Ventilatorassociated lower respiratory tract infections: etiology and diagnosis | CMAC

Ventilatorassociated lower respiratory tract infections: etiology and diagnosis

Clinical Microbiology and Antimicrobial Chemotherapy. 2021; 23(1):17-25

​ Rudnov V.A., Bagin V.A., Belsky D.V., Astafyeva M.N., Nevskaya N.N., Kolotova G.B., Rosanova S.M., Bykova T.I.
10.36488/cmac.2021.1.17-25
lower respiratory tract infections mechanical ventilation ventilator-associated pneumonia etiology carbapenemase
Section
Diseases and Pathogens
Type
Original Article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2021; 23(1):17-25

Objective.

To review a literature published over the past 5 years and our own data on the etiology of lower respiratory tract infections (LRTI), antimicrobial resistance and its relationships between sepsis and choice of appropriate antibiotic therapy.

Materials and Methods.

National Nosocomial Infections Surveillance (NNIS) criteria were used to diagnose LRTI. A review of the articles regarding LRTI from the Russian and international English language journals published over 6 years was performed. Identification of microorganisms was performed by culture over the period of 2003–2013; since 2014, MALDI-TOF MS method was used for this purpose.

Results.

Despite the ongoing policy to limit the use of antimicrobial therapy in the ICUs, there is an increase in carbapenemase-producing isolates in the ICUs from 2.2% (2018) to 11.7% (2020, 9 months). Along with the trend to increase in carbapenemase-producing pathogens causing LRTI, their variability is also increasing. In particular, it applies to strains producing carbapenemases OXA-48 or combination of OXA-48 with KPC; with the trend to combined production of carbapenemase beginning at 2019.

Conclusions.

Carbapenemase producers are becoming more widespread in the ICU settings, including the lower respiratory tract in mechanically ventilated patients. Practitioners didn’t get used to associate VAP with the Sepsis-3 criteria. The changes in etiology include the increased rate of carbapenem-resistant Enterobacterales and non-fermenting Gram-negative bacteria, primarily Acinetobacter spp., in Russia. It’s due to improved quality of respiratory support and increased consumption of carbapenems, tigecycline and polymyxins. Significant increase of OXA-48-producing pathogens is likely to be associated with a poor compliance with temporary guidelines on COVID-19 with regard to antibiotic therapy.

Vladimir A. Rudnov

City Clinical Hospital

Vladimir A. Bagin

City Clinical Hospital

Belsky D.V.

City Clinical Hospital

Maria N. Astafyeva

City Clinical Hospital

Nevskaya N.N.

City Clinical Hospital

Kolotova G.B.

City Clinical Hospital

Rosanova S.M.

City Laboratory Center, Yekaterinburg, Russia

Bykova T.I.

