Determinants of ventilator associated pneumonia and its impact on prognosis: A tertiary care experience

Abstract

Background:Ventilator associated pneumonia (VAP) is a major cause of poor outcome among patients in the intensive care units (ICU) world-wide. We sought to determine the factors associated with development of VAP and its prognosis among patients admitted to different ICUs of a Tertiary Care Hospital in India.Methodology:We did a matched case control study during October 2009 to May 2011 among patients, ≥18 years with mechanical ventilation. Patients who developed pneumonia after 48 h of ventilation were selected in the case group and those who did not develop pneumonia constituted the control group. Patients’ history, clinical and laboratory findings were recorded and analyzed.Results:There were 52 patients included in each group. Among cases, early onset ventilator associated pneumonia (EVAP) occurred in 27 (51.9%) and late onset ventilator associated pneumonia (LVAP) in 25 (48.1%). Drug resistant organisms contributed to 76.9% of VAP. Bacteremia (P = 0.002), prior use of steroid/immunosuppressant (P = 0.004) and re-intubations (P = 0.021) were associated with the occurrence of VAP. The association of Acinetobacter (P = 0.025) and Pseudomonas (P = 0.047) for LVAP was found to be statistically significant. Duration of mechanical ventilation (P = 0.001), ICU stay (P = 0.049) and requirement for tracheostomy (P = 0.043) were significantly higher in VAP. Among each case and control groups, 19 (36.5%) expired.Conclusion:We found a higher proportion of LVAP compared with EVAP and a higher proportion of drug resistant organisms among LVAP, especially Pseudomonas and Acinetobacter. Drug resistant Pseudomonas was associated with higher mortality.

Ventilator Associated Pneumonia: Incidence and Risk Factors in a University Hospital

“…A significant association was found in this study between re-intubation and development of VAP, which is in accordance with a previous study by Saravu et al, (16) . Reintubation is associated with transfer of organisms from upper respiratory to lower respiratory tract, which could explain the higher incidence of VAP among such cases.…”

“…This may be due to the higher chances of aspiration in comatosed patients. Steroid usage was found significantly higher in VAP group than that of non-VAP group; the results of this study coincide with the results of the stud by Saravu et al, (16) this may be attributed to the suppressive effects of steroids on innate and acquired immunity. A significant difference among the study groups regarding H 2 blockers usage was found.…”

“…In the present study the duration of mechanical ventilation for the VAP group was significantly high. Similarly, the VAP group also had significantly longer duration of ICU stay which is similar to the findings reported by Saravu et al, in their study about the determinants of VAP (16) .…”

“…This finding is similar to that reported by Saravu et al, as position was considered as a risk factor in the development of VAP. (16) Also impaired consciousness was a significant risk of VAP. Findings are consistent with the study by Joseph et al, (2) .…”

Clinical study of ventilator-associated pneumonia in tertiary care hospital, Kolhapur, Maharashtra, India

“…It is characterized by the presence of new or progressive infiltrate, sign of systemic infection (fever, altered white cell count), changes in sputum characteristics. 3 Ventilator-associated pneumonia (VAP) is the most commonly seen nosocomial infection among mechanically ventilated patients and is the biggest concern for critical care specialists. Eighty-six percent of nosocomial pneumonias are associated with mechanical ventilation.…”