The article presents assessment of antibiotic resistance of gram-negative bacteria causing nosocomial pneumonia in stroke patients at 103 Military hospital.
Trang 1STUDY OF GRAM-NEGATIVE BACTERIA RESISTANCE TO ANTIBIOTICS CAUSING NOSOCOMIAL PNEUMONIA IN
PATIENTS WITH STROKE AT MILITARY HOSPITAL 103
Dang Phuc Duc*; Nguyen Minh Hien* Mai Xuan Khan*; Nguyen Thai Son*
SUMMARY
Objectives: To evaluate the antibiotic resistance of Gram-negative bacteria causing pneumonia in stroke patients Methods: Descriptive study Results: P aeruginosa resistance
> 80% was observed in most antibiotics (14/20 patients), 100% was resistant to imipenem, norfloxacin; sensitivity to polymycin (100%) K pneumoniae strains 100% with 8/20 antibiotics, including ciprofloxacin, cefpirome, cefuroxime K pneumoniae strains were sensitivity 100% to doxycylins and carbapenem antibiotics A baumannii strains resist 100% to 5 antibiotics, including piperacillin + tazobactam; 50% of A baumannii strains resist to the carbapenem group
* Keywords: Nosocomial pneumonia; Antibiotic resistance; Stroke
INTRODUCTION
Stroke patients have many potential
risk factors for nosocomial pneumonia
such as: poor mobility due to paralysis,
swallowing disorders, immuno-depression,
mechanical ventilation Most causes of
pneumonia are Gram-negative bacteria
Antibiotic resistance of bacteria, especially
Gram-negative bacteria is increasing
and causing difficulties in treatment We
conducted this study aiming at: Assessment
of antibiotic resistance of Gram-negative
bacteria causing nosocomial pneumonia
in stroke patients at 103 Military Hospital
SUBJECTS AND METHODS
1 Subjects
215 patients were diagnosed with stroke
at Department of Stroke, 103 Military
Hospital, divided into two groups: pneumonia and non-pneumonia
* Inclusion criteria:
- American Thoracic Society's 2005 nosocomial pneumonia diagnostic criteria:
- Pneumonia appears after hospitalization
> 48 hours
- The presence of a new or progressive radiographic infiltrate plus at least two of three clinical features
- Fever greater than 38oC
- Leukocytosis or leukopenia
- Purulent secretions
- For patients who do not meet new pulmonary radiographic criteria, clinical signs and sputum cultures are pathogenic,
we also classify pneumonia
* 103 Military Hospital
Corresponding author: Dang Phuc Duc (dangphucduc103@gmail.com)
Date received: 08/12/2017 Date accepted: 18/01/2018
Trang 2* Exclusion criteria:
- Patients died or discharged within 48 hours after hospitalization
- Pneumonia within 48 hours after admission
- Tuberculosis, lung tumors
2 Method
Descriptive research with analysis Statistical processing using SPSS 15.0 software
RESULTS AND DISCUSSION
We studied 215 stroke patients who were divided into two groups: pneumonia group (n = 29); non pneumonia group (n = 186), we obtained the following results:
1 Patients’ characteristics
Table 1: Stroke characteristics
Pneumonia (n = 186)
Non pneumonia (n = 29)
Total (n = 215) Stroke type
p
< 0.05
Out of 215 stroke patients, 136 patients (63.3%) suffered from ischemia and 79 patients had hemorrhage (36.7%) 29 patients (13.5%) caught pneumonia
According to the research by Phan Nhut Tri, the proportion of stroke patients accquired pneumonia was 19.1% [9]
2 The bacteria that cause nosocomial pneumonia in stroke patients
Table 2: Types of bacteria in pneumonia group
Gram negative
Gram positive
Of 29 patients with nosocomial pneumonia, 5 patients had sputum culture without bacterial growth (17.2%) Of the 24 samples cultured with bacteria, 15 samples had Gram-negative bacteria (62.5%), only 37.5% had Gram-positive bacteria
Trang 3According to data from the Vietnamese Ministry of Health, the leading cause of hospital-acquired pneumonia is Gram-negative bacteria [1]
