. The SEM and TEM investigation gave visual proof of the antibacterial impacts of the silver nitrate and NaOH arrangements on the bacterial surface or interior of the bacterial cells. Moreover, the investigation revealed that a concentration of 0.03496% was the foremost successful in hindering the development of ETT bacterial colonization at the nanoscale level. Conclusions: We propose that cautious control and alteration of the pH and thickness of the arrangements are essential to guaranteeing the reproducibility and quality of the sol-gel materials. The silver nitrate and NaOH arrangements may serve as a potential preventative degree against VAP in sick patients, with a concentration of 0.03496% appearing to show the most elevated viability. The coating tube may serve as a secure and viable preventative measure against VAP in sick patients. Further investigation is required to optimize the concentration and introduction time of the arrangements to maximize their adequacy in avoiding VAP in real-world clinical settings.

Objectives: Investigate the prevalence of pulmonary superinfections in COVID-19 patients on ventilators and the susceptibility of causative microorganisms to antibiotics during 2020 pandemic. To investigate the outcome of coinfected or superinfected patients in a 30-day period, LOS (length of stay) in ICU and hospital Materials and methods: During 2020, 184 patients were admitted to the COVID-19 ICU of the Department of Anesthesia, Resuscitation, & Intensive Care, University Hospital of Split; of these, 181 was included in this study. Three patients were excluded due to incomplete files. The study was conducted as an observational retrospective study. Medical data were collected by reviewing the history and discharge papers in medical files stored in the archive. Results: Out of 181 patients, 102 patients were tested for respiratory coinfection/superinfection. 3.3% of patients had a respiratory coinfection upon admittance, and 44.8% developed a respiratory superinfection. The mean time to develop a respiratory superinfection was 10.9 days, with a median of 10 days after admittance to the hospital. The mean time to develop a respiratory superinfection was 5.3 days, with a median of 4 days after admittance to ICU. Patients with a positive respiratory sample had a statistically significant increase in mortality (p=0.002); they also had a significantly longer stay in Hospital and ICU compared with noninfected patients. The most common etiology of positive respiratory samples was Acinetobacter baumannii, Candida albicans, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Conclusion: The prevalence of pulmonary superinfections in patients in the ICU was 44.8%. The most common causative microorganisms of pulmonary coinfection/superinfection were MDR Acinetobacter baumannii, Candida albicans, MDR Pseudomonas aeruginosa, and Klebsiella pneumoniae. Patients with a respiratory coinfection/superinfection had statistically significantly higher mortality than patients without respiratory coinfection/superinfection., Ciljevi: Istražiti prevalenciju plućnih superinfekcija u bolesnika s COVID-19 na strojnoj ventilaciji i osjetljivost uzročnih mikroorganizama na antibiotike tijekom 2020. U cilju istraživanja ishoda bolesnika zaraženih korona virusom ili bolesnika sa superinfekcijama u razdoblju od 30 dana. Također je istraživana duljina boravka/liječenja (LOS) na intenzivnoj njezi i u bolnici. Materijali i metode: Tijekom 2020. godine na intenzivnoj njezi COVID-19 Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje KBC-a Split primljena su 184 pacijenta; od toga je 181 bio uključen u ovu studiju. Tri bolesnika su isključena zbog nepotpunih podataka. Istraživanje je provedeno kao opservacijska retrospektivna studija. Medicinski podaci prikupljeni su pregledom povijesti bolesti i otpusnim pismima u medicinskim datotekama pohranjenim u arhivi. Rezultati: Od 181 bolesnika, 102 bolesnika testirana su na respiratornu coinfekciju/superinfekciju. 3.3% bolesnika imalo je respiratornu infekciju nakon prijema, a 44.8% respiratornu superinfekciju. Srednje vrijeme za razvoj respiratorne superinfekcije bilo je 10.9 dana, s medijanom od 10 dana nakon prijema u bolnicu. Srednje vrijeme za razvoj respiratorne superinfekcije bilo je 5.3 dana, s medijanom od 4 dana nakon prijema na intenzivnu. Bolesnici s pozitivnim respiratornim uzorkom imali su statistički značajno povećanje smrtnosti (p=0.002); također su imali znatno duži boravak u bolnici i intenzivnoj njezi u usporedbi s nezaraženim pacijentima. Najčešća etiologija pozitivnih respiratornih uzoraka bila je Acinetobacter baumannii, Candida albicans, Pseudomonas aeruginosa i Klebsiella pneumoniae. Zaključak: Prevalencija plućnih superinfekcija u bolesnika na intenzivnoj njezi iznosila je 44,8%. Najčešći uzročni mikroorganizmi plućne coinfekcije/superinfekcije bili su MDR Acinetobacter baumannii, Candida albicans, MDR Pseudomonas aeruginosa i Klebsiella pneumoniae. Bolesnici s respiratornom coinfekcijom/superinfekcijom imali su statistički značajno veću smrtnost od bolesnika bez respiratorne coinfekcije/superinfekcije.

Ventilator-associated pneumonia (VAP) is an unresolved problem in nosocomial settings, remaining consistently associated with a lack of treatment, high mortality, and prolonged hospital stay in mechanically ventilated patients. The endotracheal tube (ETT) is the major culprit for VAP development owing to its early surface microbial colonization and biofilm formation by multiple pathogens, both critical events for VAP pathogenesis and relapses. To combat this matter, gradual research on antimicrobial ETT surface coating/modification approaches has been made. This review provides an overview of the relevance and implications of the ETT bioburden for VAP pathogenesis and how technological research on antimicrobial materials for ETTs has evolved. Firstly, certain main VAP attributes (definition/categorization; outcomes; economic impact) were outlined, highlighting the issues in defining/diagnosing VAP that often difficult VAP early- and late-onset differentiation, and that generate misinterpretations in VAP surveillance and discrepant outcomes. The central role of the ETT microbial colonization and subsequent biofilm formation as fundamental contributors to VAP pathogenesis was then underscored, in parallel with the uncovering of the polymicrobial ecosystem of VAP-related infections. Secondly, the latest technological developments (reported since 2002) on materials able to endow the ETT surface with active antimicrobial and/or passive antifouling properties were annotated, being further subject to critical scrutiny concerning their potentialities and/or constraints in reducing ETT bioburden and the risk of VAP while retaining/improving the safety of use. Taking those gaps/challenges into consideration, we discussed potential avenues that may assist upcoming advances in the field to tackle VAP rampant rates and improve patient care. Statement of significance : The use of the endotracheal tube (ETT) in patients requiring mechanical ventilation is associated with the development of ventilator-associated pneumonia (VAP). Its rapid surface colonization and biofilm formation are critical events for VAP pathogenesis and relapses. This review provides a comprehensive overview on the relevance/implications of the ETT biofilm in VAP, and on how research on antimicrobial ETT surface coating/modification technology has evolved over the last two decades. Despite significant technological advances, the limited number of gathered reports (46), highlights difficulty in overcoming certain hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation duration; hospital length of stay; VAP occurrence), which makes this an evolving, complex, and challenging matter. Challenges and opportunities in the field are discussed., This research was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2020 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020–Programa Operacional Regional do Norte. The authors also acknowledge the support, through the Programa Operacional Competitividade e Internacionalização (COMPETE2020) and by national funds, through FCT for the POLY-PrevEnTT project (PTDC/BTMSAL/29841/2017- POCI-01-0145-FEDER029841) and the Ph.D. Grant of Tânia Grainha (SFRH/BD/136544/2018)., info:eu-repo/semantics/publishedVersion

