Study of gram - negative bacteria resistance to antibiotics causing nosocomial pneumonia in patients with stroke at military hospital 103

Nội dung text: Study of gram - negative bacteria resistance to antibiotics causing nosocomial pneumonia in patients with stroke at military hospital 103

1. Journal of military pharmaco-medicine n o2-2018 STUDY 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 Hospital, divided into two groups: pneumonia Stroke patients have many potential and non-pneumonia. risk factors for nosocomial pneumonia * Inclusion criteria: such as: poor mobility due to paralysis, - American Thoracic Society's 2005 swallowing disorders, immuno-depression, nosocomial pneumonia diagnostic criteria: mechanical ventilation... Most causes of - Pneumonia appears after hospitalization pneumonia are Gram-negative bacteria. > 48 hours. Antibiotic resistance of bacteria, especially Gram-negative bacteria is increasing - The presence of a new or progressive and causing difficulties in treatment. We radiographic infiltrate plus at least two of conducted this study aiming at: Assessment three clinical features. of antibiotic resistance of Gram-negative - Fever greater than 38 oC. bacteria causing nosocomial pneumonia - Leukocytosis or leukopenia. in stroke patients at 103 Military Hospital. - Purulent secretions. SUBJECTS AND METHODS - For patients who do not meet new 1. Subjects. pulmonary radiographic criteria, clinical 215 patients were diagnosed with stroke signs and sputum cultures are pathogenic, at Department of Stroke, 103 Military 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 128
2. Journal of military pharmaco-medicine n o2-2018 * 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 Non pneumonia Total p Stroke type (n = 186) (n = 29) (n = 215) n % n % n % Ischemia 125 67.2% 11 37.9% 136 63.3% < 0.05 Hemorrhage 61 32.8% 18 62.1% 79 36.7% Total 186 29 215 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. Bacteria n = 29 % Do not grow bacteria 5 17.2 Gram negative Pseudomonas aeruginosa 7 24.1 Klebsiella pneumoniae 4 13.8 Acinetobacter baumannii 2 6.9 Klebsiella oxytoca 1 3.4 Klebsiella ozaenae 1 3.4 Gram positive Staphylococcus aureus 3 10.3 Streptococcus.d 1 3.4 Streptococcus viridans 5 17.2 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. 129
3. Journal of military pharmaco-medicine n o2-2018 According 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. Sensitive Resistant Intermediate Total Antibiotics n % n % n % Gatifloxacin 0 0.0% 5 100% 0 0.0% 5 Gentamycin 0 0.0% 2 100% 0 0.0% 2 Imipenem 0 0.0% 3 100% 0 0.0% 3 Netilmycin 0 0.0% 4 100% 0 0.0% 4 Norfloxacin 0 0.0% 2 100% 0 0.0% 2 Ofloxacin 0 0.0% 3 100% 0 0.0% 3 Ticar/clavulanic 0 0.0% 6 100% 0 0.0% 6 Ticarcillin 0 0.0% 2 100% 0 0.0% 2 Tobramycin 0 0.0% 3 100% 0 0.0% 3 Trime/sulfamethoxazole 0 0.0% 1 100% 0 0.0% 1 