Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jun 9, 2023; 12(3): 165-175
Published online Jun 9, 2023. doi: 10.5492/wjccm.v12.i3.165
Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain: Prevalence and antibiotics susceptibility pattern
Mohamed Eliwa Hassan, Safaa Abdulaziz Al-Khawaja, Nermin Kamal Saeed, Sana Abdulaziz Al-Khawaja, Mahmood Al-Awainati, Sara Salah Yusuf Radhi, Mohamed Hameed Alsaffar, Mohammed Al-Beltagi
Mohamed Eliwa Hassan, Sana Abdulaziz Al-Khawaja, Sara Salah Yusuf Radhi, Mohamed Hameed Alsaffar, Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
Safaa Abdulaziz Al-Khawaja, Infectious Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Bahrain, Busiateen 15503, Muharraq, Bahrain
Mahmood Al-Awainati, Department of Family Medicine, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
Author contributions: Hassan ME, Al-Khawaja S, and Radhi SSY designed the study; Hassan ME, Radhi SSY, Al-Awainati M, and Alsaffar M collected and analyzed data; Saeed NK performed microbiological testing, data, and analysis; Hassan ME wrote the manuscript draft; Al-Beltagi M wrote, revised, and edited the final draft; All authors have read and approved the manuscript and take full responsibility for the study.
Institutional review board statement: The study was ethically approved by the Research and Research Ethics Committee for Governmental Hospitals, Salmaniya Medical Complex, Bahrain.
Informed consent statement: Consent was unnecessary as the study was observational without exposure to the patient’s data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at mbelrem@hotmail.com. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MBChB, MD, MSc, PhD, Academic Editor, Chairman, Consultant Physician-Scientist, Professor, Researcher, Department of Pediatrics, Faculty of Medicine, Tanta University, Al Bahr Street, Tanta 31511, Alghrabia, Egypt. mbelrem@hotmail.com
Received: December 23, 2022
Peer-review started: December 23, 2022
First decision: January 31, 2023
Revised: February 3, 2023
Accepted: March 24, 2023
Article in press: March 24, 2023
Published online: June 9, 2023
Processing time: 167 Days and 0.4 Hours
Abstract
BACKGROUND

Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that. It is the most common infection encountered among intubated patients. VAP incidence showed wide variability between countries.

AIM

To define the VAP incidence in the intensive care unit (ICU) in the central government hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.

METHODS

The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020. It included adult and adolescent patients (> 14 years old) admitted to the ICU and required intubation and mechanical ventilation. VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score, which considers the clinical, laboratory, microbiological, and radiographic evidence.

RESULTS

The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155. Forty-six patients developed VAP during their ICU stay (29.7%). The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period, with a mean age of 52 years ± 20. Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96 ± 6.55. Gram-negative contributed to most VAP cases in our unit, with multidrug-resistant Acinetobacter being the most identified pathogen.

CONCLUSION

The reported VAP rate in our ICU was relatively high compared to the international benchmark, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Keywords: Ventilator-associated pneumonia; Intensive care unit; Antibiotics susceptibility pattern; Kingdom of Bahrain; Adults; Bacterial resistance; Acinetobacter

Core Tip: Ventilator-associated pneumonia (VAP) is the most common infection among intubated patients. Early-onset VAP is usually caused by sensitive pathogens, while multidrug-resistant bacteria usually cause late-onset. Early, appropriate, and empirical antibiotics therapy for VAP is crucial to decreasing mortality risk. The VAP rate in Bahrain is relatively high compared to the international rates, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle. Gram-negative bacteria were the most common organisms that cause VAP in the current study, where Acinetobacter baumannii was the most common organism, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Knowing the prevalent organisms helps choose the appropriate antibiotics until culture and sensitivity become available.