International audience; Purpose: Duration of antibiotic therapy for ventilator-associated pneumonia (VAP) due to non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA) remains uncertain. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) vs. prolonged antibiotic therapy (15 days) in VAP due to PA (PA-VAP).Methods: We conducted a nationwide, randomized, open-labeled, multicenter, non-inferiority trial to evaluate optimal duration of antibiotic treatment in PA-VAP. Eligible patients were adults with diagnosis of PA-VAP and randomly assigned in 1:1 ratio to receive a short-duration treatment (8 days) or a long-duration treatment (15 days). A pre-specified analysis was used to assess a composite endpoint combining mortality and PA-VAP recurrence rate during hospitalization in the intensive care unit (ICU) within 90 days.Results: The study was stopped after 24 months due to slow inclusion rate. In intention-to-treat population (n = 186), the percentage of patients who reached the composite endpoint was 25.5% (N = 25/98) in the 15-day group versus 35.2% (N = 31/88) in the 8-day group (difference 9.7%, 90% confidence interval (CI) -1.9%-21.2%). The percentage of recurrence of PA-VAP during the ICU stay was 9.2% in the 15-day group versus 17% in the 8-day group. The two groups had similar median days of mechanical ventilation, of ICU stay, number of extra pulmonary infections and acquisition of multidrug-resistant (MDR) pathogens during ICU stay.Conclusions: Our study failed to show the non-inferiority of a short duration of antibiotics in the treatment of PA-VAP, compared to a long duration. The short duration strategy may be associated to an increase of PA-VAP recurrence. However, the lack of power limits the interpretation of this study.

Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation in the intensive care unit. The incidence, patient characteristics, and outcomes have not been described in a regional Australian setting.Τhe primary objective was to establish the incidence of VAP in a regional intensive care unit using predetermined diagnostic criteria. The secondary objective was to compare the agreement between criteria-based and physician-based diagnostic processes. The tertiary objectives were to compare patient characteristics and clinical outcomes of cases with and without VAP.A retrospective clinical audit was performed of adult patients admitted to Rockhampton Intensive Care Unit, Australia, between 2013 and 2016. We included all patients ventilated for ≥72 h and not diagnosed with a pneumonia before or during the first 72 h of ventilation.A total of 170 cases met the inclusion criteria. The incidence of VAP as per the criteria-based diagnosis was 27.3 cases per 1000 ventilator days (95% confidence interval [CI]: 18.4-36.2) and as per the physician-based diagnosis was 25.8 cases per 1000 ventilator days (95% CI: 17.1-34.4). There was a moderate chance-corrected agreement between the criteria- and physician-based diagnosis. Very obese cases (body mass index [BMI] ≥40) were nearly four times more likely to develop VAP than cases with normal BMI (BMI30) (odds ratio: 3.664; 95% CI: 1.394-9.634; p = 0.008). After controlling for sex, BMI category, comorbidities, and Acute Physiology and Chronic Health Evaluation II scores, there was a trend (p = 0.283) for higher adjusted mortality rate for cases with VAP (10.1%, 95% CI: 4.8-21.5) than for those without VAP (6.1%, 95% CI: 3.0-12.4). Cases with VAP had a higher total hospital cost ($123,223 AUD vs $66,425 AUD, p 0.001), than cases without VAP.This is the first study reporting incidence of VAP in an Australian regional intensive care unit setting. An increased length of stay and significantly higher hospital costs warrant research investigating reliable and valid clinical prediction rules to forecast those at risk of VAP.

Background Device-associated infections (DAIs) such as ventilator associated pneumonia (VAP), central line–associated blood stream infection (CLABSI), and catheter-related urinary tract infection (CAUTI) are principal contributors to health hazard and a major preventable threat to patient safety. Robust surveillance of DAI delineates infections, pathogens, resistograms, and facilitates antimicrobial therapy, infection-control, antimicrobial stewardship, and improvement in quality of care. Methods This prospective outcome surveillance study was conducted amongst 2067 ICU patients in a 1000-bedded teaching hospital. Clinical, laboratory, and environmental surveillance, as well as screening of health care professionals (HCPs) were conducted using the modified US Centers for Disease Control and Prevention–National Healthcare Safety Network definitions and methods. Morbidity, mortality, and health-care indices were analyzed and two-tier infection prevention and control was promulgated. Results Mean occupancy was 95.34% for 2061 patients of 7381 patients/bed/ICU days. One hundred seventeen episodes of DAI occurred in 1258 patients of 12,882 device-days with mean device utilization ratio of 1.79. Mean rate of DAI was 7.40 per 1000 device days. Multiresistant Pseudomonas aeruginosa was most commonly followed by Acinetobacter. Mean all-cause mortality in ICU was 24.85%, whereas all-cause mortality after DAI was 9.79%. Methicillin-resistant Staphylococcus aureus prevalence was 38.46% amongst health-care professionals. Conclusion Mean rates of VAP, CLABSI, and CAUTI were 20.69, 2.53, and 2.23 per 1000 device days comparable with Indian and global ICUs. Resolute conviction and sustained momentum in infection prevention and control is an essential step toward patient safety.

Machine learning; Mechanical ventilation; Prognostic model Aprenentatge automàtic; Ventilació mecànica; Model pronòstic Aprendizaje automático; Ventilacion mecanica; Modelo pronóstico Purpose Existing expert systems have not improved the diagnostic accuracy of ventilator-associated pneumonia (VAP). The aim of this systematic literature review was to review and summarize state-of-the-art prediction models detecting or predicting VAP from exhaled breath, patient reports and demographic and clinical characteristics. Methods Both diagnostic and prognostic prediction models were searched from a representative list of multidisciplinary databases. An extensive list of validated search terms was added to the search to cover papers failing to mention predictive research in their title or abstract. Two authors independently selected studies, while three authors extracted data using predefined criteria and data extraction forms. The Prediction Model Risk of Bias Assessment Tool was used to assess both the risk of bias and the applicability of the prediction modelling studies. Technology readiness was also assessed. Results Out of 2052 identified studies, 20 were included. Fourteen (70%) studies reported the predictive performance of diagnostic models to detect VAP from exhaled human breath with a high degree of sensitivity and a moderate specificity. In addition, the majority of them were validated on a realistic dataset. The rest of the studies reported the predictive performance of diagnostic and prognostic prediction models to detect VAP from unstructured narratives [2 (10%)] as well as baseline demographics and clinical characteristics [4 (20%)]. All studies, however, had either a high or unclear risk of bias without significant improvements in applicability. Conclusions The development and deployment of prediction modelling studies are limited in VAP and related outcomes. More computational, translational, and clinical research is needed to bring these tools from the bench to the bedside. The project is supported by the Academy of Finland (project number 326291) and the University of Oulu.

Ventilator-associated pneumonia in patients with severe traumatic brain injury can be up to 40 % and this is largely due to the prolonged exposure to mechanical ventilation. The presence of ventilator-associated pneumonia compounds the severity of the disease, which is associated with the factors such as hypoxia, fever, hypotension, increased intracranial pressure. Patients with invasive monitoring of intracranial pressure are at high risk of infection, which is 27 %. The article, based on the position of Guidelines for Management of Severe Traumatic Brain Injury 4th Edition, 2016 provides evidence on the prevention of infection risks associated with ventilator-associated pneumonia and external ventricular drain. Concerning ventilator-associa­ted pneumonia three positions were analyzed: the first estimated the time of overlay of tracheostomy (early, late); second one evaluated oral care with povidone-iodine; in the third there were estimated the infection prevention methods associated with the systems for external ventricular drain, by impregnating the catheters with antibiotics. The analysis found that early tracheostomy is recommended to reduce the days of mechanical ventilation, when the total benefits significantly outweigh the complications associated with this procedure. However, there is no evidence that early tracheostomy reduces mortality or incidence of nosocomial pneumonia. The use of povidone-iodine for the purpose of oral care in order to reduce the incidence of ventilator-associated pneumoniais not recommended and may lead to increased risk of developing acute respiratory distress syndrome. Catheters for external ventricular drainage, impregnated with antibiotic, may be considered for the prevention of catheter-related infections in the external ventricular drainage.

