Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multidrug resistant pathogens

Abstract

Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multidrug resistant pathogensOriginal Article INTRODUCTIONVentilator associated pneumonia (VAP) is pneumonia that occurs 48 h or more after endotracheal intubation and mechanical ventilation (MV) that was not intubating at the time of admission, also including pneumonia developing after extubation.[1] Pneumonia is the second most common intensive care unit (ICU) acquired infection and 86% of nosocomial pneumonias are VAP.[1] Around 10-20% of patients on MV for longer than 48 h, develops VAP. [2,3] Early onset VAP, which occurs during the fi rst 4 days of MV is usually less severe, associated with a better prognosis and more likely caused by antibiotic sensitive bacteria. Late onset VAP, which develops 5 or more days after initiation of MV, is caused by multidrug resistant (MDR) pathogens and associated with increased mortality and morbidity.[4] The common pathogens causing VAP include aerobic gram negative rods such as Pseudomonas aeruginosa, Acinetobacter species, Klebsiella pneumoniae, and Escherichia coli. [1,5,6] VAP due to methicillin resistant Staphylococcus aureus (MRSA) has been rapidly emerging. [5,6] Treatment of VAP is usually supportive, along with administration of proper antibiotic. The selection of proper antimicrobial agents, active against the VAP pathogens is an important determinant for reducing morbidity and Background: Ventilator associated pneumonia (VAP), a hospital acquired infection (HAI) is seen among critically ill patients on mechanical ventilation (MV) due to various causes, in intensive care units (ICUs). VAP increases morbidity, mortality, as well as the cost of healthcare. Materials and Methods: A prospective study was done over a period of 10 months in a tertiary care hospital in India to determine the incidence, etiological agents, their sensitivity profi les, and risk factors associated with VAP. Combination disc method, ethylenediaminetetraacetic acid (EDTA) disc synergy (EDS) tests, and AmpC disc tests were performed for detection of extendedspectrum beta-lactamases (ESBL), metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: One hundred and forty adult patients, on MV for 48 h and more, were included and 28 (20%) developed VAP. The incidence density rate of VAP was 21.875 per 1,000 ventilator days. Most of the patients had late onset VAP (60.7%) with average number of days for onset around 8 days. Pseudomonas spp. and Acinetobacter spp. were signifi cantly associated with late onset VAP, whereas Enterobacteriaceae, Staphylococcus aureus, Haemophilus infl uenzae, Streptococcus pneumoniae, Burkholderia cepacia, and Candida species were commonly isolated from early onset VAP. Polymicrobial infections occurred in 14 cases, so overall 43 VAP pathogens were isolated. Thirty (69.7%) of them were multidrug resistant (MDR), among which ESBL contributed 23.25%, MBL 30.23%, AmpC beta-lactamases 9.30%, and to methicillin resistant S. aureus (MRSA) c...

Characterization of Carbapenem Resistant Acinetobacter baumannii causing Ventilator associated Pneumonia in ICUs of Zagazig University Hospitals, Egypt

“…In this study, A. baumannii represented the predominant isolated organism from endotracheal aspiration samples of VAP patients (32.6%), this result was in agreement with many studies as that of Rit et al, (2014) andChawla (2008)who reported that A. baumannii was the most common pathogen in VAP in Pakistan, India, Thailand and Malaysia however, other organisms were often responsible for VAP in Korea and Taiwan Chawla (2008).The difference in incidences of isolated organisms may be due to different communities, different hospital wards and different strategies of infection control applications among countries.…”

Characteristics of Monomicrobial and Polymicrobial Ventilator Associated Pneumonia in a Tertiary Care Hospital

“…[ Figure no:3] 63.3% were males and 36.7% were females in a study by Rashmi et al [10] . Similar male preponderance was also noted in similar studies by Rit et al, and Patil et al [11,12] Age distribution of VAP cases The highest incidence was seen in the age group of 41-60 years-38.89% 61-80 years-33.33% followed by 21-40 years-16.67% and 81-100 years-11.11% [Figure no :4]. As seen in Table no:1, monomicrobial VAP was common in 41-60 years age group but polymicrobial VAP was common in 61-80 years age group.…”

A Study on Bacterial Etiology of Ventilator Associated Pneumonia and its Antimicrobial Pattern

“…18 In a similar study by Rit et al,colistin was found to be most effective antibiotic followed by piperacillin/ tazobactum combination and the imipenem. 19 Early administration of broad-spectrum antibiotics, in patients with clinical suspicion of hospital acquired pneumonia, decreases their bacterial load, minimizes potential risks and devastating consequences of delays in therapy.…”