Cefepime 1 14.3% 6 85.7% 0 0.0% 7 Levofloxacin 0 0.0% 5 83.3% 1 16.7% 6 Meropenem 1 16.7% 5 83.3% 0 0.0% 6 Ceftazindin 1 20.0% 4 80.0% 0 0.0% 5 Ciprofloxacine 1 33.3% 2 66.7% 0 0.0% 3 Aztreonam 0 0.0% 2 50.0% 2 50.0% 4 Piperacillin 1 25.0% 1 25.0% 2 50.0% 4 Pipe/tazobactam 5 83.3% 1 16.7% 0 0.0% 6 Amikacine 2 50.0% 0.0% 2 50.0% 4 Polymycin 3 100% 0 0.0% 0 0.0% 3 Total 15 19.0% 57 72.2% 7 8.9% 79 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%) 130
4. Journal of military pharmaco-medicine n o2-2018 Multidrug 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. Sensitive Resistant Intermediate Antibiotics Total n % n % n % Cefepime 0 0.0% 1 100% 0 0.0% 1 Cefpirome 0 0.0% 1 100% 0 0.0% 1 Cefurocime 0 0.0% 3 100% 0 0.0% 3 Ciprofloxacine 0 0.0% 2 100% 0 0.0% 2 Chloramphenicol 0 0.0% 1 100% 0 0.0% 1 Fosfomycin 0 0.0% 2 100% 0 0.0% 2 Tobramycin 0 0.0% 1 100% 0 0.0% 1 Amo + clavulanic acid 0 0.0% 3 75.0% 1 25.0% 4 Ceftriaxone 1 25.0% 3 75.0% 0 0.0% 4 Gatifloxacin 1 25.0% 3 75.0% 0 0.0% 4 Levofloxacin 1 33.3% 2 66.7% 0 0.0% 3 Cefotaxim 1 50.0% 1 50.0% 0 0.0% 2 Ceftazindin 1 25.0% 2 50.0% 1 25.0% 4 Ofloxacin 1 50.0% 1 50.0% 0 0.0% 2 Amikacine 2 66.7% 1 33.3% 0 0.0% 3 Aztreonam 1 33.3% 1 33.3% 1 33.3% 3 Doxyxylin 1 100% 0 0.0% 0 0.0% 1 Ertapenem 2 100% 0 0.0% 0 0.0% 2 Imipenem 1 100% 0 0.0% 0 0.0% 1 Meropenem 4 100% 0 0.0% 0 0.0% 4 Total 17 35.4% 28 58.3% 3 6.3% 48 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 131
5. Journal of military pharmaco-medicine n o2-2018 K. 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. Sensitive Resistant Intermediate Antibiotics Total n % n % n % Aztreonam 0 0.0% 1 100% 0 0.0% 1 Doxyxylin 0 0.0% 1 100% 0 0.0% 1 Gentamycin 0 0.0% 1 100% 0 0.0% 1 Pipe/tazobactam 0 0.0% 1 100% 0 0.0% 1 Ticarcillin 0 0.0% 1 100% 0 0.0% 1 Cefepime 1 50.0% 1 50.0% 0 0.0% 2 Ceftazindin 1 50.0% 1 50.0% 0 0.0% 2 Ciprofloxacine 1 50.0% 1 50.0% 0 0.0% 2 Imipenem 1 50.0% 1 50.0% 0 0.0% 2 Levofloxacin 1 50.0% 1 50.0% 0 0.0% 2 Amikacine 1 100% 0 0.0% 0 0.0% 1 Cefotaxim 0 0.0% 0 0.0% 1 100% 1 Ceftriaxone 0 0.0% 0 0.0% 1 100% 1 Meropenem 1 50.0% 0 0.0% 1 50.0% 2 Piperacillin 0 0.0% 0 0.0% 1 100% 1 Rifampin 0 0.0% 0 0.0% 1 100% 1 Tobramycin 2 100% 0 0.0% 0 0.0% 2 Trime/sulfamethoxazole 1 100% 0 0.0% 0 0.0% 1 Total 10 40.0% 10 40.0% 5 20.0% 25 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]. 132
6. Journal of military pharmaco-medicine n o2-2018 CONCLUSION đường t ại B ệnh vi ện Đạ i h ọc Y d ược TP. HCM. Y h ọc TP. HCM. 2015, 19 (1), tr.473-479. In our study on 215 patients with stroke at Department of Stroke, 103 Military 5. Ngô Th ế Hoàng, Qu ế Lan H ươ ng, Hospital, we drew some conclusions: Nguy ễn Bá L ươ ng . Tính kháng thu ốc c ủa klebsiella pneumoniae trong viêm ph ổi b ệnh - The incidence of nosocomial vi ện t ại B ệnh vi ện Th ống Nh ất.. Y h ọc TP. HCM. pneumonia was 13.5%. 