VAP

Infeksi nosokomial yg sering di ICU

Kuntaman
Department of Microbiology,
School of Medicine Airlangga University
Dr. Soetomo Hospital Surabaya

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 VAP
1. the presence of new or progressive radiographic
infiltrates plus clinical evidence that these
infiltrates are of infectious origin.
2. Mostly caused by commen/saphr microbials
from environments
3. Earlier identifiation of clinical sign and
symptoms are benefecial.

Fabregas et al: Clinical diagnosis of ventilator associated pneumonia revisited: comparative

validation using immediate post-mortem lung biopsies. Thorax 1999, 54:867- 873.
 Diagnosis first day
1. Clinically:
o Bronc secr
o Phys exam
2. Radiologic, Temp., Leu count
3. Specimen:
o Taking the secrete from lower part of
Bronchial branching
o Aseptic approach
o Staining: GRAM, AFB
 Diagnosis first day
1. Gram Stain: is reported for narrowing
the empirical antibiotic choices
2. Selected Biomarker/s if needed
CRP
PCT
3. Empirical therapy should be started:
o Based on Antibiogram (Local) of
pathogens and its susceptibility test
o Broad spectrum, based on the data
 Diagnosis 1st day/2nd
1. Micro Culture :
o Qual: identify the isolate and its
susceptibility
o Quan: Counting for increasing the
validity of causative agent
2. Is reported in the second/third
day
 Diagnosis Micro Culture
Lab Quali Quanti
Measure
Lab work + ++
Sensitivity +++ +
Specificity: ++ 105: +++
106: ++++
Steril:
Valuable
 Quantitative: Micro Culture
Specimen: trach/bronch aspirate
Yielding emt 105 cfu/ml
25 out of 38 cases of true VAP,
Sens: 65.8% and speci. 48%.
When emt 106 cfu/ml
sensitivity: 26% and speci. 78%.
vs quali. : sensi. 81%, spec. 23%.
Luna1 and Chirino.Critical Care 2004, 8:425-426 (DOI 10.1186/cc2988) 7
emt, equal or more than
 Quanti vs Quali: Micro Culture
To do qualitative cultures is better than not to
do cultures,
If no growth for justify discont AB.
Quantitative cultures are preferable for
making decisions regarding therapy for VAP
Bacterial count emt 105 106 : justify for
starting AB

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Luna1 and Chirino.Critical Care 2004, 8:425-426 (DOI 10.1186/cc2988)
 ESBL Multicentre Study 2010
Surabaya, Semarang, Malang
Producing microbes Total %
Citrobacter spp 3 1.5
Ent aerogenes 1 0.5
Entero cloacae 12 6
E coli 91 44
Kleb oxytoca 2 1
Kleb pneumo 93 45
Proteus mir 1 0.5
Seratia fonficola 1 0.5
Seratia marcescens 1 0.5
Total 205 100

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 ESBL Producers 2010
Surabaya, Semarang, Malang
E coli Kleb pne
(n=91) (n=93)
Antibiotic Res (%) Res (%)
CTX 89 97,8 87 93,55
MEM 0 0 3 3,23
FOS 4 4,4 3 3,23
Cefo-Sulb 3 3,3 4 4,30
AK 7 7,7 8 8,60
CIP 68 74,7 43 46,24
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 Isolates 2010
Specimens: ESBL Producers SBY,
MLG
Kleb pne
E coli (%) (%)
Spec Malang Sby Malan
Sby (n=18) (n=44 g
(n=46) ) (n=26)
Ur 46 39 22 19
Blo 8 11 13 8
Pus 13 33 29 35
Spu 11 11 31 31 11
Team work is the best solution for
Diagn & management of VAP

Clinician/s
Clin Microbiologist
Clin Pharmacist
Infection Control practitioner

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