Assessing Respiratory Tract Infections' Prevalence and Microbial Profiles in Mechanically Ventilated Patients: Insights From Broncho Alveolar Lavage Examination

TL;DR

This study examines chest infections in ventilated patients using broncho-alveolar lavage, finding high prevalence of gram-negative bacteria and significant mortality despite treatment.

Contribution

The study provides insights into microbial profiles and treatment outcomes of respiratory infections in mechanically ventilated patients using BAL.

Findings

78.94% of 38 mechanically ventilated patients had chest infections, primarily caused by gram-negative bacteria.

Infections were susceptible to carbapenems and β-lactam/β-lactamase inhibitors but resistant to fluoroquinolones.

Mortality remained high at 31.57% despite appropriate treatment, highlighting the severity of these infections.

Abstract

Introduction

Chest infections represent a significant challenge in mechanically ventilated patients, often leading to adverse outcomes despite advancements in critical care. This prospective study was conducted in the intensive care unit of tertiary referral care, with objectives to assess chest infection prevalence, microbial profiles, and outcomes in mechanically ventilated patients through broncho-alveolar lavage (BAL) examination.

Methodology

This prospective study involved 38 patients aged 15 to 65 years who were receiving mechanical ventilation and underwent BAL. The procedure of BAL was followed as per the guidelines and recommendations outlined by the American Thoracic Society for Bronchoscopic Lavage. Microbial analysis involves the use of microscopic examination and quantitative culture methods. Different staining techniques were utilized to identify bacteria, fungi, and mycobacteria. Complications and adverse events were monitored and recorded.

Results

Out of the 38 patients who underwent BAL, the majority, 30 (78.94%), were found to have chest infections, with gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii, being the causative agents. The antibiotic sensitivity profiles indicated that the organisms were susceptible to carbapenems and broad-spectrum β-lactam/β-lactamase inhibitor combinations while showing resistance to fluoroquinolones. Despite adequate treatment, mortality remained significant in 12 (31.57%) patients.

Conclusion

Study findings underscore the importance of proactive surveillance, early diagnosis, and targeted management strategies to mitigate the burden of respiratory infections in critical care settings.