In our study, the most common bacterial cause of nosocomial pneumonia was
S aeruginosa (24.1%) The results were consistent with those by Huynh Thi Ngoc Chi
et al (2012) [2]; Doan Ngoc Duy et al [3]: P aeruginosa accounted for the highest
rate (16.7%)
3 Antibiotic resistance characteristics of some Gram-negative bacteria cause nosocomial pneumonia in stroke patients
Table 3: Antibiotic resistant characteristics of Pseudomonas aeruginosa
Antibiotics
Trime/sulfamethoxazole 0 0.0% 1 100% 0 0.0% 1
P aeruginosa was resistant to > 80% with most antibiotics (14/20), 100% was resistant to imipenem, norfloxacin P aeruginosa was sensitive to polymycin (100%),
piperacillin/tazobactam (83.3%) and amikacine (50%)
Trang 4Multidrug resistant P aeruginosa is common in both domestic and international
studies [1, 3, 8, 12]
The carbapenem resistance leads to a return to colistin, an antibiotics of the
polymicin family Many domestic and international studies have shown that
P aeruginosa are highly susceptible to colistin: Tran Thi Thanh Nga (2010), Labarca et
al (2016) [11], Yayan (Germany, 2015)
Table 4: Characteristics of Klebsiella pneumoniae antibiotic resistant
Antibiotics
Amo + clavulanic acid 0 0.0% 3 75.0% 1 25.0% 4
In our study, K pneumoniae was 100% resistant to 8/28 antibiotics, including
ciprofloxacin, cefpirome, cefuroxime The bacterial had sensitivity 100% to doxycylin
and carbapenem antibiotics
The antibiotic resistance of K pneumoniae in our study was higher than in previous
studies Le Thi Kim Nhung (Thong Nhat Hospital, 2008 - 2010) [7]: K pneumoniae was
resistant to empiric antibiotics, including third generation cephalosporins, with levels of
resistance ranging from 18 - 38% Ngo The Hoang (2012) studied the resistance of
Trang 5K pneumoniae in nosocomial pneumonia indicating that P pneumoniae was resistant
to most quinolones generation I - II and third generation cephalosporine 54.8 - 64.3%; sensitivity to carbapenem antibiotics (imipenem sensitivity 90.5%; meropenem sensitivity 97.6%) [5]
Many studies also show that K pneumoniae is relatively sensitive to carbapenem
antibiotics [5, 7, 8]
Table 5: Antibiotic resistant characteristics of Acinetobacter baumannii
Antibiotics
Trime/sulfamethoxazole 1 100% 0 0.0% 0 0.0% 1
A baumannii was resistant 100% to 5 antibiotics, including piperacillin/tazobactam For carbapenem antibiotics, A baumannii was resistant 50%
The rapid emergence of multidrug-resistant A baumannii strains is becoming a
challenge for treatment Multidrug-resistant status of this bacterium has been reported
in several studies [4, 12]
A baumannii was resistant to the carbapenem group, which is one of the widest
spectrum of antibiotics currently available [4, 6, 8] Not only in Vietnam, there are many
international reports about A baumannii resistance to carbapenem [10, 11]
Trang 6CONCLUSION
In our study on 215 patients with stroke
at Department of Stroke, 103 Military
Hospital, we drew some conclusions:
- The incidence of nosocomial
pneumonia was 13.5%
- Of 24 bacterial strains, 62.5% of
Gram-negative bacteria were cultured
- P aeruginosa was resistant to > 80%
with most antibiotics (14/20), resistance 100%
to imipenem, norfloxacin P aeruginosa was
sensitive to polymycin (100%); piperacillin/
tazobactam (83.3%) and amikacine (50%)
- K pneumoniae was resistant 100%
to 8/21 antibiotics, including ciprofloxacin,
cefpirome, cefuroxime K pneumonia
sensitivity 100% to doxycylins and carbapenem
antibiotics
A baumannii was resistant 100% to
5 antibiotics, including piperacillin +
tazobactam For carbapenem antibiotics,
A baumannii was resistant to 50%
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