Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens

Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality for patients who are managed in Intensive Care Unit (ICU). It is the leading cause of prolonged hospital stay, infection with multidrug-resistant organisms and increased hospital cost. Surveillance respiratory cu...

Full description

Saved in:

Bibliographic Details
Main Author:	Tajudin, Syazwani Mohd
Format:	Thesis
Language:	English
Published:	2020
Subjects:	R Medicine (General) RC705-779 Diseases of the respiratory system
Online Access:	http://eprints.usm.my/56934/1/Syazwani%20Mohd%20Tajudin%20-%20e%2024.pdf
Tags:	Add Tag No Tags, Be the first to tag this record!

id	my-usm-ep.56934
record_format	uketd_dc
spelling	my-usm-ep.569342023-02-14T08:53:21Z Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens 2020 Tajudin, Syazwani Mohd R Medicine (General) RC705-779 Diseases of the respiratory system Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality for patients who are managed in Intensive Care Unit (ICU). It is the leading cause of prolonged hospital stay, infection with multidrug-resistant organisms and increased hospital cost. Surveillance respiratory cultures are routinely done despite the absence of clinical evidence for an infection. The value of the surveillance respiratory cultures to predict the causative organism is still uncertain and debatable. To evaluate the clinical value of respiratory culture surveillance in predicting the causative agents for VAP in ICU patients. This was a prospective observational study which was carried out in the General ICU of Hospital Universiti Sains Malaysia, between July 2017 to December 2018. All adults’ patients who were taken surveillance respiratory were included in the study. Patients were followed up till they were transferred out from the ICU. Results of respiratory culture for surveillance and diagnostic were reviewed and analysed using Cohen's kappa coefficient (κ). A total of 193 patients were included in this study. 88/193 (46%) patients had positive surveillance cultures with a total of 108 isolates. Out of 63/193 (32.6%) patients had subsequent respiratory cultures, 45/63 (71.4%) patients fulfilled the research criteria for VAP. Only 35/45 (78%) had positive diagnostic cultures. The most common microorganism isolated from surveillance respiratory cultures was Klebsiella pneumoniae (33/108, 30.5%). The other microorganisms were Staphylococcus aureus (22/108, 20.3%), Pseudomonas aeruginosa (11/108, 10.2%), Enterobacter species (10/108, 9.2%), and Acinetobacter species (8/108, 7.4%). The most common microorganism isolated from diagnostic cultures was Acinetobacter species (16/53, 30%). The other microorganisms were Pseudomonas aeruginosa (12/53, 22.6%), and Klebsiella pneumoniae (11/53, 20.7%). The level of agreement between surveillance and diagnostic culture using Cohen’s kappa coefficient show only fair agreement, 0.229 (according to the number of VAP cases n=45) and slight agreement, 0.168 when calculated according to the number of isolates (n=66). Gram-negative bacteria were the most common microorganism isolated in both surveillance and diagnostic culture. Surveillance respiratory cultures had limited value in predicting the causative agents of VAP. Diagnostic culture taken on suspicion or onset of VAP remained as the gold standard for the diagnosis. 2020 Thesis http://eprints.usm.my/56934/ http://eprints.usm.my/56934/1/Syazwani%20Mohd%20Tajudin%20-%20e%2024.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	R Medicine (General) RC705-779 Diseases of the respiratory system
spellingShingle	R Medicine (General) RC705-779 Diseases of the respiratory system Tajudin, Syazwani Mohd Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens
description	Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality for patients who are managed in Intensive Care Unit (ICU). It is the leading cause of prolonged hospital stay, infection with multidrug-resistant organisms and increased hospital cost. Surveillance respiratory cultures are routinely done despite the absence of clinical evidence for an infection. The value of the surveillance respiratory cultures to predict the causative organism is still uncertain and debatable. To evaluate the clinical value of respiratory culture surveillance in predicting the causative agents for VAP in ICU patients. This was a prospective observational study which was carried out in the General ICU of Hospital Universiti Sains Malaysia, between July 2017 to December 2018. All adults’ patients who were taken surveillance respiratory were included in the study. Patients were followed up till they were transferred out from the ICU. Results of respiratory culture for surveillance and diagnostic were reviewed and analysed using Cohen's kappa coefficient (κ). A total of 193 patients were included in this study. 88/193 (46%) patients had positive surveillance cultures with a total of 108 isolates. Out of 63/193 (32.6%) patients had subsequent respiratory cultures, 45/63 (71.4%) patients fulfilled the research criteria for VAP. Only 35/45 (78%) had positive diagnostic cultures. The most common microorganism isolated from surveillance respiratory cultures was Klebsiella pneumoniae (33/108, 30.5%). The other microorganisms were Staphylococcus aureus (22/108, 20.3%), Pseudomonas aeruginosa (11/108, 10.2%), Enterobacter species (10/108, 9.2%), and Acinetobacter species (8/108, 7.4%). The most common microorganism isolated from diagnostic cultures was Acinetobacter species (16/53, 30%). The other microorganisms were Pseudomonas aeruginosa (12/53, 22.6%), and Klebsiella pneumoniae (11/53, 20.7%). The level of agreement between surveillance and diagnostic culture using Cohen’s kappa coefficient show only fair agreement, 0.229 (according to the number of VAP cases n=45) and slight agreement, 0.168 when calculated according to the number of isolates (n=66). Gram-negative bacteria were the most common microorganism isolated in both surveillance and diagnostic culture. Surveillance respiratory cultures had limited value in predicting the causative agents of VAP. Diagnostic culture taken on suspicion or onset of VAP remained as the gold standard for the diagnosis.
format	Thesis
qualification_level	Master's degree
author	Tajudin, Syazwani Mohd
author_facet	Tajudin, Syazwani Mohd
author_sort	Tajudin, Syazwani Mohd
title	Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens
title_short	Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens
title_full	Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens
title_fullStr	Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens
title_full_unstemmed	Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens
title_sort	evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2020
url	http://eprints.usm.my/56934/1/Syazwani%20Mohd%20Tajudin%20-%20e%2024.pdf
_version_	1776101181756538880

Evaluation of surveillance respiratory culture in predicting nosocomial pneumonia pathogens

Similar Items