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

Background 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. Materials and Methods: In this cross-sectional study ۳۴۳ isolates were detected from ۲۴۳ pediatric patients, from August ۲۰۱۷ to December ۲۰۱۸ 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. Results: Out of ۳۴۳ isolates ۴۲ (۱۲.۲%) of the positive cultures were Candida albicans and ۳۰۱ (۸۷.۸%) were bacterial isolates. Gram-negative bacteria were the most common organisms with the cumulative percentage of ۶۲.۹% of bacterial isolates. When tested with oxacillin, ۶۱.۵% of Staphylococcus aureus were MSSA and ۳۸.۵% were MRSA. The mentioned common gram-negative organisms had more than ۲۵% resistance to at least one antibiotic from three or more antibiotic classes. However, P. aeruginosa showed below ۲۰% resistance to majority of antibiotics. Twenty-seven (۱۱.۱%) of patients had VAP, ۲۵ (۹۲.۶%) of whom were gram-negative infections. Conclusion: 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.