City Clinical Hospital

  • 1. Torres A., Niederman M.S., Chastre J., Ewig S., FernandezVandellos P., Hanberger H., et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia. Eur Respir J. 2017;50(3):1700582. DOI: 10.1183/13993003.00582-2017
  • 2. Rosenthal V.D., Bijie H., Maki D.G., Mehta Y., Apisarnthanarak A., Medeiros E.A., et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. Am J Infect Control. 2012;40(5):396-407. DOI: 10.1016/j.ajic.2011.05.020
  • 3. Rosenthal V.D., Maki D.G., Jamulitrat S., Medeiros E.A., Todi S.K., Gomez D.Y., et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009. Am J Infect Control. 2010;38(2):95-104.e2. DOI: 10.1016/j.ajic.2009.12.004
  • 4. Asehnoune K., Seguin P., Allary J., Feuillet F., Lasocki S., Cook F., et al. Hydrocortisone and fludrocortisone for prevention of hospital-acquired pneumonia in patients with severe traumatic brain injury (Corti-TC): a double-blind, multicentre phase 3, randomised placebo-controlled trial. Lancet Respir Med. 2014;2(9):706-716. DOI: 10.1016/s2213-2600(14)70144-4
  • 5. Hunter J., Annadurai S., Rothwell M. Diagnosis, management and prevention of ventilator-associated pneumonia in the UK. Eur J Anaesthesiol. 2007;24(11):971-977. DOI: 10.1017/s0265021507001123
  • 6. Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355(25):2619-30. DOI: 10.1056/NEJMoa052904
  • 7. Dudeck M.A., Horan T.C., Peterson K.D., Allen-Bridson K., Morrell G., Anttila A., et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control. 2013;41(4):286-300. DOI: 10.1016/j.ajic.2013.01.002
  • 8. Koulenti D., Tsigou E., Rello J. Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study. Eur J Clin Microbiol Infect Dis. 2016;36(11):19992006. DOI: 10.1007/s10096-016-2703-z
  • 9. Bonell A., Azarrafiy R., Huong V.T.L., Viet T.L., Phu V.D., Dat V.Q., et al. A Systematic review and meta-analysis of ventilator-associated pneumonia in adults in Asia: an analysis of national income level on incidence and etiology. Clin Infect Dis. 2018;68(3):511-518. DOI: 10.1093/cid/ciy543
  • 10. Gelfand B.R., Gologorsky V.A., Belotserkovsky B.Z. Nosocomial pneumonia associated with mechanical ventilation (VAP) in surgical patients. Moscow, 2000. P. 1-43. Russian.
  • 11. Demeschenko V.A., Rudnov V.A., Bagin V.A. Rozanova S.M., Frolova Z.A. Ventilator-associated pneumonia in patients with abdominal sepsis: risk factors, etiology and prognosis. Ural'skij medicinskij zhurnal. 2008;7(47):4-11. Russian.
  • 12. Belsky D.V., Rudnov V.A., Belkin A.A., Cherkasov G.V., Yazov O.A., Shchegolev A.V., et al. The prevalence of nosocomial infections in neurosurgical ICU in hospitals in Russia. Vestnik anesteziologii i reanimatologii. 2011;4:2229. Russian.
  • 13. Kuzovlev A.N., Moroz V.V. Nosocomial pneumonia – principles of early diagnosis and prevention. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2019;2:40-47. Russian. DOI: 10.21320/1818474x-2019-2-40-47
  • 14. Prokhorov A.V., Khalimov Yu.Sh., Gaiduk S.V., Gavrilin S.V., Meshakov D.P., Chepel A.I. Diagnostics of nosocomial pneumonia in those with multiple traumas (basing on data of foreign publications). Vestnik anesteziologii i reanimatologii. 2017;14(2):80-88. Russian. DOI: 10.21292/2078-5658-2017-14-2-80-88
  • 15. Heyland D.K., Cook D.J., Griffith L., Keenan S.P., BrunBuisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med. 1999;159(4):1249-1256. DOI: 10.1164/ajrccm.159.4.9807050
  • 16. Fagon J-Y., Chastre J., Hance A.J., Montravers P., Novara A., Gibert C. Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993;94(3):281-288. DOI: 10.1016/0002-9343(93)90060-3
  • 17. Masterton R.G., Galloway A., French G., Street M., Armstrong J., Brown E., et al. Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2008;62(1):5-34. DOI: 10.1093/jac/dkn162
  • 18. Nosocomial pneumonia in adults. Russian national recommendations. 2nd Ed. M.: Medical Information Agency, 2016. P. 1-176. Russian.
  • 19. Kalil A.C., Metersky M.L., Klompas M., Muscedere J., Sweeney D.A., Palmer L.B., et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. DOI: 10.1093/cid/ciw353
