ACINETOBACTER BAUMANNII RESISTEN

CARBAPENEM PADA VENTILATOR

ASSOCIATED PNEUMONIA
Fadel Ahmad Pratama, Irvan Medison, Dewi Wahyu Fitrina, Dessy Mizarti, Masrul Basyar, Sabrina Ermayanti
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Andalas University

BACKGROUND
Ventilator-associated pneumonia (VAP) is a Hospital Acquired Pneumonia (HAP) that occurs after 48 hours
of mechanical ventilation. VAP is one of the most common infections in the Intensive Care Unit (ICU) and
accounts 25% of ICU infections. Several studies have found that patients with HAP and VAP have a high
risk of infected by multidrug resistant bacteria associated with late onset VAP.

CASE ILLUSTRATION
• Female patient aged 32 years was consulted from the obstetrics department with post tracheostomy due
to indication of prolonged ventilator + P3A0H2 post vaginal partus + HELLP Syndrome + History of
decreased consciousness ec impending eclampsia antepartum + History of sepsis ec Intrauterine fetal
death (IUFD). Patients felt of increased shortness of breath since 2 days ago. Shortness of breath has been
felt since 20 days ago, tightness does decreases, increases with activity. The patient has been treated for 18
days. The patient was admitted to the ICU for 16 days with a 5-day ventilator attached and tracheostomy
was performed on day 6 of treatment in the ICU
• Examination of the patient's vital signs obtained, general condition of moderate pain, cooperative
composmentis awareness, blood pressure 130/79, HR 80x/min, RR: 22 x/min, T: 36.8 and SpO2: 98%
attached tracheostomy cannula with T-piece 5 lpm.
• Patients received ceftriaxone 2x2 grams and levofloxacin 1x750 mg for 2 days, then continued meropenem
3x1 grams and amikacin 1x1600 mg for 10 days. Patients received cefepime therapy 3x1 grams and
gentamicin 1x560 mg for 6 days.

LABORATORY TEST RESULT RESULTS OF BLOOD GAS ANALYSIS

Haemoglobin 10,9 pH/ pCO2/ Effects of
10th
pO2/ 7,514/ 43,4/ 99/ metabolic
Hematocrti 35 August
HCO3/BE/ 35,3/ 11,5/ 96,5 alkalosis with
10th August 2022
Leukocyte 14.610 SpO2 mild ARDS
2022
Trombosit 189.000
GRAM STAINING RESULTS
Procalcitonin 11,4
Haemoglobin 11,7 Gram-positive coccus germ image,
25th July 2022
epithelium 0-1/LP, leukocytes > 25/LP
Hematocrti 33

15th August Leukocyte 8.510 4th August Gram-positive coccus germ image,
2022 2022 epithelium 0-1/LP, leukocytes > 25/LP.
Trombosit 302.000
Procalcitonin 0,52 10th August Gram-positive coccus germ image,
2022 epithelium 0-1/LP, leukocytes > 25/LP
Diffcount 0/0/0/62/25/9

CULTURE RESULTS AND SENSITIVITY OF BANAL SPUTUM GERMS

There are pathogenic bacteria Acinetobacter baumannii, isolated bacteria resistant to
carbapenems. Sensitivity results were obtained sensitive to Gentamicin and Trimethoprim /
25th July 2022 Sulfamethoxazole and Indeterminet to Tigecycline. Bacteria resistant to Ampicillin / Sulbactam,
Piperacillin / Tazobactam, Cefazolin, Ceftazidime, Ceftriaxone, Cefepime, Meropenem, Amikacin,
Ciprofloxacin.
There are pathogenic bacteria Acinetobacter baumannii, isolated bacteria resistant to
carbapenems. The sensitivity results were obtained sensitive to Tigecycline and resistant to
4th August 2022 Ampicillin / Sulbactam, Piperacillin / Tazobactam, Cefazolin, Ceftazidime, Ceftriaxone, Cefepime,
Meropenem, Amikacin, Gentamicin, Ciprofloxacin, Trimethoprim / Sulfamethoxazole.
10th August 2022 Same result on 4th August 2022

• Patients received ceftriaxone therapy 2x2 grams

and levofloxacin 1x750 mg for 2 days, then
continued meropenem 3x1 grams and amikacin
1x1600 mg for 10 days. Patients received cefepime
therapy 3x1 grams and gentamicin 1x560 mg for 6
days. When moved to the pulmonary treatment
room, patients received Tygecycline therapy
1x200 mg (i.v) the first day followed by 2x100 mg
H2 and so on, N acetylcysteine 2x200 mg (p.o)
and periodic suction. The patient is planned to
consul chest physiotherapy.
Figure 1. Thoracic photo dated 07/23/2022 (left), thoracic
DISCUSSION photo dated 08/03/2023 (right)
• Mechanical ventilation is an effective intervention
method to save the lives of critically ill patients CONCLUSION
and is often used in intensive care units.2
• VAP patients are at great risk of infection with
Increased duration of use of mechanical
multidrug-resistant bacteria.13 There are several
ventilation is associated with an increased
risk factors for antibiotic resistance in patients
incidence of VAP.7
such as treatment room factors, patient factors
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