title: Drug-resistant ventilator associated pneumonia in a tertiary care hospital in Saudi Arabia.
abstract: BACKGROUND
  There is a wide geographic and temporal variability of bacterial resistance among microbial causes of ventilator-associated pneumonia (VAP). The contribution of multi-drug resistant (MDR) pathogens to the VAP etiology in Saudi Arabia was never studied. We sought to examine the extent of multiple-drug resistance among common microbial causes of VAP.
  
  
  METHODS
  We conducted a retrospective susceptibility study in the adult intensive care unit (ICU) of King Abdulaziz Medical City, Riyadh, Saudi Arabia. Susceptibility results of isolates from patients diagnosed with VAP between October 2004 and June 2009 were examined. The US National Healthcare Safety Network definition of MDR was adopted.
  
  
  RESULTS
  A total of 248 isolates including 9 different pathogens were included. Acinetobacter spp. was highly (60-89%) resistant to all tested antimicrobials, including carbapenems (three- and four-class MDR prevalence were 86% and 69%, respectively). Pseudomonas aeruginosa was moderately (13-31%) resistant to all tested antimicrobials, including antipseudomonal penicillins (three- and four-class MDR prevalence were 13% and 10%, respectively). With an exception of ampicillin (fully resistant), Klebsiella spp. had low (0-13%) resistance to other tested antimicrobials with no detected MDR. Staphylococcus aureus was fully susceptible to vancomycin with 42% resistance to oxacillin. There were significant increasing trends of MDR Acinetobacter spp. however not P. aeruginosa during the study. Resistant pathogens were associated with worse profile of ICU patients but not patients' outcomes.
  
  
  CONCLUSIONS
  Acinetobacter in the current study was an increasingly resistant VAP-associated pathogen more than seen in many parts of the world. The current finding may impact local choice of initial empiric antibiotics.
authors.affiliation: Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia ; Gulf Cooperation Council States and WHO Collaborating Center for Infection Prevention and Control, Riyadh, Kingdom of Saudi Arabia ; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Balkhy
authors.affiliation: Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia ; Gulf Cooperation Council States and WHO Collaborating Center for Infection Prevention and Control, Riyadh, Kingdom of Saudi Arabia ; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Community Medicine, Faculty of Medicine, Mansoura University, Egypt.
authors.forename: Aiman
authors.initials: A
authors.lastname: El-Saed
authors.affiliation: Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Rana
authors.initials: R
authors.lastname: Maghraby
authors.affiliation: King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Hasan M
authors.initials: HM
authors.lastname: Al-Dorzi
authors.affiliation: Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Khan
authors.affiliation: Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Asgar H
authors.initials: AH
authors.lastname: Rishu
authors.affiliation: King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
keywords: Acinetobacter; Saudi Arabia; antimicrobial resistance; microbiology; ventilator-associated pneumonia