Aerosolized antibiotics are being increasingly used to treat respiratory infections, especially those caused by drug-resistant pathogens. Their use in the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in critically ill patients is especially significant. They are also used as an efficient alternative to overcome the issues caused by systemic administration of antibiotics, including the occurrence of drug-resistant strains, drug toxicity, and insufficient drug concentration at the target site. However, the rationale for the use of aerosolized antibiotics is limited owing to their insufficient efficacy and the potential for underestimated risks of developing side effects. Despite the lack of availability of high-quality evidence, the use of aerosolized antibiotics is considered as an attractive alternative treatment approach, especially in patients with multidrug-resistant pathogens. In this review, we have discussed the effectiveness and side effects of aerosolized antibiotics as well as the latest advancements in this field and usage in the Republic of Korea.

Prevention of healthcare-associated infections (HAI) like ventilator associated pneumonia (VAP) is particularly challenging especially in resource limited settings. Complex microbial interactions between patients and health care workers (HCWs) further complicate the situation, requiring a holistic approach for successful management. To bridge the gap between laboratory and intensive care unit (ICU) this study was conducted to find the role of hand-held microscope 'Foldscope' in restricting empirical therapy in intubated patients.A total of 75 endotracheal aspirates (ETA) were collected from intubated patients in the ICU with (group 1) and without (group 2) VAP. For group 2, those with less than 48 ​h ventilation and with endotracheal tube (ETT) in situ were considered. Presence of biomass was detected through foldscope and ETA samples were processed for quantitative gram staining (QGS), semi-quantitative and quantitative culture. Phenotypic and genotypic characterization of Acinetobacter baumannii, the commonest isolate, was done and findings were statistically analysed.Biomass was present as seen through a foldscope in 45 cases (90%) in group 1 and 17 cases (68%) in group 2. In both the groups, A. baumannii was the most common isolate. Biomass production, significant QGS and culture was significantly more in group 1 (p ​ ​0.05). However, carbapenem resistant A. baumannii (CRAB) was comparably present in both the groups thus showing limited role of empirical carbapenem therapy.Early assessment of biomass in mechanically ventilated patients could provide guidance for empirical antibiotic therapy. Foldscope proved to be an excellent tool for restricting empirical therapy and driving antimicrobial stewardship in low resource settings.

Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and the determinants that potentially affect mortality are poorly evaluated. We assessed the prognosis of VAP in severe COVID-19 cases and the impact of relapse, superinfection, and treatment failure on 60-day mortality. Methods: We evaluated the incidence of VAP in a multicenter prospective cohort that included adult patients with severe COVID-19, who required mechanical ventilation for ≥48 h between March 2020 and June 2021. We investigated the risk factors for 30-day and 60-day mortality, and the factors associated with relapse, superinfection, and treatment failure. Results: Among 1424 patients admitted to eleven centers, 540 were invasively ventilated for 48 h or more, and 231 had VAP episodes, which were caused by Enterobacterales (49.8%), P. aeruginosa (24.8%), and S. aureus (22%). The VAP incidence rate was 45.6/1000 ventilator days, and the cumulative incidence at Day 30 was 60%. VAP increased the duration of mechanical ventilation without modifying the crude 60-day death rate (47.6% vs. 44.7% without VAP) and resulted in a 36% increase in death hazard. Late-onset pneumonia represented 179 episodes (78.2%) and was responsible for a 56% increase in death hazard. The cumulative incidence rates of relapse and superinfection were 45% and 39.5%, respectively, but did not impact death hazard. Superinfection was more frequently related to ECMO and first episode of VAP caused by non-fermenting bacteria. The risk factors for treatment failure were an absence of highly susceptible microorganisms and vasopressor need at VAP onset. Conclusions: The incidence of VAP, mainly late-onset episodes, is high in COVID-19 patients and associated with an increased risk of death, similar to that observed in other mechanically ventilated patients. The high rate of VAP due to difficult-to-treat microorganisms, pharmacokinetic alterations induced by renal replacement therapy, shock, and ECMO likely explains the high cumulative risk of relapse, superinfection, and treatment failure.

RESUMEN Objetivo: Describir la frecuencia de IAAS y el uso de antibióticos en una UCI COVID del norte peruano. Método: estudio descriptivo trasversal. Se revisaron 85 historias. Hallazgos: mediana de edad= 57 años, RIC (49- 78); 70 % hombres; 74/85 en ventilador, mediana en días= 13 (RIC=7-45). Frecuencia de IAAS: 28,2%: Neumonía asociada a Ventilador 79,1%; 26/85 tuvo al menos un cultivo: 22/26 secreción bronquial: 10/26 Acinetobacter baumani,10/26 Pseudomona Aeruginosa; 8/10 de Acinetobacter y 5/10 de las Pseudomonas fueron multidrogoresistentes; 100% de pacientes recibieron antibióticos; 63 % Carbapenems (36 % Imipenem y 27 % Meropenem) y 22 % cefalosporinas de tercera (14% Ceftazidime y 8% Ceftriaxona); mortalidad: 30,6%. De 19 NAV, 7/19 fueron por Acinetobacter Baummani y 10/19 por Pseudomona Aeruginosa. De los fallecidos, 19% tuvo Acinetobacter baumani y 11% Pseudomona Aeruginosa. Conclusión: gérmenes más frecuentes: Acinetobacter y Pseudomona, todos los pacientes recibieron antibióticos; el más frecuente fue Imipenem. ABSTRACT Objective: To describe the frequency of HAIs and the use of antibiotics in a COVID ICU in northern Peru. The methods cross-sectional descriptive study. 85 stories were reviewed. Findings: median age= 57 years, IQR (49-78); 70% men; 74/85 on a ventilator, median in days= 13 (IQR=7-45). HAI frequency: 28.2%: Ventilator-associated pneumonia 79.1%; 26/85 had at least one culture: 22/26 bronchial secretions: 10/26 Acinetobacter baumani, 10/26 Pseudomonas Aeruginosa; 8/10 of Acinetobacter and 5/10 of Pseudomonas were multidrug resistant; 100% of patients received antibiotics; 63% Carbapenems (36% Imipenem and 27% Meropenem) and 22% third-class cephalosporins (14% Ceftazidime and 8% Ceftriaxone); mortality: 30.6%. Of the 19 VAP, 7/19 were due to Acinetobacter Baummani and 10/19 due to Pseudomonas Aeruginosa. Of the deceased, 19% had Acinetobacter baumani and 11% had Pseudomonas Aeruginosa. Conclusion: the most frequent germs: Acinetobacter and Pseudomona, all patients received antibiotics and the most frequent was imipenem.

