Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 17 , ISSUE 6 ( December, 2013 ) > List of Articles

RESEARCH ARTICLE

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

V. Preethi, Rishikesh Kumar, Vasudev Guddattu, Ananthakrishna Shastry, Chiranjay Mukhopadhyay

Keywords : Hospital acquired pneumonia, India, multidrug resistant organism, ventilator associated pneumonia

Citation Information : Preethi V, Kumar R, Guddattu V, Shastry A, Mukhopadhyay C. Determinants of ventilator associated pneumonia and its impact on prognosis: A tertiary care experience. Indian J Crit Care Med 2013; 17 (6):337-342.

DOI: 10.4103/0972-5229.123435

License: CC BY-ND 3.0

Published Online: 01-12-2013

Copyright Statement:  Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.


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.


PDF Share
  1. Coppadoro A, Bittner E, Berra L. Novel preventive strategies for ventilator-associated pneumonia. Crit Care 2012;16:210.
  2. Rakshit P, Nagar VS, Deshpande AK. Incidence, clinical outcome, and risk stratification of ventilator-associated pneumonia: A prospective cohort study. Indian J Crit Care Med 2005;9:211-6.
  3. Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: Role of multi-drug resistant pathogens. J Infect Dev Ctries 2010;4:218-25.
  4. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.
  5. Hunter JD. Ventilator associated pneumonia. Postgrad Med J 2006;82:172-8.
  6. Morehead RS, Pinto SJ. Ventilator-associated pneumonia. Arch Intern Med 2000;160:1926-36.
  7. Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: A nine months′ prospective study. Ann Thorac Med 2007;2:52-7.
  8. Ahmed S, Choudhary J, Ahmed M, Arora V, Ali S. Treatment of ventilator-associated pneumonia with piperacillin-tazobactum and amikacin vs. cefepime and levofloxacin: A randomized prospective study. Indian J Crit Care Med 2007;11:117-21.
  9. Lu Q, Luo R, Bodin L, Yang J, Zahr N, Aubry A, et al. Efficacy of high-dose nebulized colistin in ventilator-associated pneumonia caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Anesthesiology 2012;117:1335-47.
  10. Türkoðlu MA, Iskit AT. Ventilator-associated pneumonia caused by high risk microorganisms: A matched case-control study. Tuberk Toraks 2008;56:139-49.
  11. Noor A, Hussain SF. Risk factors associated with development of ventilator associated pneumonia. J Coll Physicians Surg Pak 2005;15:92-5.
  12. Gadani H, Vyas A, Kar AK. A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesth 2010;54:535-40.
  13. Craven DE. Epidemiology of ventilator-associated pneumonia. Chest 2000;117:186S-7S.
  14. Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115-21.
  15. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.
  16. Agbaht K, Diaz E, Muñoz E, Lisboa T, Gomez F, Depuydt PO, et al. Bacteremia in patients with ventilator-associated pneumonia is associated with increased mortality: A study comparing bacteremic vs. nonbacteremic ventilator-associated pneumonia. Crit Care Med 2007;35:2064-70.
  17. Papazian L, Bregeon F, Thirion X, Gregoire R, Saux P, Denis JP, et al. Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:91-7.
  18. Kofteridis DP, Alexopoulou C, Valachis A, Maraki S, Dimopoulou D, Georgopoulos D, et al. Aerosolized plus intravenous colistin versus intravenous colistin alone for the treatment of ventilator-associated pneumonia: A matched case-control study. Clin Infect Dis 2010;51:1238-44.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.