  • 20. Papazian L., Klompas M., Luyt C-E. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;46(5):888-906. DOI: 10.1007/s00134-02005980-0
  • 21. Singer M., Deutschman C.S., Seymour C.W., Shankar-Hari M., Annane D., Bauer M., et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. DOI: 10.1001/jama.2016.0287
  • 22. Kuzmenkov A.Yu., Trushin I.V., Avramenko A.A., Edelstein M.V., Dekhnich A.V., Kozlov R.S. AMRmap: Internet platform for monitoring resistance. Klinicheskaja mikrobiologija i antimikrobnaja himioterapija. 2017;19(2):84-90. Russian.
  • 23. The Center for Disease Dynamics, Economics & Policy. Resistance map. Antibiotic Resistance. Available at: https://resistancemap.cddep.org/AntibioticResistance.php. Accessed: December 15, 2020.
  • 24. Sukhorukova M.V., Edelstein M.V., Skleenova E.Yu., Ivanchik N.V., Mikotina A.V., Dekhnich A.V., et al. Antimicrobial resistance of nosocomial Enterobacteriaceae isolates in Russia: results of national multicenter surveillance study «MARATHON» 2011-2012. Klinicheskaja mikrobiologija i antimikrobnaja himioterapija. 2014;16(4):254265. Russian.
  • 25. Yakovlev S.V., Suvorova M.P., Beloborodov V.B., Basin E.E., Eliseev E.V., Kovelenov S.V., et al. Multicentre study of the prevalence and clinical value of hospital-acquired infections in emergency hospitals of Russia: ERGINI Study. Antibiotiki i himioterapija. 2016;61(5-6):32-42. Russian.
  • 26. Public health focus: surveillance, prevention and control nosocomial infection. MMWR. 1992;41(42):783-787.
  • 27. Garner J.S., Jarvis W.R., Emori T.G., Horan T.C., Hughes J.M. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-140. DOI: 10.1016/0196-6553(88)90053-3
  • 28. Ministry of Health of the Russian Federation. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Temporary guidelines. Version 9 (10/26/2020). Russian.
  • 29. De Winter F., ’s Jongers B., Bielen K., Mancuso D., Timbermont L., Lammens C., et al. Mechanical ventilation impairs IL-17 cytokine family expression in ventilatorassociated pneumonia. Int J Mol Sci. 2019;20(20):5072. DOI: 10.3390/ijms20205072
  • 30. Rozanova S.M., Starodubova I.G., Kirichenko T.A., Sheveleva L.V., Perevalova E.Yu., Kyrf M.V., et al. Use of 16S-metagenomic analysis to determine the etiology of nosocomial pneumonia. Laboratory diagnostics of infectious and somatic diseases. Yekaterinburg: Medicine and Health, 2020. P. 72-78. Russian.
  • 31. Schuetz P., Albrich W., Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Medicine. 2011;9:107. DOI: 10.1186/1741-7015-9-107
  • 32. De Jong E., van Oers J.A., Beishuizen A., Vos P., Vermeijden W.J., Haas L.E., et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis. 2016;16(7):819-827. DOI: 10.1016/s1473-3099(16)00053-0
  • 33. Van Berkel M., Kox M., Frenzel T., Pickkers P., Schouten J. Biomarkers for antimicrobial stewardship: a reappraisal in COVID-19 times? Crit Care. 2020;24(1). DOI: 10.1186/s13054-020-03291-w
  • 34. Divatia J.V., Pulinilkunnathil J.G., Myatra S.N. Nosocomial infections and ventilator-associated pneumonia in cancer patients. Oncologic Critical Care. 2019;1419-1439. DOI: 10.1007/978-3-319-74588-6_125
  • 35. Van der Kooi T.I.I., Boshuizen H., Wille J.C., de Greeff S.C., van Dissel J.T., Schoffelen A.F., et al. Using flexible methods to determine risk factors for ventilator-associated pneumonia in the Netherlands. PLoS One. 2019;14(6):e0218372. DOI: 10.1371/journal.pone.0218372
  • 36. Klompas M. Complications of mechanical ventilation – the CDC’s new surveillance paradigm. New Engl J Med. 2013;368(16):1472-1475. DOI: 10.1056/NEJMp1300633
  • 37. Gaudet A., Martin-Loeches I., Povoa P., Rodriguez A., Salluh J., Duhamel A., et al. Accuracy of the clinical pulmonary infection score to differentiate ventilatorassociated tracheobronchitis from ventilator-associated pneumonia. Ann Intensive Care. 2020;10(1):101. DOI: 10.1186/s13613-020-00721-4
  • 38. Kernéis S., Valade S., Woerther P-L. Back into the wild: how resistant pathogens become susceptible again? Intensive Care Med. 2020;46(2):361-363. DOI: 10.1007/s00134-020-05932-8
Views
0 Abstract
0 PDF
0 Crossref citations
Shared