PURPOSE: 

To identify the causative bacteria, antibiotic sensitivity and antibiotic resistance in patients with ventilator associated pneumonia (VAP) in Upper Egypt

METHODS: 

A multicentre prospective study was performed in Assiut, El-Minia and Sohag universities. Sampling was done for all patients including, sputum and /or tracheal aspirate for gram stain and culture, and serum sample for serology. The validated sputum as well as aspirate samples were cultured on three bacteriological media (Nutrient, Chocolate and MaConkey,s agar plates) . The colonies were processed for identification of micro-organisms by Automated Walkaway Microscan 96.Pneumoslide IgM kit (Vircell-slide) was used for detection of atypical pathogens through the use of serological indirect Fluorescent Antibody method.

RESULTS: 

The predominant isolates in 112 patients with VAP (Ventilator acquired pneumonia)   were: in Early onset VAP, Staphylococcus aerus  (35%),Pseudomonas Aerogonasa (25%), Proteus species(20%) and Stryptococcus pneumonae (25%). In late onset VAP, Pseudomonas aeruginosa (35%), Proteus species (25%), Klebsiella pneumonia (19%), Staphylococcus aureus (14%) and Stryptococcus pneumonae (7%). Overall sensitivity pattern in all  cases of VAP included in the study to different groups of antibiotics showed the following;  as regards penicillin; absolute resistance was found in 96% of cases to Ampicillin, Amoxicillin and Ampicillin+ Sulbactam respectively versus 78% of cases to Amoxycillin+ Clavulinic acid. As regards to anti Pseudomonas activity cefipime, levofloxacin and Piperacillin + Tazobactam recorded the highest sensitivity followed by ceftazidime  and amikacin. The highest resistance was recorded for erythromycin and stryptomycin.  

CONCLUSIONS: 

in general the most predominant bacteria for VAP in Upper Egypt  is Pseudomonas aeruginosa (60%) of cases followed by Staphylococcus aureus (49%) of cases. Stryptococcus pneumonae is responsible for a minor number of cases(7%). Cefipime, levofloxacin and Piperacillin + Tazobactam recorded the highest anti Pseudomonas activity.

CLINICAL IMPLICATIONS:

 Respiratory quinolones, cefipime and Piperacillin + Tazobactam are the most efficient antibiotics in treatment of VAP  in upper Egypt.