Ventilator associated pneumonia: An enduring hitch in intensive care units!! A study from a tertiary care center

Abstract

Ventilator-associated pneumonia (VAP) is a serious health care-associated infection. It prolongs hospital stay and drives up hospital costs reporting high morbidity and mortality. VAP is defined as pneumonia that occurs 48h or more after endotracheal intubation or tracheostomy, caused by infectious agents not present or incubating at the time mechanical ventilation.VAP requires rapid diagnosis and initiation of the appropriate antibiotics. Materials and Methods: The present study was done in the department of Microbiology, Rajarajeswari Medical college, Bangalore. All the clinically suspected cases of VAP from intensive care units over a period of one year were included in the study. Endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) samples were collected from all patients and processed . Identification was carried out according to standard biochemical tests. Sensitivity pattern was determined using Kirby-bauer disc diffusion according to CLSI guidelines. Results: Out of 160 patients, who were on mechanical ventilation, 7 patients fulfilled the clinical and microbiological criteria. Incidence of VAP in our study is 4.4 and incidence density is 10.5 for 1000 ventilator days.57% of bacterial isolates were found to be Acinetobacter spp. followed by Pseudomonas aeruginosa 29% and Klebsiella pneumoniae 14%. Among 7 cases, 3(43%) were Early onset, 4(57%) were late onset VAP. Discussion and Conclusion: Even in the era of advanced medical care VAP remains a major challenge. The risk of developing VAP can be reduced by VAP prevention care bundles. Timely diagnosis is a major step to initiate appropriate antibiotics for better outcomes. Both patients and units are at risk of developing multidrug-resistant organisms and therefore appropriate antibiotic stewardship is essential. Better knowledge of local patterns of pathogens causing VAP can help facilitate treatment choice, in turn reducing the ventilator days and hospital stay.