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VOLUME 29 , ISSUE 4 ( April, 2025 ) > List of Articles

Original Article

Incidence, Risk Factors, Microbiology and Outcomes of VAP at an NCU in India: A Prospective Observational Study

Kapil Zirpe, Upendrakumar S Kapse, Akansha Sharma, Atul P Kulkarni, Sushma Gurav, Anand Tiwari, Chaitanya Bhujbal, Abhijeet Deshmukh, Prasad Suryawanshi, Prajakta Pote, Abhaya Bhoyar, Kaustubh Zirpe, Rupali Suryawanshi, Rahul Sharma, Piyush Dhawad, Hrishikesh Vaidya

Keywords : Incidence, Microbiology, Neurocritical care, Outcomes, Risk factors, Ventilator-associated pneumonia

Citation Information : Zirpe K, Kapse US, Sharma A, Kulkarni AP, Gurav S, Tiwari A, Bhujbal C, Deshmukh A, Suryawanshi P, Pote P, Bhoyar A, Zirpe K, Suryawanshi R, Sharma R, Dhawad P, Vaidya H. Incidence, Risk Factors, Microbiology and Outcomes of VAP at an NCU in India: A Prospective Observational Study. Indian J Crit Care Med 2025; 29 (4):308-313.

DOI: 10.5005/jp-journals-10071-24948

License: CC BY-NC 4.0

Published Online: 31-03-2025

Copyright Statement:  Copyright © 2025; The Author(s).


Abstract

Background: Ventilator-associated pneumonia (VAP) remains a major challenge while managing ventilated critically ill patients in neurocritical care units (NCUs). Materials and methods: This was a prospective, single-center, observational study. All adult patients admitted to our NCU requiring mechanical ventilation (MV) for >48 hours were screened for VAP as per clinical pulmonary infectious score (CPIS) criteria. The primary outcome was the incidence of VAP in the ICU. Secondary outcomes were risk factors, microbiology, percentage of MDR/XDR organisms, mortality, and length of stay (LOS) of VAP. Results: A total of 24.94% (114 of 457) patients developed VAP. The incidence of VAP was 39.43/1000 ventilator days. Multivariate analysis of the risk factors identified, male gender, low Glasgow coma scale (GCS) of 3–8, prolonged ventilation, and diabetes mellitus as significant risk factors for the development of VAP (p < 0.05). Acinetobacter baumannii (31.58%), Klebsiella pneumoniae (28.95%), and Pseudomonas aeruginosa (13.16%) were the most common organisms responsible for VAP. Most of these isolates were multidrug resistant (MDR) (81.58%), and extensively drug-resistant (XDR) organisms (12.28%). Although VAP patients had longer ICU-LOS (26.2 ± 24.2 vs 11.8 ± 6.9 days, p < 0.0001), it did not affect the mortality (18.4% for VAP vs 14.3% for non-VAP, p = 0.5). Conclusion: Ventilator-associated pneumonia has a high incidence of 39.43 per 1,000 ventilator days in the Indian neurocritical care setting.