Ventilator-associated pneumonia remains commonplace in critically ill patients and is associated with an increased morbidity and mortality. Multidrug-resistant Gram-negative bacillary pathogens, such as Pseudomonas aeruginosa, are commonly implicated in the pathogenesis of ventilator-associated pneumonia. Increasing rates of antibiotic resistance have led to increasing interest in repurposing old antibiotics with alternative administration methods and the development of new antibiotics that have activity against these multidrug-resistant isolates. Moreover, ensuring that the optimal dose is used is of paramount importance to improve patient outcomes and prevent resistance emergence to these novel antibiotic therapies. Amikacin, an aminoglycoside antibiotic, is of interest in the management of ventilator-associated pneumonia given that it retains activity in up to 70% of multi-drug resistant P. aeruginosa isolates. However, amikacin penetrates poorly into the infection site in patients with ventilator-associated pneumonia, resulting in subtherapeutic exposures when administered intravenously. Therefore, there has been renewed interest in dosing for innovative administration methods, such as inhaled dosing for direct drug delivery to the site of infection. Alternatively, new agents such as ceftolozane/tazobactam, have been developed and are increasingly used clinically, particularly for multidrug-resistant P. aeruginosa. However, a paucity of pharmacodynamic studies exist to assist clinicians with prescribing a dose that both increases the probability of treatment success and minimises the emergence of resistance. Therefore, the primary aims of this thesis are to describe the infection site pharmacodynamics of amikacin and ceftolozane/tazobactam against P. aeruginosa, to determine the likely dosing strategies for both agents that will achieve maximal bacterial killing and minimise the risk of resistance emerging. A series of in vitro studies and in silico simulations are used to describe the impact of different dosing regimens on bacterial killing and emergence of resistance.

Einleitung: Nosokomiale Infektionen, besonders ventilatorassoziierte Pneumonien, welche aufgrund einer invasiven Beatmung entstehen, sind häufige Gründe für einen längeren Aufenthalt auf einer Intensivstation, eine längere Beatmungsdauer, eine höhere Mortalität sowie vermehrte Kosten für das Gesundheitssystem. Um diesen präventiv entgegenzuwirken, wird in dieser Arbeit dargestellt, wie die Mundpflege von beatmeten Patient*innen gestaltet werden soll. Methodik: Die Literaturrecherche fand zwischen Jänner und März 2023 statt. Nach dem Screening anhand der Ein- und Ausschlusskriterien und der kritischen Beurteilung der Literatur, wurden 13 wissenschaftliche Publikationen zur Beantwortung der Fragestellung herangezogen. Ergebnisse: Die Untersuchung der Studien ergab folgende Ergebnisse: das Antiseptikum Chlorhexidin hat positive Auswirkungen auf die Inzidenz von VAP; als alternative Methoden zu Chlorhexidin zeigen auch Miswak und Glutamin ähnliche Effekte; Care Bundles in Kombination mit der Anwendung von Zahnbürsten zeigen die größten Effekte in der Prävention einer ventilatorassoziierten Pneumonie. Schlussfolgerung: Trotz der Wirkung verschiedener Maßnahmen und Care Bundles, fehlt es an einheitlichen Richtlinien bezüglich deren Anwendung. Dementsprechend muss hierbei weiter geforscht werden und an der Edukation der durchführenden Pflegepersonen gearbeitet werden. Schlüsselbegriffe: Mundpflege, mechanische Beatmung, ventilatorassoziierte Pneumonie, nosokomiale Infektionen Introduction: Nosocomial infections, especially ventilator-associated pneumonia, which occur due to invasive ventilation, are frequent reasons for a longer stay in an intensive care unit, a longer duration of ventilation, higher mortality, and increased costs for the health care system. In order to counteract these in a preventive way, this thesis shows how the oral care of ventilated patients should be designed. Methodology: The literature research took place between January and March 2023. After the screening based on the inclusion and exclusion criteria and the critical assessment of the literature, 13 scientific publications were used to answer the research question. Results: The screening of the studies revealed the following results: the antiseptic chlorhexidine has positive effects on the incidence of VAP; as alternative methods to chlorhexidine, miswak and glutamine also show similar effects; care bundles in combination with the use of toothbrushes show the greatest effects in the prevention of ventilator-associated pneumonia. Conclusio: Despite the effectiveness of different interventions and care bundles, there is a lack of consistent guidelines regarding their application. Accordingly, further research and education of nurses is needed. Keywords: oral care; mechanical ventilation; ventilator-associated pneumonia; nosocomial infections

Einleitung: Eine nosokomiale Infektion stellt eine Infektion dar, die in einer Gesundheitseinrichtung erworben wurde. Auf Intensivstationen ist die am häufigst auftretende nosokomiale Infektion eine beatmungsassoziierte Pneumonie. Die Inzidenzen liegen zwischen fünf und 40%. Die Mundpflege mittels Zahnreinigung und Mundspüllösung ist Komponente von Interventionsbundles, die zur Prävention einer VAP eingesetzt werden. Methodik: Es wurde eine systematische Literaturrecherche in den Datenbanken CINAHL, Cochrane Library, PubMed und MEDLINE durchgeführt. Unter Einbeziehung der Ein- und Ausschlusskriterien wurden 13 quantitative Studien zur Ergebnisdarstellung herangezogen. Ergebnisse: Die Ergebnisse zeigen, dass sowohl die Anwendung einer Zahnreinigung und/oder Mundspüllösung die Inzidenzrate einer beatmungsassoziierten Pneumonie senken kann. Eine Reduzierung der Mortalitätsrate, Beatmungs- und Aufenthaltsdauer und Bakterien-Flora sowie eine Erhöhung der Mundgesundheit werden beschrieben. In diesen Hinsichten liefern nicht alle Studien ein signifikantes Ergebnis. Schlussfolgerung: Die Inzidenzen einer VAP können durch Zahnreinigung und/oder Mundspüllösungen gesenkt werden. Für aussagekräftigere Resultate bedarf es an mehr Studien mit größeren Stichproben und längerer Anwendungsdauer. Introduction: A nosocomial infection represents an infection acquired in a healthcare facility. In intensive care units, the most common nosocomial infection is a ventilator-associated pneumonia. Incidences range from five to 40%. Oral care via tooth cleaning and mouth rinses are components of interventionbundles used to prevent VAP. Methodology: A systematic literature search was performed in databases such as CINAHL, Cochrane Library, PubMed and MEDLINE. Considering the inclusion and exclusion criteria, 13 quantitative studies were used to present the results. Results: The results show that both the use of a dental cleaning and/or mouth rinses can reduce the incidence of ventilator-associated pneumonia. Reductions in mortality rates, length of ventilation, stay and bacterial flora, as well as increases in oral health, are described. In these respects, not all studies provide a significant result. Conclusion: The incidences of VAP can be reduced by tooth cleaning and/or mouth rinses. More studies with larger samples and longer duration of use are needed for more conclusive results.

Background The role of upper airways microbiota and its association with ventilator-associated pneumonia (VAP) development in mechanically ventilated (MV) patients is unclear. Taking advantage of data collected in a prospective study aimed to assess the composition and over-time variation of upper airway microbiota in patients MV for non-pulmonary reasons, we describe upper airway microbiota characteristics among VAP and NO-VAP patients. Methods Exploratory analysis of data collected in a prospective observational study on patients intubated for non-pulmonary conditions. Microbiota analysis (trough 16S-rRNA gene profiling) was performed on endotracheal aspirates (at intubation, T0, and after 72 h, T3) of patients with VAP (cases cohort) and a subgroup of NO-VAP patients (control cohort, matched according to total intubation time). Results Samples from 13 VAP patients and 22 NO-VAP matched controls were analyzed. At intubation (T0), patients with VAP revealed a significantly lower microbial complexity of the microbiota of the upper airways compared to NO-VAP controls (alpha diversity index of 84 ± 37 and 160 ± 102, in VAP and NO_VAP group, respectively, p-value Prevotella 7, Fusobacterium, Neisseria, Escherichia–Shigella and Haemophilus) was found in VAP patients. In contrast, eight genera belonging to the Bacteroidetes, Firmicutes and Fusobacteria phyla was predominant in this group. However, it is unclear whether VAP caused dysbiosis or dysbiosis caused VAP. Conclusions In a small sample size of intubated patients, microbial diversity at intubation was less in patients with VAP compared to patients without VAP.

