Incidence of Ventilator-Associated Pneumonia and its Bacterial Characterization – Intervention Based Prospective Study

Abstract

Objectives: Ventilator-associated pneumonia (VAP) is a widely recognized and potentially fatal healthcare-related infection that occurs in all high-dependency units. Mechanically ventilated patients are at an elevated risk of developing VAP, which has a high death and morbidity rate. The prevalence of VAP varies greatly depending on the location and diagnostic approach. Radiological and clinical markers impact VAP diagnosis accuracy. Reliable sampling and confirmation of microbes are highly recommended. The purpose of this study was to document the incidence, patient distribution, bacteriological profile, and antibiotic susceptibility pattern of VAP patients. Material and Methods: A prospective observational study was done between January 2016 and December 2019. Critically, ill patients on mechanical ventilation for more than 48 hours were included in the study. Based on the initial baseline, positive end-expiratory pressure, and fraction of inspired oxygen were followed by three-tier VAP criteria as per NSHN guidelines. Results: Out of 1220 VAP-suspected patients (mechanically ventilated), 49 patients developed hospital-acquired VAP. The incidence of VAP significantly reduced from 10.7 to 1.4 VAP/1000 ventilator days with continuous intervention and auditing over some time. Elderly males aged 51–66 years were found to be in higher risk groups. Klebsiella pneumoniae and Pseudomonas aeruginosa were found to be the most common pathogen. The majority of Enterobacterales (79%) were found to be resistant to third-generation cephalosporin, 69% were resistant toward fluoroquinolone and cotrimoxazole, followed by 55% resistance to beta-lactam and beta-lactamase inhibitor combination. Conclusion: Targeted strategies with implementable policies, such as the care bundle approach, will reduce the in-patient days. It might improve patient outcomes and reduce the incidence of VAP.