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VOLUME 18 , ISSUE 4 ( April, 2014 ) > List of Articles

RESEARCH ARTICLE

Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality

Uma Chaudhary, Neelima Ranjan, K. P. Ranjan

Keywords : Incidence, intensive care unit, mortality, risk factors, ventilator-associated pneumonia

Citation Information : Chaudhary U, Ranjan N, Ranjan KP. Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality. Indian J Crit Care Med 2014; 18 (4):200-204.

DOI: 10.4103/0972-5229.130570

License: CC BY-ND 3.0

Published Online: 01-03-2004

Copyright Statement:  Copyright © 2014; The Author(s).


Abstract

Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection diagnosed in the intensive care unit (ICU) and in spite of advances in diagnostic techniques and management it remains a common cause of hospital morbidity and mortality. Objective: The primary objective of the following study is to determine the incidence, various risk factors and attributable mortality associated with VAP and secondary objective is to identify the various bacterial pathogens causing VAP in the ICU. Materials and Methods: This prospective observational study was carried out over a period of 1 year. VAP was diagnosed using the clinical pulmonary infection score. Endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) samples of suspected cases of VAP were collected from ICU patients and processed as per standard protocols. Statistical Analysis: Fisher′s exact test was applied when to compare two or more set of variables were compared. Results: The incidence of VAP in our study was 57.14% and the incidence density of VAP was 31.7/1000 ventilator days. Trauma was the commonest underlying condition associated with VAP. The incidence of VAP increased as the duration of mechanical ventilation increased and there was a total agreement in bacteriology between semi-quantitative ETAs and BALs in our study. The overall mortality associated with VAP was observed to be 48.33%. Conclusions: The incidence of VAP was 57.14%. Study showed that the incidence of VAP is directly proportional to the duration of mechanical ventilation. The most common pathogens causing VAP were Acinetobacter spp. and Pseudomonas aeruginosa and were associated with a high fatality rate.


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  1. Morehead RS, Pinto SJ. Ventilator-associated pneumonia. Arch Intern Med 2000;160:1926-36.
  2. Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989;139:877-84.
  3. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 2002;122:262-8.
  4. Rodrigues DO, Cezário RC, Filho PP. Ventilator-associated pneumonia caused by multidrug-resistant Pseudomonas aeruginosa vs. other microorganisms at an adult clinical-surgical intensive care unit in a Brazilian University Hospital: Risk factors and outcomes. Int J Med Med Sci 2009;1:432-7.
  5. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.
  6. Michael S N, Donald E C. 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.
  7. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143:1121-9.
  8. Fagon JY, Chastre J, Wolff M, Gervais C, Parer-Aubas S, Stéphan F, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med 2000;132:621-30.
  9. Duguid JP. Staining methods. In: Collee JG, Fraser AG, Marimion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology: 14th ed. New York: Churchill Livingstone; 1996; p. 793-812.
  10. Collee JG, Fraser AG, Marimion BP, Simmons A. Laboratory strategy in the diagnosis of infective syndromes. In: Collee JG, Fraser AG, Marimion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology. 14 th ed. New York: Churchill Livingstone; 1996. p. 53-95.
  11. Chastre J, Fagon JY, Bornet-Lecso M, Calvat S, Dombret MC, al Khani R, et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995;152:231-40.
  12. Marquette CH, Georges H, Wallet F, Ramon P, Saulnier F, Neviere R, et al. Diagnostic efficiency of endotracheal aspirates with quantitative bacterial cultures in intubated patients with suspected pneumonia. Comparison with the protected specimen brush. Am Rev Respir Dis 1993;148:138-44.
  13. Collee JG, Miles RB, Watt B. Test for identification of bacteria. In: Collee JG, Fraser AG, Marimion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology. 14 th ed. New York: Churchill Livingstone; 1996. p. 131-49.
  14. Hugonnet S, Uçkay I, Pittet D. Staffing level: A determinant of late-onset ventilator-associated pneumonia. Crit Care 2007;11:R80.
  15. Cunnion KM, Weber DJ, Broadhead WE, Hanson LC, Pieper CF, Rutala WA. Risk factors for nosocomial pneumonia: Comparing adult critical-care populations. Am J Respir Crit Care Med 1996;153:158-62.
  16. Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433-40.
  17. Langer M, Mosconi P, Cigada M, Mandelli M. Long-term respiratory support and risk of pneumonia in critically ill patients. Intensive Care Unit Group of Infection Control. Am Rev Respir Dis 1989;140:302-5.
  18. Langer M, Cigada M, Mandelli M, Mosconi P, Tognoni G. Early onset pneumonia: A multicenter study in intensive care units. Intensive Care Med 1987;13:342-6.
  19. 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.
  20. Gupta A, Agrawal A, Mehrotra S, Singh A, Malik S, Khanna A. Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia. Indian J Crit Care Med 2011;15:96-101.
  21. Mukhopadhyay C, Bhargava A, Ayyagari A. Role of mechanical ventilation and development of multidrug resistant organisms in hospital acquired pneumonia. Indian J Med Res 2003;118:229-35.
  22. 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.
  23. Giantsou E, Liratzopoulos N, Efraimidou E, Panopoulou M, Alepopoulou E, Kartali-Ktenidou S, et al. Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria. Intensive Care Med 2005;31:1488-94.
  24. Wu CL, Yang DIe, Wang NY, Kuo HT, Chen PZ. Quantitative culture of endotracheal aspirates in the diagnosis of ventilator-associated pneumonia in patients with treatment failure. Chest 2002;122:662-8.
  25. Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986;133:792-6.
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