Einleitung: Eine beatmungsassoziierte Pneumonie verlängert nicht nur den Aufenthalt auf der Intensivstation und anschließend auf einer Normalstation, sie erhöht die Krankenhauskosten, den Aufwand des Gesundheitspersonals und die Sterblichkeitsrate. Durch gezielte Maßnahmen des gesamten Gesundheitspersonals und vor allem des Pflegepersonals kann die beatmungsassoziierte Pneumonie verhindert werden. Methodik: Für die vorliegende Bachelorarbeit wurde in den Datenbanken PubMed und CINAHL nach evidenzbasierter Literatur zur Beantwortung der Fragestellung gesucht. Um passende Literatur zu finden, wurden Ein- und Ausschlusskriterien definiert. Des Weiteren wurde nach Literatur der letzten fünf bis sieben Jahren geforscht, um möglichst aktuelle Ergebnisse heranziehen zu können. In Summe konnten 12 Studien verwendet werden. Ergebnisse: Die Ergebnisse zeigen, dass präventive Maßnahmen, wie beispielsweise die regelmäßige Cuffdruckmessung und Aufrechterhaltung des Druckes, die Erhöhung des Kopfteiles der Patient*innen, das abwechselnde Positionieren des Endotrachealtubus oder das geschlossene Absaugen von Sekret das Risiko an einer beatmungsassoziierten Pneumonie zu erkranken verringern können. Auch ist zu erwähnen, dass das Personal mehr Schulung im Bereich der Prävention benötigt und ein Mangel an passenden Leitlinien für präventive Maßnahmen herrscht. Schlussfolgerung: Präventive Maßnahmen des Pflegepersonals können die Infektionsrate einer beatmungsassoziierten Pneumonie senken. Gesundheits- und Krankenpfleger*innen müssen im Bereich der Prävention besser geschult werden, um die Maßnahmen effizienter umsetzen zu können. Introduction: Ventilator-associated pneumonia not only prolongs the stay in the intensive care unit as well as in a normal ward, it increases hospital costs, the health staff’s effort and the mortality rate. Respiratory-associated pneumonia can be prevented through targeted measures by all healthcare professionals, especially nurses. Methodology: For this bachelor thesis, I searched the databases PubMed and CINAHL for evidence- based literature in order to answer the research question. Inclusion and exclusion citera were defined for the purpose of finding suitable literature. Literature from the last five to seven years was searched in order to use the most recent results. A total of 12 studies could be found. Results: The results show that preventive measures, such as regular cuff pressure measurement and maintenance, elevation of the patient's head, alternating positioning of the endotracheal tube or closed suction of secretions can reduce the risk of developing respiratory-associated pneumonia. Increased staff training measurements in the area of prevention is being recommended as appropriate guidelines for preventive actions are missing. Conclusion: Preventive action by caregivers may reduce the rate of infection of respiratory- associated pneumonia. Healthcare workers and nurses need to be trained more in the field of prevention in order to be able to better implement the measures.

Background Aetiology detection is crucial in the diagnosis and treatment of ventilator-associated pneumonia (VAP). However, the detection method needs improvement. In this study, we used Nanopore sequencing to build a quick detection protocol and compared the efficiency of different methods for detecting 7 VAP pathogens. Methods The endotracheal aspirate (ETA) of 83 patients with suspected VAP from Peking University Third Hospital (PUTH) was collected, saponins were used to deplete host genomes, and PCR- or non-PCR-amplified library construction methods were used and compared. Sequence was performed with MinION equipment and local data analysis methods were used for sequencing and data analysis. Results Saponin depletion effectively removed 11 of 12 human genomes, while most pathogenic bacterial genome results showed no significant difference except for S. pneumoniae. Moreover, the average sequence time decreased from 19.6 h to 3.62 h. The non-PCR amplification method and PCR amplification method for library build has a similar average sensitivity (85.8% vs. 86.35%), but the non-PCR amplification method has a better average specificity (100% VS 91.15%), and required less time. The whole method takes 5–6 h from ETA extraction to pathogen classification. After analysing the 7 pathogens enrolled in our study, the average sensitivity of metagenomic sequencing was approximately 2.4 times higher than that of clinical culture (89.15% vs. 37.77%), and the average specificity was 98.8%. Conclusions Using saponins to remove the human genome and a non-PCR amplification method to build libraries can be used for the identification of pathogens in the ETA of VAP patients within 6 h by MinION, which provides a new approach for the rapid identification of pathogens in clinical departments.

Purpose To describe the incidence and risk factors of methicillin sensitive Staphylococcus aureus ventilator associated pneumonia (MSSA-VAP) relapse in trauma and non-traumatic brain injury patients. Materials and methods Retrospective observational monocentric cohort study of consecutive ICU patients who developed a first episode of MSSA-VAP after trauma and non-traumatic brain injury. MSSA-VAP relapse encompass MSSA-VAP treatment failure (persistence or recurrence of MSSA) or other pathogen - VAP. Results A total of 165 patients (71% of trauma and 29% of non-traumatic brain injury) with MSSA-VAP were included. MSSA-VAP relapse occurred in 54 (33%) patients, including 28 (17%) MSSA-VAP treatment failure and 46 (28%) other pathogen-VAP. Empirical first-line antibiotic therapy was appropriate in 96% of cases. In multivariate analysis, the presence of Streptococcus species (Odds ratio [OR] 7.37) and oropharyngeal flora (OR 3.64) as initial MSSA co-pathogen, suggested aspiration at the time of admission and independently predicted MSSA-VAP treatment failure. Initial Glasgow coma scale (OR 0.89), need for emergent surgery (OR 5.71) and the presence of an acute respiratory distress syndrome at the time of the first MSSA-VAP (3.99), independently predicted the onset of other pathogen – VAP. Conclusion Early and simple factors may help to identify patients with high-risk of MSSA-VAP relapse.

The Centers for Disease Control and Prevention shifted the focus of safety surveillance in mechanically ventilated patients from ventilator-associated pneumonia to ventilator-associated events in 2013 to increase the objectivity and reproducibility of surveillance and to encourage quality improvement programs to focus on preventing a broader array of complications. Ventilator-associated events are associated with a doubling of the risk of dying. Prospective studies have found that minimizing sedation, increasing spontaneous awakening and breathing trials, and conservative fluid management can decrease event rates and the duration of ventilation. Multifaceted interventions to enhance these practices can decrease ventilator-associated event rates.

Data indicate a tendency towards an increased incidence through the last decades of various forms of pneumonia. Among these, nosocomial pneumonia in patients who have been on mechanical ventilation support (increased after the Covid-19 pandemic) is a condition that must be addressed as soon as possible to avoid complications. Current literature lacks an in-depth analysis of the potential correlation between ventilator-associated pneumonia and poor oral hygiene, especially in children. The aim of this literature review is to investigate if improving oral hygiene could affect the onset of nosocomial pneumonia in children.A search was performed in Pubmed, Medline, and Scopus for the keywords: oral care, children, neonates, ventilator-associated pneumonia, combined with 'AND' or 'OR' Boolean Operators.The relevant papers retrieved in the scientific literature emphasised the importante of good oral care bundles to mitigate the bacteria proliferation in the bloodstream, and to prevent the development of ventilator-associated pneumonia.

