Treatment Protocol of Ventilator-Associated Pneumonia based on Microbial Susceptibility in Pediatric Intensive Care Unit, Isfahan, Iran

 Choosing a unique empiric treatment for ventilator associated pneumonia (VAP) can be challenging. We aimed to determine the antimicrobial susceptibility pattern of Intensive Care Unit (ICU) of the only referral pediatric hospital in Isfahan in order to design the optimal empiric treatment protocol.

In this cross-sectional study 343 isolates were detected from 243 pediatric patients, from August 2017 to December 2018 in Imam Hossein Hospital, Isfahan, Iran. In suspicious cases of VAP, sampling was performed via non-Bronchoscopic Bronchoalveolar Lavage (NB-BAL). Microbial susceptibility and resistance were assessed. The treatment protocol of VAP was prepared based on existing guidelines.

Out of 343 isolates 42 (12.2%) of the positive cultures were Candida albicans and 301 (87.8%) were bacterial isolates. Gram-negative bacteria were the most common organisms with the cumulative percentage of 62.9% of bacterial isolates. When tested with oxacillin, 61.5% of Staphylococcus aureus were MSSA and 38.5% were MRSA. The mentioned common gram-negative organisms had more than 25% resistance to at least one antibiotic from three or more antibiotic classes. However, P. aeruginosa showed below 20% resistance to majority of antibiotics. Twenty-seven (11.1%) of patients had VAP, 25 (92.6%) of whom were gram-negative infections.

The limited time period and sample size without any follow-up, made it impossible to define an effective treatment protocol. We defined our antibiogram in accordance with the existing standard guidelines and we designed a local protocol. An effective antibiotic against MRSA should be used in the empiric treatment of VAP. Also, in presence or absence of multidrug-resistant (MDR) pathogen risk-factors, it is necessary to use two effective antipseudomonal antibiotics from different antibiotic classes.