Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
A Comparative Analysis of Antimicrobial Resistance Patterns in Ventilator-Associated Pneumonia Pathogens: Pre- and During the COVID-19 Pandemic-A Cohort Study
Ventilatör İlişkili Pnömoni Etkenlerinin Antimikrobiyal Direnç Paternlerinin Karşılaştırmalı Analizi: COVID-19 Pandemisi ve Öncesinde-Bir Kohort Çalışması
Rafet YARIMOĞLUa , Saliha YARIMOĞLUb
aKaramanoğlu Mehmetbey University Faculty of Medicine, Department of Anesthesiology and Reanimation, Karaman, Türkiye
bKaramanoğlu Mehmetbey University Faculty of Medicine, Department of Infection Diseases and Clinical Microbiology, Karaman, Türkiye
Turkiye Klinikleri J Anest Reanim. 2024;22(2):47-56
doi: 10.5336/anesthe.2024-105196
Article Language: EN
Full Text
ABSTRACT
 Objective: During the coronavirus disease-2019 (COVID19) pandemic, antibiotics were widely used in many countries without regard for the general rules of antibiotic use. This intense antibiotic use is thought to have caused antimicrobial resistance in agents that cause ventilator-associated pneumonia (VAP). This study aimed to compare antimicrobial resistance patterns of VAP agents before and during the COVID-19 pandemic. Material and Methods: This retrospective cohort study involved patients diagnosed with VAP before and during COVID19 in a training and research hospital. The antimicrobial resistance patterns of VAP agents were examined in endotracheal aspirate samples. Results: The results were compared between the COVID-19 and pre-COVID-19 groups. From 178 patients who met the VAP diagnostic criteria in the intensive care unit, the COVID-19 group comprised 107, and the preCOVID-19 group, 71. In both periods, Acinetobacter baumannii was the most common infectious agent, followed by Pseudomonas aeruginosa (35.2%) in the pre-COVID-19 period. During the COVID-19 pandemic, Klebsiella pneumoniae was the second most common infectious agent (20.6%). During the COVID-19 pandemic, there was an increase in antimicrobial resistance to piperacillin-tazobactam, ciprofloxacin, amikacin, and cefepime antibiotics compared to before. Conclusion: The results of this study demonstrated increased antimicrobial resistance in some microorganisms that caused VAP in COVID-19 patients receiving mechanical ventilator support in the intensive care unit. The increased resistance pattern may have contributed to the failure to treat VAP. Determination of the antibiotic resistance patterns is essential concerning reducing treatment failures and preventing antimicrobial resistance.

Keywords: Acinetobacter baumannii; antimicrobial resistance; critical care; ventilator-associated pneumonia
ÖZET
 Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] salgını sırasında antibiyotikler, antibiyotik kullanımının genel kurallarına bakılmaksızın birçok ülkede yaygın olarak kullanıldı. Bu yoğun antibiyotik kullanımının, ventilatör ilişkili pnömoniye (VİP) neden olan etkenlerde antimikrobiyal dirence neden olduğu düşünülmektedir. Bu çalışma, COVID-19 salgını öncesi ve sırasında VİP etkenlerinin antimikrobiyal direnç paternlerini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif kohort çalışmasına, bir eğitim ve araştırma hastanesinde COVID-19 öncesi ve sırasında VİP tanısı konulan hastalar dâhil edildi. VİP etkenlerinin antimikrobiyal direnç modelleri, endotrakeal aspirat örneklerinde incelendi. Bulgular: Sonuçlar COVID-19 ve COVID19 öncesi gruplar arasında karşılaştırıldı. Yoğun bakım ünitesinde VİP tanı kriterlerini karşılayan 178 hastadan 107'si COVID-19 grubunda, 71'i ise COVID-19 öncesi grubunda yer aldı. Her iki dönemde de en sık görülen enfeksiyon etkeni Acinetobacter baumannii iken COVID-19 öncesi dönemde bunu Pseudomonas aeruginosa (%35,2) izledi. COVID-19 pandemisi sırasında ise Klebsiella pneumoniae ikinci en sık görülen enfeksiyon etkeniydi (%20,6). COVID-19 pandemisi sırasında, pandemi öncesi döneme göre piperasilin-tazobaktam, siprofloksasin, amikasin ve sefepim antibiyotiklerine karşı antimikrobiyal dirençte artış görüldü. Sonuç: Bu çalışmanın sonuçları, yoğun bakımda mekanik ventilatör desteği alan COVID-19 hastalarında VİP etkeni olan bazı mikroorganizmalarda antimikrobiyal direncin arttığını göstermiştir. Artan direnç paterni, VİP tedavisindeki başarısızlığa katkıda bulunmuş olabilir. Antibiyotik direnç paternlerinin belirlenmesi, tedavi başarısızlıklarının azaltılması ve antimikrobiyal direncin önlenmesi açısından önemlidir.

Anahtar Kelimeler: Acinetobacter baumannii; antimikrobiyal direnç; yoğun bakım; ventilatör-ilişkili pnömoni
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