Madhurima Saha

Chikungunya Viral Infection Requiring Intensive Care – Experience in a Tertiary Care Hospital in Bangladesh

Background: Chikungunya fever is a benign self-limiting viral illness. Although it is considered as a nonfatal disease but in elderly patients who have co-morbidities can present with atypical life threatening clinical menifestations which may cause significant morbidity and mortality.The Aim of this study is to observe atypical presentations ,various complications and outcome of chikungunya fever. Methods: This was a cross sectional observational study was carried out on 23 adult patients with chikungunya fever from 1 st June to 31 st July of 2017 in the Department of Critical Care Medicine of BIRDEM General Hospital, Dhaka, Bangladesh. Results: Total 23 patients were included in this study, male 83% and female 17%.From indoor 17(73.9%) patients got admitted in ICU, 3(13%) patients came directly from home and 3(13%) patients from another hospitals. Most of the patients were elderly having co-morbidities like diabetes, Hypertension, IHD and CKD. COPD and CVD were also present in a few numbers of patients. Most of the patients had fever , arthralgia and headache but respiratory distress (73.9%), altered mental status (56.5%), vomiting (21.7%), diarrhoea (17.3%) and low urine output (17.3%) are the causes of ICU admission. Major Organ involvement of the study subjects were respiratory system (52.1%), renal system (47.8%), CVS (34.7%) and nervous system (34.7%). Among 23, 16(70%) patients improved and 4(17%) patients died in ICU. Conclusion: This study highlights that though chikungunya fever is considered as a benign non-fatal disease it can produce life threatening clinical menifestations and serious complications requiring Intensive Care particularly in elderly comorbid patients and can cause high mortality. Birdem Med J 2018; 8(1): 16-20

Antibiotic Resistance Pattern among Bacteria causing Ventilator Associated Pneumonia in An Intensive Care Unit of Bangladesh

Background : Ventilator-associated pneumonia (VAP) is the most common type of nosocomial infection in critical care practice with high morbidity and mortality. Microorganisms responsible for VAP vary from place to place. So, identification of causative organism and knowledge of their resistance pattern is very important for empirical choice of antibiotic in managing VAP. The aim of this survey was to evaluate the quantitative cultures of endotracheal aspirates to determine the microorganisms responsible for VAP and to study their antibiotic resistance pattern. Materials and Methods: This cross sectional study was performed over a period of six month starting from November, 2015 to April, 2016 in the Intensive Care Unit (ICU) of BIRDEM General Hospital. Patients with a clinical and radiological diagnosis of VAP were included in this study. Result: A total of 51 patients with a clinical diagnosis of VAP were included in this study. Growth was obtained in100% of the samples yielding 88 organisms. Gram-negative organisms were the mostly isolated organism (76.13%), followed by fungi (17.04%) and gram-positive cocci (6.81%). The most common pathogen was Acinetobacter sp. followed by Klebsiella sp., Candida sp. and Pseudomonas sp. respectively. Among the gram negative organisms, Acinetobacter sp., Klebsiella sp. and Pseudomonas sp. were highly resistant (>80%) to third generation cephalosporins and fluoroquinolones. Resistance to aminoglycosides (>68%) and imipenem (>60%) was also high. Resistance of Pseudomonas sp. to piperacillin-tazobactum was lower (18.2%) in comparison to Acinetobacter sp. and Klebsiella sp. All the Gram-negative organisms were 100% sensitive to colistin except proteus. Regarding gram-positive cocci,Staphylococcus aureus is 100% sensitive to netilmycin and vancomycin with variable resistance pattern to other antibiotics. Conclusion: Emergence of drug resistance against the microorganism causing VAP is a serious concern in most of the ICUs. A knowledge of antibiotic susceptibility pattern will avoid its irrational use in order to control the spread of infection and for proper management of VAP. Bangladesh Crit Care J September 2016; 4 (2): 69-73