Study of Ventilator Associated Pneumonia in Neonatal Intensive Care Unit: characteristics, risk factors and outcome

Abstract

Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates. Neonates admitted to neonatal intensive care unit (NICU), over a period of 1 year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Diagnosis of VAP was made by the guidelines given by National Nosocomial infection Surveillance System (NNIS, 1996). Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 10 5 CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The risk factors such as birth weight, prematurity (gestational age < 37 weeks), duration of mechanical ventilation, number of reintubations, length of hospital stay, primary diagnosis of neonate, postnatal age and small for gestational age (SGA) were studied for the development of VAP. Risk factors found significant on bivariate analysis were subjected to multiple regression analysis to determine the most important predictors of VAP. The study group comprised of 98 neonates out of which, 30 neonates developed VAP (30.6%). VAP rates were 37.2 per 1000 days of mechanical ventilation. Most common bacterial isolated from endotracheal aspirate of VAP patients was Klebsiella spp (32.8%), E.coli (23.2%) and Acinetobacter (17.8%) being the other two common organisms. Very low birth weight (<1500 grams), prematurity (gestational age < 37 week), duration of mechanical ventilation, number of reintubations and length of NICU stay were significantly associated with VAP in bivariate analysis. Multiple regression analysis revealed that duration of mechanical ventilation (OR 1.10, 95% CI 1.02, 1.21; P = 0.021) and very low birth weight (OR 3.88, 95% CI 1.05, 14.34; P = 0.042) were two single independent and statistically significant risk factors for predicting VAP. VAP developed in nearly one third of intubated neonates having gram negative organisms as predominant etiological agent.

Outcome of neonatal ventilation: a prospective and cross-sectional study in tertiary care centre

“…Out of 6 cases that had pulmonary complication, 1 case had adverse outcome as DAMA as reference from published data, VAP is not associated with adverse outcome but it increases the mean length of NICU stay. [18][19][20][21][22] Statistical analysis of the study population showed that, mechanical/pulmonary complications associated with ventilation are not predictor of outcome of mechanical ventilation.…”

Endo-Tracheal Tube Associated Bacterial Infection, Prevalence and their Drug Susceptibility Pattern in NICU

“…Incidence is shown in Table 3. But klebsiella and E.coli having highest prevalence among the gramnegative and S. aureus among gram-positive, [16,22,29] in contrast to developing world, developed countries having more Gram-positive bacterial infection. Group B streptococci were reported as the most common pathogens in terminfant in United States by National Institute of child health and development [32] as shown the incidence in Table 4.…”

“…38.57 Table 4: Incidence of individual bacteria in the published articles included in our study Bacteria Shreshta et al [19] Tripathi et al [29] Afif Ahmad et al [15] Eman M.Rbie shehab ElDin et al [20] Yalaz M et al [18] D.Mohammmed OSE seifi et al [16] Klebsiella Pneumoniae Risk factor and prevention strategy NIs depends on multiple factors like prematurity, Low birth-weight and Days of mechanical ventilation (MV). Extremely low birth-weight neonates need prolonged use of MV, which is an independent risk factor for developing VAP.…”

Comparative study of incidence, risk factors, etiological agents and outcome of early and late ventilator associated pneumonia in paediatric intensive care unit at a tertiary care centre

“…5,9,11 However, in developing countries the reported rates are significantly higher, ranging from 16.1 to 89 episodes per 1,000 ventilator days. [12][13][14] The incidence of VAP increases with the duration of mechanical ventilation. Estimated rates are 3% per day for the first 5 days, 2% per day for days 6-10, and 1% per day after day 10.…”