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<p>Ventilator-associated pneumonia (VAP) is the most common infection encountered in intensive care units and is closely linked with elevated mortality, morbidity, and healthcare expenditure. The predominant pathogens responsible for VAP are multidrug-resistant (MDR) Gram-negative bacteria, including <i>Acinetobacter baumannii</i>, <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i>, and <i>Escherichia coli</i>. This study aimed to investigate the molecular antibiotic resistance profiles of bacterial isolates from hospital-acquired VAP cases. Conducted between 30 November 2022 and 30 November 2023 at Kırşehir Training and Research Hospital, resistance genes were identified using Polymerase Chain Reaction (PCR), while clonal relatedness and genotyping were assessed through Repetitive Extragenic Palindromic-PCR (rep-PCR) and Multi-Locus Sequence Typing (MLST). The most frequently isolated organisms were <i>A. baumannii</i> (46.2%), <i>K. pneumoniae</i> (42.3%), and <i>P. aeruginosa</i> (7.7%). <i>A. baumannii</i> strains exhibited 100% resistance to ciprofloxacin and carbapenems, and 70.83% to colistin. <i>K. pneumoniae</i> strains demonstrated 94.73% resistance to carbapenems and 100% to piperacillin–tazobactam and colistin. Molecular analyses identified <i>bla</i><sub><i>TEM</i></sub>, <i>bla</i><sub><i>OXA−1</i></sub>, <i>bla</i><sub><i>CTX−M1</i></sub>, <i>bla</i><sub><i>OXA−51</i></sub>, <i>bla</i><sub><i>OXA−23</i></sub>, and <i>bla</i><sub><i>OXA−40</i></sub> in <i>A. baumannii</i>, and <i>bla</i><sub><i>TEM</i></sub>, <i>bla</i><sub><i>SHV</i></sub>, <i>bla</i><sub><i>CTX−M1</i></sub>, <i>bla</i><sub><i>OXA−1</i></sub>, <i>bla</i><sub><i>OXA−48</i></sub>, and <i>bla</i><sub><i>NDM−1</i></sub> in <i>K. pneumoniae</i>. Nine isolates (17%) were identified as transconjugants. MLST analysis revealed <i>K. pneumoniae</i> ST2096 and <i>A. baumannii</i> ST2 as predominant. Clones not previously reported in Türkiye <i>A. baumannii</i> ST78 and <i>K. pneumoniae</i> ST45, ST437, and ST1128 were also detected. This study provides a comprehensive molecular characterisation of VAP pathogens based on an extensive dataset. The results underscore the need for stricter infection control, restrained use of broad-spectrum antibiotics, and ongoing surveillance of resistance mechanisms.</p>

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Bacterıal pathogens ın ventılator-assocıated pneumonıa; molecular assessment of resıstance profıles

  • 期刊论文

  • 发表日期：

    2025年12月10日

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  • Besim Çam,
  • Lokman Hi̇zmali̇,
  • Elif Sevi̇m,
  • Rukiye Akyol

摘要

Ventilator-associated pneumonia (VAP) is the most common infection encountered in intensive care units and is closely linked with elevated mortality, morbidity, and healthcare expenditure. The predominant pathogens responsible for VAP are multidrug-resistant (MDR) Gram-negative bacteria, including Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. This study aimed to investigate the molecular antibiotic resistance profiles of bacterial isolates from hospital-acquired VAP cases. Conducted between 30 November 2022 and 30 November 2023 at Kırşehir Training and Research Hospital, resistance genes were identified using Polymerase Chain Reaction (PCR), while clonal relatedness and genotyping were assessed through Repetitive Extragenic Palindromic-PCR (rep-PCR) and Multi-Locus Sequence Typing (MLST). The most frequently isolated organisms were A. baumannii (46.2%), K. pneumoniae (42.3%), and P. aeruginosa (7.7%). A. baumannii strains exhibited 100% resistance to ciprofloxacin and carbapenems, and 70.83% to colistin. K. pneumoniae strains demonstrated 94.73% resistance to carbapenems and 100% to piperacillin–tazobactam and colistin. Molecular analyses identified blaTEM, blaOXA−1, blaCTX−M1, blaOXA−51, blaOXA−23, and blaOXA−40 in A. baumannii, and blaTEM, blaSHV, blaCTX−M1, blaOXA−1, blaOXA−48, and blaNDM−1 in K. pneumoniae. Nine isolates (17%) were identified as transconjugants. MLST analysis revealed K. pneumoniae ST2096 and A. baumannii ST2 as predominant. Clones not previously reported in Türkiye A. baumannii ST78 and K. pneumoniae ST45, ST437, and ST1128 were also detected. This study provides a comprehensive molecular characterisation of VAP pathogens based on an extensive dataset. The results underscore the need for stricter infection control, restrained use of broad-spectrum antibiotics, and ongoing surveillance of resistance mechanisms.