Ventilator-associated pneumonia in a tertiary care hospital in India: incidence and risk factors

Abstract

Background: Knowledge of the incidence of ventilator-associated pneumonia (VAP) and its associated risk factors is imperative for the development and use of more effective preventive measures. Methodology: We performed a prospective study over a period of 15 months to determine the incidence and the risk factors for development of VAP in critically ill adult patients admitted in different intensive care units (ICUs) of Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), a tertiary care hospital in Pondicherry, India. Results: The incidence of VAP was 30.67 and 15.87 per 1,000 ventilator days in the two different ICUs. In our study 58.3% of the cases were late-onset VAP, while 41.7% were early-onset VAP. Univariate analysis indicated that the following were significantly associated with VAP: impaired consciousness, tracheostomy, re-intubation, emergency intubation, and nasogastric tube. Emergency intubation and intravenous sedatives were found to be the specific risk factors for early onset VAP, while tracheostomy and re-intubation were the independent predictors of late-onset VAP by multivariate logistic regression analysis. Conclusions: Knowledge of these risk factors may be useful in implementing simple and effective preventive measures including noninvasive ventilation, precaution during emergency intubation, minimizing the occurrence of reintubation, avoidance of tracheostomy as far as possible, and minimization of sedation.

Ventilator-Associated Pneumonia in a Tertiary Care Hospital

“…In the current study, 40% of cases were earlyonset VAP, which is similar to other studies reporting early-onset VAP in almost half of all VAP episodes 4,13 .Our study found that majority of the VAP episodes occurred within the first two weeks of MV. In the current study Patients with neurological disorders and CNS infections were significantly predisposed for the development of VAP which was similar to Noyalmariya Joseph et al 14 in Pondicherry. Our study found that Supine head position & impaired consciousness documented as independent risk factors for the development of VAP which was similar to other studies done by Noyalmaria et al 14 and Hinagadani et al 12 .…”

“…In the current study Patients with neurological disorders and CNS infections were significantly predisposed for the development of VAP which was similar to Noyalmariya Joseph et al 14 in Pondicherry. Our study found that Supine head position & impaired consciousness documented as independent risk factors for the development of VAP which was similar to other studies done by Noyalmaria et al 14 and Hinagadani et al 12 .…”

Bacteriological Profile of Ventilator Associated Pneumonia in a Tertiary Care Hospital of South India with Special Reference to Multi Drug Resistant Pathogens

“…Enterobacteriaceae isolated showed a high level of resistance to betalactam antibiotics and were sensitive to carbapenems. Such a high level of drug resistance has also been documented in studies conducted by Joseph et al, (2009) and Dey et al, (2007).…”

“…A study by Joseph NM et al, (2009) showed methicillin sensitive Staphylococcus aureus (MSSA) to be a major Gram positive bacteria causing VAP. In our study 2 isolates of MSSA causing early-onset VAP were isolated.…”

Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens

“…VAP is the most frequent intensive-care-unit (ICU)-acquired infection, occurring in 9 to 24% of patients intubated for longer than 48 hours [2,3].…”