LEYLA KAZANCIOĞLU, İLKAY BAHÇECİ
Comprehensive Medicine - 2024;16(3):136-141
INTRODUCTION: Tracheostomy is essential for long-term ventilator patients, but can lead to serious infections like ventilator-associated pneumonia, increasing morbidity and mortality. This study examines microorganisms in endotracheal aspirates from ICU patients with tracheostomies, assessing antibiotic susceptibility and clinical outcomes. METHODS: Endotracheal aspirate samples taken from 149 patients treated in Anesthesia and Surgical Intensive Care Units between January 15, 2017 and December 15, 2021 were included in this retrospective study. Endotracheal aspirate samples of 50 patients before tracheostomy, patients’ age, gender, body mass index, admission diagnosis, length of stay in the Intensive Care Unit, Glasgow coma score, Acute Physiology and Chronic Health Evaluation II score, and risk factors for colonization were recorded. Results: Before tracheostomy, colonization was detected in 42% of patients. The most common microorganisms were Acinetobacter baumannii (40.5%), Pseudomonas aeruginosa (19%), and others (40.5%). A total of 184 pathogens were identified. Colonization with 4 pathogens was observed in 2 patients, 3 pathogens in 8 patients, 2 pathogens in 43 patients, and a single pathogen in 72 patients. Additionally, 13 different microorganisms were isolated from endotracheal aspirate cultures, with Acinetobacter baumannii (38.6%), Pseudomonas aeruginosa (18.5%), and Serratia marcescens (8.1%) being the most frequent, while other microorganisms accounted for 34.8%. The overall mortality rate of patients with colonization was 60.5%, with the highest mortality observed in the group with Acinetobacter baumannii detected in endotracheal aspirate cultures (41.2%). This group also had a higher incidence of ischemic or hemorrhagic cerebral damage (62.3%). DISCUSSION AND CONCLUSION: The prevalent microorganisms in our tracheostomy patients were Acinetobacter baumannii and Pseudomonas aeruginosa, which were found to be 100% sensitive to colistin upon examination of their antibiotic susceptibility. The group of patients affected by Acinetobacter baumannii had the highest mortality rate compared to other groups, and the diagnosis of ischemic/hemorrhagic brain disease occurred in this group with the highest mortality rates. Further comprehensive studies are warranted to explore the impact of expanding tracheostomy with a ventilator on mortality in intensive care patients, and we anticipate that our research can guide the selection of targeted antibiotics.