2012, 16 (phụ b ản số 1), tr.264-270. - Of 24 bacterial strains, 62.5% of 6. Nguy ễn Phú H ươ ng Lan, Nguy ễn V ăn Gram-negative bacteria were cultured. Vĩnh Châu, Đinh H ữu Huy M ẫn và CS . Kh ảo - P. aeruginosa was resistant to > 80% sát m ức độ đề kháng kháng sinh c ủa Acinetobacter và Pseudomonas phân l ập t ại with most antibiotics (14/20), resistance 100% Bệnh vi ện Nhi ệt đớ i n ăm 2010. Th ời s ự Y h ọc. to imipenem, norfloxacin. P. aeruginosa was 2012, 68, tr.9-12. sensitive to polymycin (100%); piperacillin/ 7. Lê Th ị Kim Nhung . Gia t ăng kháng tazobactam (83.3%) and amikacine (50%). kháng sinh c ủa vi khu ẩn Gram âm gây b ệnh - K. pneumoniae was resistant 100% tại B ệnh vi ện Th ống Nh ất trong 3 n ăm 2008 - to 8/21 antibiotics, including ciprofloxacin, 2010. Y h ọc TP. HCM. 2011, 15 (ph ụ b ản s ố cefpirome, cefuroxime. K. pneumonia 2), tr.42-49. sensitivity 100% to doxycylins and carbapenem 8. Lê Th ị Kim Nhung, V ũ Th ị Kim C ươ ng . antibiotics. Tính kháng kháng sinh c ủa các vi khu ẩn gây bệnh đường hô h ấp d ưới t ại B ệnh vi ện Th ống A. baumannii was resistant 100% to Nh ất. Y h ọc TP. HCM. 2012, 16 (phụ b ản c ủa 5 antibiotics, including piperacillin + số 2), tr.89-93. tazobactam. For carbapenem antibiotics, 9. Phan Nh ựt Trí, Nguy ễn Th ị Thu H ươ ng . A. baumannii was resistant to 50%. Nghiên c ứu r ối lo ạn nu ốt theo GUSS ở b ệnh nhân đột qu ỵ não c ấp t ại B ệnh vi ện Cà Mau REFERENCES năm 2010 - 2011. Nghiên c ứu Y h ọc. 2011, 3 1. B ộ Y t ế. H ướng d ẫn phòng ng ừa viêm (tháng 6) (74). tr.167-170. ph ổi B ệnh vi ện trong các c ơ s ở khám b ệnh, 10. Chaari A, Mnif B, Bahloul M. et al . ch ữa b ệnh. Ban hành kèm Quy ết đị nh s ố Acinetobacter baumannii ventilator-associated 3671/Q Đ-BYT c ủa B ộ Y t ế. pneumonia: Eidemiology, clinical characteristics 2. Hu ỳnh Th ị Ng ọc Chi, Bùi Th ị H ằng . T ỷ l ệ and prognosis factors. International Journal of viêm ph ổi b ệnh vi ện trên b ệnh nhân độ t qu ỵ Infectious Diseases. 2013, 17 (12), pp.e1225- não và b ệnh nhân có di ch ứng đột qu ỵ não. Y e1228. học TP. HCM. 2012, 16 (phụ b ản số 1). 11. Labarca J.A, Salles M.J.C, Seas C et tr.276-279. al . Carbapenem resistance in Pseudomonas 3. Đoàn Ng ọc Duy, Tr ần V ăn Ng ọc. Đặc aeruginosa and Acinetobacter baumannii in điểm viêm ph ổi b ệnh vi ện do pseudomonas the nosocomial setting in Latin America. Critical aeruginosa t ại B ệnh vi ện Ch ợ R ẫy t ừ 6 - 2009 reviews in microbiology. 2016, 42 (2), pp.276-292. đến 6 - 1010. Y h ọc TP. HCM. 2012, 16 (phụ 12. World Health Organization . Guidelines bản số 1, tr.87-90. for the prevention and control of carbapenem- 4. Trần Minh Anh Đào, Nguy ễn Thanh B ảo. resistant Enterobacteriaceae , Acinetobacter Kh ảo sát tác nhân và tính đề kháng kháng baumannii and Pseudomonas aeruginosa in sinh c ủa tr ực khu ẩn Gram âm không lên men health care facilities. pp.1-76. 133