IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 16, Issue 12 Ver. XI (Dec. 2017), PP 41-44 www.iosrjournals.org DOI: 10.9790/0853-1612114144 www.iosrjournals.org 41 | Page VAP in Neonatal Sepsis: An ET Tube Based Microbiological Study Purba Mukherjee 1 , Prativa Biswas 2 1 Demonstrator, Department of Microbiology, Midnapore Medical College and Hospital, Paschim Medinipur, West Bengal 2 RMO, Department of Paediatrics, Midnapore Medical College and Hospital, Paschim Medinipur, West Bengal, *Corresponding author: *Prativa Biswas Abstract: Neonatal sepsis was found to be the singleton important cause of high mortality and morbidity of the Sick neonatal care Unit of our institution, where the majority of patients were still striving to find proper measures to access the medical facility in time, being entangled in the webs of poor socio-economic conditions, remoteness and lack of transport facilities, poor hygiene, malnutrition, inadequate antenatal care; and above all, ignorance. In this background, prematurity, low birth weight, birth asphyxia including Hypoxic Ischemic Encephalopathy, even sometimes congenital anomalies, were prominent predisposing factors for neonatal sepsis; often requiring intubation and mechanical ventilation which led to ventilator associated pneumonia (VAP). In this study extended over one year, we intended to search for the predictability of ET tube culture reports for VAP among neonatal sepsis cases, the bacteriological profile, and antibiotic susceptibility pattern of the isolates. We found that, intubation longer than 4 days was crucial for bacterial colonisation in the ET tube progressing to VAP. Bacteriological profile was monomicrobial and predominated by Staphylococcus aureus, followed by Pseudomonas aeruginosa, Acinetobactor baumannii complex, coliforms and CONS. Comorbid conditions mentioned above were important prognostic factors and prevalence of multi drug resistant strains made the situation grave. Keywords: ET tube culture, Neonatal sepsis, VAP, Ventilator associated pneumonia --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 16-12-2017 Date of acceptance: 28-12-2017 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Neonatal sepsis is among the top three primary causes of morbidity worldwide with a high mortality rate, 99% of these deaths occurring in developing countries alone. 1, 2 Of the 6.9 million neonatal sepsis burden, 3.5 million cases occur in South Asia per year and India claims a large proportion of this disease thanks to its huge population. 3,4 Although no population based figures are available, bulk of these sepsis related neonatal deaths are considered to be occurring in rural India, where more than 60% of Indian population lives. Inadequate information are available on these infections and deaths due to sub optimal public health surveillance systems and lack of transportation to appropriate health care facilities where culture, other diagnostic tools and antimicrobial testing may be available. In the context of worldwide increase in antimicrobial resistance, India’s condition is considered more stark than any other place. 4 Our institution, being a peripheral Medical College in West Bengal, India, reflects the same situation, where majority of the patients come from remote villages with limited access to transport facilities. Their poor socioeconomic conditions, malnutrition, lack of awareness regarding antenatal and child care, and many other cultural and social customs put hand in hand to serve them the ill-fate of a very high rate of neonatal morbidity and mortality. In the SNCU, patients of neonatal sepsis with or without co-morbid conditions are often compelled to put in intubation and mechanical ventilation, but unfortunately, development of ventilator associated pneumonia (VAP) is not uncommon. As yet there is no gold standard for the microbiological diagnosis of VAP 5 and the problems related to the excessive use of antibiotics and growing antimicrobial resistance have made the situation worse; improving the accuracy of microbiological diagnosis becomes an essential element for ensuring adequate antibiotic coverage for Multi-Drug Resistant Organism (MDRO), and to limit the use and duration of empirically prescribed broad spectrum antibiotic therapy. 6,7 This study was a clinico-bacteriological analysis of the neonatal sepsis patients having intubated and subsequently developing VAP, their bacteriological profile and antimicrobial sensitivity against the commonly prescribed antibiotics.