Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review

Abstract

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). The South East Asian Region is a part of the world with limited health resources where infectious diseases are still underestimated. We aimed to review the literature in this part of the world to describe incidence, mortality and microbiological evidence of VAP and explore preventive and control strategies. We selected 24 peer-reviewed articles published from January 1, 2000 to September 1, 2020 from electronic databases and manual searching for observational studies among adult patients diagnosed with VAP expressed per thousand days admitted in ICU. The VAP rates ranged from 2.13 to 116 per thousand days, varying among different countries of this region. A significant rate of mortality was observed in 13 studies ranging from 16.2% to 74.1%. Gram negative organisms like Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae and Gram-positive organisms like Staphylococcus aureus and Enterococcus species were frequently found. Our findings suggest an alarming situation of VAP among patients of most of the countries of this region with increasing incidence, mortality and antibiotic resistance. Thus, there is an urgent need for cost effective control and preventive measures like interventional studies and educational programs on staff training, hand hygiene, awareness on antibiotic resistance, implementation of antibiotic stewardship programs and appropriate use of ventilator bundle approach.

Biofilm Formation by Pathogens Causing Ventilator-Associated Pneumonia at Intensive Care Units in a Tertiary Care Hospital: An Armor for Refuge

“…VAP itself deals with resistant pathogens, and use of broad-spectrum antibiotics for its control further aggravates the condition. In a systematic review of VAP in south-east Asian countries, the incidence of VAP ranges from 2.13 to 116 per thousand ventilator days [ 7 ]. According to the systemic meta-analysis of the incidence of adult VAP in Asian countries (2018), Nepal has VAP incidence density of 21.4 per 1000 ventilator days and period prevalence of 21.7% [ 8 ].…”

Pathogens and antimicrobial resistance amongst stroke patients in the intensive care unit: A five years review from Benin City, Nigeria

“…Ventilator associated pneumonia is prominent in the ICU amongst device infections and has been well documented. 8,9,10,44,45 Catheter associated UTI was the second commonest device associated infection in this study. Majority of ICU admitted patients would need catheterization for reason of quantifying the urinary output, but the stroke patient is especially likely to be catheterized.…”

Nebulized plasma‐activated water has an effective antimicrobial effect on medically relevant microbial species and maintains its physicochemical properties in tube lengths from 0.1 up to 1.0 m

“…Tracheal tubes and appliances are commonly contaminated by microorganisms, such as E. coli, S. aureus , [ 47,48 ] and C. albicans forming biofilms [ 49 ] capable of causing recurrent lung infections. [ 47,50 ] The resistance of intubated patients to antibiotics is more prominent in the presence of E. coli and S. aureus present in tubes and tracheal appliances. [ 48 ] Therefore, coping measures are necessary to treat infections caused by intubations.…”

“…RONS can cause an impact on intracellular components and the surrounding environment of cells that can be transported through the pores to the inner nucleus, increasing the amount of RONS in the cell with the consequent reduction in internal pH and oxidation of DNA, proteins, lipids, and carbohydrates. [ 50 ] Tian et al [ 54 ] showed a decrease in the membrane potential of S. aureus when the plasma jet above and below the water surface was used. They reported a reduction in the membrane potential of S. aureus depending on the time of plasma treatment.…”