Purpose of review We conducted a systematic literature review to summarize the available evidence regarding the incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because of acute respiratory distress syndrome secondary to SARS-CoV-2 infection (C-ARDS). Recent findings Sixteen studies (6484 patients) were identified. Bacterial coinfection was uncommon at baseline (50%) of developing VAP, most commonly because of Gram-negative bacteria. Further work is needed to elucidate the disease-specific risk factors for VAP, strategies for prevention, and how best to differentiate between bacterial colonization versus superinfection.

Hospital-acquired pneumonia (HAP) is defined as an infection in patients admitted in hospital for more than 48hours, and ventilator associated pneumonia (VAP) can be defined as infection occurring in patients admitted in ICU after 48hrs endotracheal intubation and mechanical ventilation. VAP has a mean of 7.3/1000 ventilator days for medical ICU patients and 13.2/1000 ventilator days for surgical ICU patients. The crude mortality rates for HAP are approximately 10% and are higher for VAP, ranging from 20% to 60%. The culture of endotracheal (ET) aspirates will help know the etiological agent and formulate the antibiotic policy for early treatment. To isolate the bacterial pathogens of ET secretions from patients with VAP and know their antibiotic susceptibility pattern. In the present study, out of 102 endotracheal secretions from cases of VAP, 88 samples (86.27%) were culture positive, and the remaining 14 samples (13.73%) were culture negative. Out of the 88 positive cultures, 62 samples (60.78%) showed growth of single isolates, and 26 samples (25.49%) showed multiple isolates. Out of the 114 isolates, 18 isolates (15.8%) were gram positive organisms, and 96 isolates (84.2%) were gram negative organisms. Of the gram positive isolates, the predominant organism was Methicillin resistant (MRSA) (55.56%), followed by Methicillin sensitive (MSSA) (22.22%) and (22.22%). Out of the gram negative isolates, the predominant organism was (36.46%), followed by Acinetobacter spp (25%), (23.96%), (12.5%), (1.04%), and Proteus mirabilis (1.04%). In the present study, Gram positives isolates showed the highest susceptibility to vancomycin and linezolid (100%), and gram negative isolates showed the highest susceptibility to polymyxin B (100%) and meropenem (47.92%). The study gives insight into the bacterial pathogens and their antibiotic susceptibility patterns of isolates from endotracheal secretions of mechanically ventilated patients to prevent the mortality and morbidity of mechanical ventilation and VAP, helping in formulating an antibiotic policy for appropriate empirical therapy.

Background: Many trauma centers have empiric treatment algorithms for ventilator-associated pneumonia (VAP) treatment prior to culture results that include antibiotic agents for methicillin-resista...

Background Neonatal pneumonia remains a significant contributor to infant mortality in India and responsible for increased prevalence of infant deaths globally. Objective To identify risk factors associated with neonatal pneumonia and its mortality in India. Study design A systematic review was conducted including both analytic study designs and descriptive study designs, which reported a quantitative analysis of factors associated with all the three types of pneumonia among neonates. The search was conducted from August to December, 2016 on the following databases; CINAHL, EMBASE, Ovid MEDLINE, PubMed, ProQuest, SCOPUS, Web of Science, WHO IMSEAR and IndMED. The search was restricted to Indian setting. Participants The population of interest was neonates. Outcomes The outcome measures included risk factors for incidences and mortality predictors of neonatal pneumonia. These could be related to neonate, maternal and pregnancy, caregiver, family, environment, healthcare system, iatrogenic and others. Results A total of three studies were included. For risk factors, two studies on ventilator-associated pneumonia were included with 194 neonates; whereas for mortality predictors, only one study with 150 neonates diagnosed with pneumonia was included. 11 risk factors were identified from two studies: duration of mechanical ventilation, postnatal age, birth weight, prematurity, sex of the neonate, length of stay in NICU, primary diagnosis, gestational age, number of re-intubation, birth asphyxia, and use of nasogastric tube. Metaanalysis with random-effects model was possible only for prematurity (250 mm Hg was found to be the single most significant predictor of mortality due to pneumonia in neonates. Conclusion The study found scant evidence from India on risk factors of neonatal pneumonia other than ventilator-associated pneumonia. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s13312-021-2374-4

Objectives Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients requiring mechanical ventilation in intensive care units (ICUs). VAP is associated with delayed extubation, prolonged hospital stays, increased healthcare costs and mortality rates. The aims of this study to evaluate the level of knowledge for the prevention of VAP among healthcare workers (HCWs) in ICUs and to assess their knowledge in relation to their socio-demographic characteristics. Methods A descriptive, cross-sectional design was conducted to assess HCWs’ knowledge of the guidelines for prevention of VAP in the ICUs of public and private hospitals in Hodeida city, Yemen. Around 140 self-administered multiple-choice questionnaires were distributed between April and July 2017. Results A total of 120 (85.6%) HCWs completed questionnaire were obtained (20 physicians, 20 anesthesia technicians and 80 nurses) in this study. The total mean score of the HCWs’ knowledge was low (41 ± 18). A statistically significant difference was found in the HCWs’ knowledge scores according to their specialties and gender. Anesthesia technicians had the highest knowledge score followed by physicians and nurses (52.2 ± 16.2, 45.6 ± 21.2 and 37.1 ± 16.9, respectively, p=0.002). Males had higher scores than females (Median [IQR] 4 [3–5] vs. 3 [2–4], p Conclusions HCWs had a low knowledge level of the guidelines for the prevention of VAP, which may affect their practice. HCWs’ knowledge was affected by their previous received information that increases the necessity to provide them with regular in-service education and training programs.

Rationale: Current guidelines recommend patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia receive empirical antibiotics for suspected bacterial superinfection on the basis of weak evidence. Rates of ventilator-associated pneumonia (VAP) in clinical trials of patients with SARS-CoV-2 pneumonia are unexpectedly low. Objectives: We conducted an observational single-center study to determine the prevalence and etiology of bacterial superinfection at the time of initial intubation and the incidence and etiology of subsequent bacterial VAP in patients with severe SARS-CoV-2 pneumonia. Methods: Bronchoscopic BAL fluid samples from all patients with SARS-CoV-2 pneumonia requiring mechanical ventilation were analyzed using quantitative cultures and a multiplex PCR panel. Actual antibiotic use was compared with guideline-recommended therapy. Measurements and Main Results: We analyzed 386 BAL samples from 179 patients with SARS-CoV-2 pneumonia requiring mechanical ventilation. Bacterial superinfection within 48 hours of intubation was detected in 21% of patients. Seventy-two patients (44.4%) developed at least one VAP episode (VAP incidence rate = 45.2/1,000 ventilator days); 15 (20.8%) initial VAPs were caused by difficult-to-treat pathogens. The clinical criteria did not distinguish between patients with or without bacterial superinfection. BAL-based management was associated with significantly reduced antibiotic use compared with guideline recommendations. Conclusions: In patients with SARS-CoV-2 pneumonia requiring mechanical ventilation, bacterial superinfection at the time of intubation occurs in

