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β-Lactamase-Producing Multidrug-Resistant Bacterial Pathogens from Tracheal Aspirates of Intensive Care Unit Patients at National Institute of Neurological and Allied Sciences, Nepal

DOI: 10.1155/2013/847569

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The widespread use of tracheal intubation and mechanical ventilation to support the critically ill patients increases the risk of development of tracheobronchitis and bronchopneumonia. This cross-sectional study was conducted with an aim to isolate and identify bacterial pathogens from tracheal aspirates producing extended-spectrum β-lactamase (ESBL), AmpC β-lactamase, and metallo-β-lactamase (MBL) from August 2011 to April 2012 at National Institute of Neurological and Allied Sciences (NINAS), Kathmandu, Nepal. ESBL was detected by combined disk assay using cefotaxime and cefotaxime with clavulanate, AmpC β-lactamase by inhibitor-based method using cefoxitin and phenylboronic acid, and MBL by Imipenem-EDTA combined disk method. 167 bacterial strains were isolated from 187 samples and majority of them were Acinetobacter spp. followed by Klebsiella pneumoniae with 32.9% and 25.1%, respectively. 68.8% of isolates were multidrug resistant (MDR) and Acinetobacter spp. constituted 85.4%. ESBL, AmpC β-lactamase, and MBL were detected in 35 (25%), 51 (37.2%), and 11 (36.7%) isolates, respectively. Pseudomonas spp. (42.8%) were the predominant ESBL producer while Acinetobacter spp. were the major AmpC β-lactamase producer (43.1%) and MBL producer (54.5%). 1. Introduction Tracheostomy is a surgical procedure that creates an opening directly into the trachea to ventilate and aspirate the patient in critical care setting [1]. The incidence of ventilator-associated pneumonia (VAP) ranges from 10 to 25% of all intensive care unit (ICU) patients resulting in high mortality rate of 22–71%, which is 6–21 times higher in intubated patients [2]. The tracheostomized patients are colonized or infected with bacteria either endogenously or exogenously. Exogenous bacteria include Pseudomonas spp., Acinetobacter spp., methicillin-resistant Staphylococcus aureus (MRSA), and members of Enterobacteriaceae and endogenous bacteria include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These bacteria are usually resistant to multiple antibiotics and cause either tracheobronchitis or bronchopneumonia [3]. Risk factors for colonization or infection with multidrug-resistant bacterial species include prolonged length of hospital stay, exposure to an ICU, receipt of mechanical ventilation, colonization pressure, exposure to broad-spectrum antimicrobial agents, recent surgery, invasive procedures, and underlying severity of illness [4, 5]. β-Lactamases are the commonest cause of bacterial resistance to β-lactam antimicrobial agents, which are used in the


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