Emergence of Highly Resistant Klebsiella sp. in Tracheal Aspirates of Ventilated Patients in Critical Care Setup at Tertiary care Hospital in Western Rajasthan, India

A B S T R A C T Patients who are mechanically ventilated are at high risk of acquiring respiratory infections due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria. To initiate empiric antimicrobial therapy knowledge of local antimicrobial resistance patterns are essential. Objective of study were to study the causative organisms and determine the antibiotic susceptibility pattern of tracheal isolates. Endotracheal aspirates from 240 patients admitted to the ICU were cultured, identified and antimicrobial susceptibility testing was performed by standard methods. Culture showed growth in 221(92%) patients. Gram negative enteric aerobic bacteria were isolated from most of the patients. The most common being commonly isolated organism was Klebsiella species in 78(32.5%), followed by Pseudomonas in 37 (15.4%) and Acinectobector 35(14.6%). Most of Klebsiella sp. were resistant to Cephalosporin (cefexime, cefuroxime, and ceftazidime). The antibiotics showed maximum sensitivity to Klebsiella sp. were imipenam and levofloxacin, followed by ciprofloxacin, aminoglycosides. (Figure 2). Gram negative organisms mostly susceptible to Carbapenem and fluoroquinolones group of antibiotics which were the predominant isolates in our critical care setup. A local antibiogram for each hospital, based on bacteriological patterns and susceptibilities is essential to initiate empiric therapy, to prevent poor outcomes and help in framing the appropriate institutional antibiotic policy. K e y w o r d s