BACKGROUND: The pandemic of coronavirus disease (COVID-19) has caused huge number of patients admitted to intensive care units (ICUs) in a critical need to mechanical ventilation. Ventilator associated pneumonia (VAP) has been noticed as a common complication in these patients with unfavorable outcomes. The current study aimed to assess bacterial and fungal VAP in COVID-19 patients admitted to ICUs during the second wave and to identify the possible risk factors. METHODS: Respiratory samples were collected from 197 critically ill COVID-19 patients under mechanical ventilation. Bacterial and fungal superinfections were diagnosed by microbiological cultures with subsequent antimicrobial susceptibility testing of the isolates using available kits. RESULTS: All specimens 197/197 (100%) were positive for bacterial infections, while fungal elements were detected in 134/197 (68%) of specimens. The most frequently isolated bacteria were pan drug resistant (PDR) Klebsiella pneumoniae (41.1%), followed by multi drug resistant (MDR) Acinetobacter baumannii (27.4%). On the other hand, Candida species represented the most frequently isolated fungi (75.4%) followed by molds including Aspergillus (16.4%) and Mucor (8.2%) species. Possible risk factors for fungal VAP included underlying diabetes mellitus (95% confidence interval [CI] 1.09-3.31; p = 0.02), chest disease (95% CI 1.01-3.32; p = 0.05), hypothyroidism (95% CI 1.01-4.78; p = 0.05), and longer duration of mechanical ventilation (p < 0.001). Furthermore, all patients 134/134 (100%) who developed fungal VAP, were already under treatment with corticosteroids and Tocilizumab. CONCLUSION: Bacterial and fungal VAP in critically ill COVID-19 patients is a serious problem in the current pandemic. Urgent and strategic steps to keep it under control are compulsory.

Introduction The efficacy and safety of adjunctive inhaled antibiotic therapy for ventilator-associated pneumonia (VAP) was systematically reviewed based on updated studies. Methods We searched four databases and four clinical trial registration platforms to identify relevant studies published prior to May 19, 2020. Randomized controlled trials (RCTs) assessing adjunctive antibiotic inhalation treatment for VAP patients were eligible for this review. Two reviewers independently screened the articles and extracted the data. Information on inhaled therapy and clinical outcomes was collected. Study quality was assessed with the Cochrane risk of bias tool. The meta-analysis was conducted with Review Manager and R software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines were used to evaluate the quality of evidence for each pooled outcome. Results Eleven RCTs and 1210 patients were included in this analysis after the application of the inclusion and exclusion criteria. Compared with the use of intravenous injection alone, the use of adjunctive inhaled antibiotic therapy improved the rates of clinical cure (relative risk (RR) 1.13, 95% CI [1.02,1.26]) and microbiological eradication (RR 1.45, 95% CI [1.19,1.76]) in VAP patients. However, despite these improvements, mortality was not reduced (RR 1.00, 95% CI [0.82,1.21]). Adjunctive antibiotics delivered through the respiratory tract were not associated with a higher risk of renal impairment but were associated with an increased risk of bronchospasm (RR 2.74, 95% CI [1.31,5.73] during treatment. Conclusions Adjunctive inhaled antibiotics improved the clinical outcomes in VAP patients, but the increased rates clinical cure and microbiological eradication were not associated with reduced mortality. The use of nebulized antibiotics is not supported by the currently available evidence as a routine therapeutic strategy for VAP. PROSPERO registration number CRD42020186970.

Background Healthcare-associated infections (HAI) are considered one of the most common adverse events in health care service provision. In order to prevent the occurrence of HAIs, it is important to implement several prevention strategies. Objectives This study aims to determine the incidence of healthcare-associated infections in a military hospital in Alkharj and the adherence to the HAIs’ prevention strategies. Methods This study included exporting data for all infected cases confirmed by the infection disease specialists in 2019. The data were collected from the reports that were written by infection control unit and infectious disease department. Results The rate of healthcare associated infections (HAIs) in 2019 was 0.43% of total patient admissions. The rate of central line associated bloodstream infections in 2019 was 1.15 per 1000 central line days. The rate of catheter associated urinary tract infections in 2019 was 1.00 per 1000 catheter days. The rate of ventilator associated pneumonia in 2019 was 2.11 per 1000 ventilator days and the rate of surgical site infections in 2019 was 0.41 %. Conclusion The rate of overall healthcare-associated infections (HAI) was low. The compliance rate of health care workers to preventive measures that control HAIs was generally high but there was a need for more awareness particularly regarding personal protective equipment and hand hygiene. So it is important to attend more awareness activities and workshops particularly regarding personal protective equipment and hand hygiene. Furthermore, infection control unit and infectious disease department in the hospital should support the robust HAI prevention programs.

Healthcare associated pneumonia (HAP)is second most common HCAIs that occur in 27% critically ill patients. Eighty-six percent of HAP are associated with mechanical ventilation and termed as ventilator associated pneumonia (VAP). VAP due to multidrug resistant has also increased in recent past. To isolate and identify the bacterial pathogens in endotracheal tubes aspirates of ICUs patients and study their antimicrobial susceptibility pattern.A prospective longitudinal study was conducted in the Microbiology laboratory of a tertiary care hospital over a period of six months after clearance from institutional Research Committee and Ethical Committee. All the samples of ETT secretions received in Clinical Microbiology lab from ICU patients and fulfilling the criteria for VAP were included in this study. Samples were processed as per standard protocol and organisms were identified on the basis of gram staining, colony characters and biochemical tests. Antibiotic sensitivity was performed by Kirby Bauer disc diffusion method as per CLSI guidelines. : A total of 100 samples of ET secretions were collected and proceeded for culture. Out of 100 samples, 76 (76.0%) were positive for bacterial growth. Among 76 positive cultures, a total 80 bacterial isolates were obtained as some cultures were showing polymicrobial growth. Five (6.26%) isolates were Gram Positive bacteria and 75(93.7%) were Gram negative. The most frequent isolates were 35(43.7%) followed by , isolates were sensitive to colistin while resistant to ampicillin and amoxiclav. isolates were sensitive to colistin and resistant to ampicillin, amoxiclav, ciprofloxacin, cefixime, piperacillin tazobactam. isolates were sensitive to colistin while resistant to ampicillin, amoxiclav, ceftizidime and piperacillin tazobactam. In our study antimicrobial pattern of isolated bacteria shows multidrug resistant pathogens which are associated with VAP and limit therapeutic options.

Introduction: With an occurrence ranging from 6-52%, ventilator-associated pneumonia (VAP) is the most common ICU acquired infection, accounting for a significant portion of hospital-acquired infections (HAIs). VAP is pneumonia that develops after a period of more than 48 hours of mechanical ventilation or endotracheal intubation. Aim: To isolate and identify the potential pathogens causing VAP and to study their antimicrobial susceptibility patterns. Materials and Methods: Endotracheal aspiration (ETA) or bronchoalveolar lavage (BAL) were collected from patients on mechanical ventilation >48 hours. Bacterial isolates were identified based on culture colony characteristics and biochemical parameters. Antibiotic susceptibility profile was determined for these isolates by Kirby-Bauer disc diffusion method as per Clinical and laboratory Standards Institute (CLSI) 2020 guidelines and studied. Results: Among the isolates, the most common were Klebsiella pneumoniae (31.31%) and Acinetobacter baumanii (31.31%). These were followed by Pseudomonas aeruginosa (22.22%), Klebsiella oxytoca (7.07%), Escherichia coli (3.03%) and Proteus mirabilis (3.03%) and Staphylococcus aureus (2.02%). Conclusion: Multi Drug Resistant (MDR) microbes causing VAP are on the increase. The patient population at risk will benefit by the application of the results of this study. The antibiotic resistance pattern of these isolates will aid clinicians in selecting the appropriate antimicrobial agents. Hence, it can lead to decreased mortality and morbidity due to life-threatening VAP. Keywords: Antimicrobial resistance, Ventilator associated pneumonia, Hospital acquired infection.

