Incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center of northern India

Abstract

Background:The incidence of VAP varies among different studies, depending on the definition, the type of hospital or ICU, the population studied, and the level of antibiotic exposure. This study was planned to ascertain and analyse the incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center. Methods: In this retrospective study, all the adult patients on mechanical ventilation (MV) for more than 48 hours in the Medicine Intensive Care Unit (MICU) and the Critical Care Unit (CCU) during September 2015 to February 2016 were included in the current study. Patients diagnosed with pneumonia prior to MV or within 48 hours of MV were excluded from the study. Patients' records served as study tools. Medical records department (MRD) was approached and data was collected on all patients who received mechanical ventilation during the study period. The relevant data were recorded from medical records, bedside flow sheets, radiographic reports, and reports of microbiological studies of the patients. The chi-square (χ²) test or Fisher's exact test was used to compare different groups. Univariate and multivariate logistic regression analysis was performed to identify risk factors associated with development of ventilator-associated pneumonia. Results: Overall incidence of VAP was 23.54 per 1,000 ventilator days. The incidence of VAP in MICU and CCU were 31.77 and 16.47 per 1,000 ventilator days respectively. 60% of the cases were late-onset VAP, while 40% were early-onset VAP. The most common organism isolated was Pseudomonas aeruginosa followed by Methicillinresistant Staphylococcus aureus (MRSA). Impaired consciousness, tracheostomy, re-intubation, emergency intubation, and nasogastric tube were significantly associated with VAP. On multivariate analysis, impaired consciousness, emergency intubation and tracheostomy were independent risk factor for VAP among study subjects. Conclusions: Data thus generated can be used to plan and modulate the potential intervention measures while managing VAP. Knowledge of the important risk factors predisposing to VAP may prove to be useful in implementing effective preventive measures.

Pattern and incidence of ventilator associated pneumonia among mechanically ventilated patients

“…17 Another study from northern India observed that the 2 most common organism isolated were Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA). 4 Considerable controversy still surrounds treatment (monotherapy or combination) for patients with VAP, which depends on organisms recovered. The primary reasons for combination therapy are to prevent the development of resistance, improve outcomes, provide synergy, and provide sufficient antibiotic coverage should the pathogen be resistant to the agent that would have been chosen as single therapy.…”

“…The incidence of VAP varies among different studies, depending on the definition, the type of hospital or ICU, the population studied, and the level of antibiotic exposure. 4 Knowledge of the incidence of VAP and their associated risk factors are imperative for development and use of more effective preventive measures. While critically ill patients experience a life-threatening illness, they commonly contract VAP.…”

Finding the Incidence of Ventilator Associated Pneumonia by Recent NHSN Guidelines and Its Bacteriological Profile: A Study Conducted in a Tertiary Care Hospital in Southern India

“…Incidence of VAP Organism wise distribution of VAPMathai et al, (2016) 21 and Ranjan et al, (2014)22 with Acinetobacterspsas the most common organism isolated. In contrast Deshmukh et al, 23 and Husain Shabbir Ali et al, (2016)24 reported Pseudomonas aeruginosa as the most common organism.In our study mortality was 48.38% and it is consistent with the recent reports from Dube et al, Maqbool et al, Ranjan et al, Goel et al, (2012) 25 and Gupta et al, (2011) 26 . Higher mortality was reported by Gupta et al, as 78.94%.…”

“…2 The incidence of VAP varies among different studies, depending on the definition, the type of hospital or ICU, the population studied, and the level of antibiotic exposure. 3 The causative…”