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  1. Kalili A, Metersky M, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63(5):e61–e111. DOI: 10.1093/cid/ciw353
  2. Battaglini D, Parodi L, Cinotti R, Asehnoune K, Taccone FS, Orengo G, et al. Ventilator-associated pneumonia in neurocritically ill patients: Insights from the ENIO international prospective observational study. Respir Res 2023;24(1):146. DOI: 10.1186/s12931-023-02456-9.
  3. Mumtaz H, Saqib M, Khan W, Ismail SM, Sohail H, Muneeb M, et al. Ventilator associated pneumonia in intensive care unit patients: A systematic review. Ann Med Surg (Lond) 2023;85(6):2932–2939. DOI: 10.1097/MS9.0000000000000836.
  4. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: A narrative review. Intensive Care Med 2020;46(5):888–906. DOI: 10.1007/s00134-020-05980-0.
  5. Wu D, Wu C, Zhang S, Zhong Y. Risk factors of ventilator-associated pneumonia in critically III patients. Front Pharmacol 2019;10:482. DOI: 10.3389/fphar.2019.00482.
  6. Weinstein RA, Bonten MJ, Kollef MH, Hall JB. Risk Factors for ventilator-associated pneumonia: From epidemiology to patient management. Clin Infect Dis 2024;38(8):1141–1149. DOI: 10.1086/383039.
  7. Farag AM, Tawfick MM, Abozeed MY, Shaban EA, Abo-Shadi MA. Microbiological profile of ventilator-associated pneumonia among intensive care unit patients in tertiary Egyptian hospitals. J Infect Dev Ctries 2020;14(2):153–161. DOI: 10.3855/jidc.12012.
  8. Park DR. The microbiology of ventilator-associated pneumonia. Respir Care 2005;50(6):742–763; discussion 763–765.
  9. Mergulhão P, Pereira JG, Fernandes AV, Krystopchuk A, Ribeiro JM, Miranda D, et al. Epidemiology and burden of ventilator-associated pneumonia among adult intensive care unit patients: A Portuguese, multicenter, retrospective study (eVAP-PT Study). Antibiotics (Basel) 2024;13(4):290. DOI: 10.3390/antibiotics13040290.
  10. Vincent JL. Ventilator-associated pneumonia. J Hosp Infect 2004;57(4):272–280. DOI: 10.1016/j.jhin.2003.06.001.
  11. Zilberberg MD, Shorr AF. Ventilator-associated pneumonia: The clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin Infect Dis 2010;51 Suppl 1:S131–S135. DOI: 10.1086/653062.
  12. Restrepo MI, Peterson J, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care 2013;58(7):1220–1225. DOI: 10.4187/respcare.02173.
  13. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268–281. DOI: 10.1111/j.1469-0691.2011.03570.x.
  14. Li Y, Liu C, Xiao W, Song T, Wang S. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: A meta-analysis. Neurocrit Care 2020;32(1):272–285. DOI: 10.1007/s12028-019-00773-w.
  15. Ranjan N, Chaudhary U, Chaudhry D, 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.
  16. Cook DJ, Kollef MH. Risk factors for ICU-acquired pneumonia. JAMA 1998;279:1605–1606. DOI: 10.1001/jama.279.20.1605.
  17. Napolitano LM, Greco ME, Rodriguez A, Kufera JA, West RS, Scalea T M. Gender differences in adverse outcomes after blunt trauma. J Trauma 2001;50:274–280. DOI: 10.1097/00005373-200102000-00013.
  18. Magnotti LJ, Fischer PE, Zarzaur BL, Fabian TC, Croce MA. Impact of gender on outcomes after blunt injury: A definitive analysis of more than 36,000 trauma patients. J Am Coll Surg 2008;206:984–991; discussion 991–992.
  19. Sharpe JP, Magnotti LJ, Weinberg JA, Brocker JA, Schroeppel TJ, Zarzaur BL. Gender disparity in ventilator-associated pneumonia following trauma: identifying risk factors for mortality. J Trauma Acute Care Surg 2014;77:161–165. DOI: 10.1097/ta.0000000000000251.
  20. Magill SS, Li Q, Gross C, Dudeck M, Allen-Bridson K, Edwards JR. Incidence and characteristics of ventilator-associated events reported to the National Healthcare Safety Network in 2014. Crit Care Med 2016;44:2154–2162. DOI: 10.1097/ccm.0000000000001871.
  21. Li W, Cai J, Ding L, Chen Y, Wang X, Xu H. Incidence and risk factors of ventilator-associated pneumonia in the intensive care unit: A systematic review and meta-analysis. J Thorac Dis 2024;16(9):5518–5528. DOI: 10.21037/jtd-24-150.
  22. Jiménez-Trujillo I, Jiménez-García R, de Miguel-Díez J, de Miguel-Yanes JM, Hernández-Barrera V, Méndez-Bailón M, et al. Incidence, characteristic and outcomes of ventilator-associated pneumonia among type 2 diabetes patients: An observational population-based study in Spain. Eur J Intern Med 2017;40:72–78. DOI: 10.1016/j.ejim.2017.01.019.
  23. Darvishi-Khezri H, Alipour A, Emami Zeydi A, Firouzian A, Mahmudi G, Omrani-Nava M. Is type 2 diabetes mellitus in mechanically ventilated adult trauma patients potentially related to the occurrence of ventilator-associated pneumonia? J Res Med Sci. 2016;21:19. DOI: 10.4103/1735-1995.179887.
  24. Vardakas KZ, Siempos II, Falagas ME. Diabetes mellitus as a risk factor for nosocomial pneumonia and associated mortality. Diabet Med 2007;24(10):1168–1171. DOI: 10.1111/j.1464-5491.2007.02234.x.
  25. Chang L, Dong Y, Zhou P. Investigation on risk factors of ventilator-associated pneumonia in acute cerebral hemorrhage patients in intensive care unit. Can Respir J 2017:7272080. DOI: 10.1155/2017/7272080.
  26. Rello J, Quintana E, Ausina V, Puzo C, Net A, Prats G. Risk factors for Staphylococcus aureus nosocomial pneumonia in critically ill patients. Am Rev Respir Dis 1990;142:1320–1324. DOI: 10.1164/ajrccm/142.6_Pt_1.1320.
  27. Blot S, Koulenti D, Dimopoulos G, Martin C, Komnos A, Krueger WA, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med 2014;42:601–609. DOI: 10.1097/01.ccm.0000435665.07446.50.
  28. Abdelrazik OA, Salah Abdelazim M. Ventilator-associated pneumonia in adult intensive care unit prevalence and complications. Egypt J Crit Care Med 2017;5:61–63. DOI: 10.1016/j.ejccm.2017.06.001.
  29. Sangale A, Vivek B, Kelkar R, Biswas S. Microbiology of ventilator-associated pneumonia in a tertiary care cancer hospital. Indian J Crit Care Med 2021;25(4):421–428. DOI: 10.5005/jp-journals-10071-23790.
  30. Yu Z, Li X, Lv C, Tian Y, Suo J, Yan Z, et al. Epidemiological characteristics of ventilator-associated pneumonia in neurosurgery: A 10-year surveillance study in a Chinese tertiary hospital. Infect Med (Beijing) 2024;3(3):100128. DOI: 10.1016/j.imj.2024.100128.
  31. Galal YS, Youssef MR, Ibrahiem SK. Ventilator-associated pneumonia: Incidence, risk factors and outcome in paediatric intensive care units at Cairo University Hospital. J Clin Diagn Res 2016;10(6):SC06–SC11. DOI: 10.7860/JCDR/2016/18570.7920.
  32. Tejerina E, Frutos-Vivar F, Restrepo MI, Anzueto A, Abroug F, Palizas F, et al. Internacional Mechanical Ventilation Study Group. Incidence, risk factors, and outcome of ventilator-associated pneumonia. J Crit Care 2006;21(1):56–65. DOI: 10.1016/j.jcrc.2005.08.005.
  33. Robba C, Rebora P, Banzato E, Wiegers EJA, Stocchetti N, Menon DK, et al. Collaborative European NeuroTrauma effectiveness research in traumatic brain injury participants and investigators. incidence, risk factors, and effects on outcome of ventilator-associated pneumonia in patients with traumatic brain injury: analysis of a large, multicenter, prospective, observational longitudinal study. Chest 2020;158(6):2292–2303. DOI: 10.1016/j.chest.2020.06.064.
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