Objective: Hospital-associated infections (HAIs) contribute to increased morbidity and mortality, excess healthcare cost, and prolonged hospital stay. This study aims to determine the incidence, risk factors of ventilator associated pneumonia (VAP), surgical site infection (SSI), and central line associated blood stream infection (CLABSI). Together it also assesses the knowledge and practice of nursing staff, physician in understanding HAIs and prevention, also to improve the core knowledge of administration procedures. Methods: A prospective study was conducted among patients, nurses, and doctors of Shamanur Shivashankarapa Institute of Medical Sciences and Research Center hospital for a period of about 6 months. The data were collected, analyzed in terms of both inferential and descriptive statistics. Results: The incidence rate of VAP was found to be 23.61%. VAP was more prominent in males and occurred more in patients who received prolonged ventilation, supine position, and altered mental status, and these risk factors was found to be statistically significant (p

INTRODUCTION: : Lower respiratory tract (LRT) sampling is an aerosol generating procedure. In COVID 19 pandemic, guidelines have advocated caution against all aerosol generating procedures. However, microbial cultures on tracheobronchial aspirates are important to guide antibiotic usage in ventilator-associated pneumonia (VAP). MATERIAL AND METHODS: In our tertiary care COVID-19 intensive care unit (ICU), a protocol was set for using closed suction system for timely LRT sampling in VAP and to reduce the risk of exposure to respiratory secretions. Timing of sample collection was as per intensivist discretion following CDC VAP definition. This prospective study was conducted between June to November 2020, to assess the utility of this technique in diagnosis of suspected VAP. Microbiological and clinico-radiological parameters were documented. Heavy growth (>105 cfu/mL) on semiquantitative culture was taken as significant. RESULTS: Total 69 samples generated from 63 patients were analyzed. Mean age 54.48 years and 77.78% of patients had one or more comorbidities. Average duration of invasive ventilation prior to the first culture was 7.14 ± 4.36 days. Progressive radiological worsening at the time of sample collection was in 92.75% (64 of 69 episodes). Microbiological diagnosis of VAP was confirmed in 76.81%. Culture reports guided antibiotic change. Insignificant culture growth in 13.06%. The positivity rate for early and late (>4days) samples were 69.56% and 80.43% respectively. 95% of culture isolates were Gram negative microorganisms. Most common being Acinetobacter baumannii (41.67%) and Klebsiella pneumoniae (31.66%) in both early and late VAP. Around 85% were multidrug resistant organisms. There were no significant adverse events related to sampling technique. CONCLUSIONS:ALower respiratory tract sampling using closed suction system is easy to execute and minimizes procedure related risk to both patient and health care workers in COVID-19 ICU. Gram negative MDR pathogens are prevalent in both early and late VAP. Need further comparative study to understand effectiveness of this technique against other conventional techniques in VAP diagnosis.

Background: We aimed to assess independent risk factors for inadequate initial antimicrobial treatment (IAT) in critically ill patients with ventilator-associated pneumonia (VAP) treated in intensi...

During COVID-19, immature granulocyte (IG) concentration is heterogeneous with higher concentrations than those found in bacterial sepsis. We investigated the relationship between IG levels at ICU admission and on days 7 (± 2) and 15 (± 2) and associated pulmonary bacterial infections in intensive care unit (ICU) patients hospitalized for an acute respiratory distress syndrome (ARDS) related to SARS-CoV-2. Patients with associated pulmonary bacterial infection had a peak of IGs. IG thresholds of 18% or 2 G/L allowed discriminating patients with ventilator associated pneumonia with 100% sensitivity and specificity. Our study supports that IGs could help identifying pulmonary bacterial infections in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00575-3.

Selective digestive decontamination (SDD) regimens, variously constituted with topical antibiotic prophylaxis (TAP) and protocolized parenteral antibiotic prophylaxis (PPAP), appear highly effective for preventing ICU-acquired infections but only within randomized concurrent control trials (RCCT’s). Confusingly, SDD is also a concept which, if true, implies population benefit. The SDD concept can finally be reified in humans using the broad accumulated evidence base, including studies of TAP and PPAP that used non-concurrent controls (NCC), as a natural experiment. However, this test implicates overall population harm with higher event rates associated with SDD use within the ICU context.

Background: High incidence of ventilator associated pneumonia (VAP) has been reported in critically ill patients with COVID-19. Among these patients, we aimed to assess the incidence, outcomes and risk factors of VAP recurrences. Methods: We conducted an observational retrospective study in three French intensive care units (ICUs). Patients admitted for a documented COVID-19 from March 2020 to May 2021 and requiring mechanical ventilation (MV) for ≥48 h were included. The study main outcome was the incidence of VAP recurrences. Secondary outcomes were the duration of MV, ICU and hospital length of stay and mortality according to VAP and recurrences. We also assessed the factors associated with VAP recurrences. Results: During the study period, 398 patients met the inclusion criteria. A total of 236 (59%) of them had at least one VAP episode during their ICU stay and 109 (46%) of these patients developed at least one recurrence. The incidence of VAP recurrence considering death and extubation as competing events was 29.6% (IC = [0.250–0.343]). Seventy-eight percent of recurrences were due to the same bacteria (relapses). Patients with a VAP recurrence had a longer duration of MV as compared with one VAP and no VAP patients (41 (25–56) vs. 16 (8–30) and 10 (5–18) days; p < 0.001) and a longer ICU length of stay (46 (29–66) vs. 22 (12–36) and 14 (9–25) days; p < 0.001). The 90-day mortality was higher in the recurrence group as compared with the no VAP group only (31.2 vs. 21.0% (p = 0.021)). In a multivariate analysis including bacterial co-infection at admission, the use of immunosuppressive therapies and the bacteria responsible for the first VAP episode, the duration of MV was the only factor independently associated with VAP recurrence. Conclusion: In COVID-19 associated respiratory failure, recurrences affected 46% of patients with a first episode of VAP. VAP recurrences were mainly relapses and were associated with a prolonged duration of MV and ICU length of stay but not with a higher mortality. MV duration was the only factor associated with recurrences.

Animals with tick paralysis often require mechanical ventilation (MV) but previous publications have identified knowledge gaps regarding the development of bacterial pneumonia, and the specific pathogens involved. The objectives of this study were to describe the clinical course and culture and susceptibility profiles of bacteria isolated from airway samples of dogs and cats mechanically ventilated for tick paralysis that had positive airway cultures. Medical records were reviewed, and cases included if they had a positive airway sample culture during MV for tick paralysis. Twenty-four dogs and two cats were included. Most (85%) received empirical antimicrobials before airway sampling. The most common organisms isolated included Staphylococcus spp. (11), Klebsiella spp. (9), Enterococcus faecalis (8), Escherichia coli (6), Enterococcus faecium (3), Pseudomonas aeruginosa (4), and Mycoplasma spp. (3). Evidence of aspiration pneumonia was present in 22/25 (88%) cases that had thoracic radiographs performed. Seventy-seven percent of cases received antimicrobials to which the cultured bacteria were susceptible during hospitalisation. The median duration of MV was 4 days (range 1–10). Most (77%) survived to discharge, 19% were euthanised, and one died. In a multivariable logistic regression analysis it was identified that selection of antimicrobials to which the causative bacteria are susceptible was associated with survival to discharge (Odds ratio 45.8, p = 0.014; 95%CI 1.98–14,808), as was length of MV, with every day an animal is ventilated associated with a 4.7 times increased chance of survival (p = 0.015; 95% CI 1.21–78.4).