Incidence, bacteriology, and clinical outcome of ventilator-associated pneumonia at tertiary care hospital

Harsha V Patil, Virendra C Patil, Harsha V Patil, Virendra C Patil

Abstract

Background: Ventilator-associated pneumonia (VAP) is the most frequent Intensive Care Unit acquired infection.

Aims: The aim is to determine the incidence, bacteriology and factors affecting VAP and to determine the multi-drug resistant (MDR) pathogens.

Settings and design: This was a prospective observational study conducted over a period of 1 year from April 1, 2011, to March 31, 2012.

Materials and methods: The patients fulfilling criteria of VAP were included in this study.

Statistical analysis: This was performed using SPSS trial version 11.0 software (SPSS Inc., Chicago, Illinois, USA) and the values of P < 0.05 were considered statistically significant.

Results: Totally 74 (27.71%) patients were developed VAP. Of total 74 patients with VAP 53 (71.62%) were females and 21 (28.37%) were females (P < 0.0001). Total 13 (17.56%) patients had early-onset VAP and 61 (82.43%) had late-onset VAP (P < 0.0001). The overall incidence of VAP rate per 1000 ventilator days was 39.59. Total 126 bacterial isolates found in 74 patients with VAP. Predominant isolates were Gram-negative 52 (70.27%). Total 41 (55.40%) patients had polymicrobial VAP, and 33 (44.59%) had single isolate. Total 55 (43.65%) isolates were MDR organisms. Total 22 patients with VAP succumbed during treatment with overall case fatality rate of 29.72%. Of total 55 MDR isolates in VAP, 13 (26.63%) were Klebsiella spp., 11(20%) Pseudomonas aeruginosa, 14 (25.45%) Acinetobacter, 8 (14.54%) Escherichia coli, and 9 (16.36%) coagulase positive Staphylococcus aureus. Total 12 (21.41%) patients succumbed among MDR isolates.

Conclusions: There was a high incidence of MDR pathogens in late-onset VAP. The Gram-negative organisms Klebsiella, PseudomonasE. coli and Acinetobacter were the most commonly isolated organisms with high mortality rates.

Keywords: Bacteriology; Intensive Care Unit; multi-drug resistant organisms; poly-microbial; ventilator-associated pneumonia.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Chest radiogram of patient with ventilator associated pneumonia
Figure 2
Figure 2
Culture growth of endotracheal aspirate. MacConkey Agar (Escherichia coli), MacConkey Agar Pseudomonas aeruginosa, Nutrient Agar (Staphylococcus aureus), blood Ager (Staphylococcus aureus), blood Ager (Klebsiella spp.)
Graph 1
Graph 1
Bacteriological profile of ventilator associated pneumonia isolates
Graph 2
Graph 2
Culture sensitivity and antibiotic suceptibility pattern of important ventilator associated pneumonia isolates

References

    1. Torres A, Ferrer M, Badia JR. Treatment guidelines and outcomes of hospital-acquired and ventilator-associated pneumonia. Clin Infect Dis. 2010;51(Suppl 1):S48–53.
    1. Niederman MS, Craven DE. 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.
    1. Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: Incidence and risk factors. J Infect Dev Ctries. 2009;3:771–7.
    1. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867–903.
    1. Fartoukh M, Maitre B, Honoré S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: The clinical pulmonary infection score revisited. Am J Respir Crit Care Med. 2003;168:173–9.
    1. Porzecanski I, Bowton DL. Diagnosis and treatment of ventilator-associated pneumonia. Chest. 2006;130:597–604.
    1. Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A. Laboratory strategy in diagnosis of infective syndromes. In: Collee JG, Fraser AG, Marmion BP, Simmons AC, editors. Mackie and McCartney Practical Medical Microbiology. 14th ed. New York: Churchill Livingstone; 1996. pp. 53–94.
    1. Clinical and Laboratory Standards Institute (CLSI) 17th Informational Supplement M100-S22. Vol. 32. Wayne, Pennsylvania, USA: Clinical and Laboratory Standards Institute; 2012. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard – Eleventh Edition. CLSI Document M02-A11.
    1. 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.
    1. 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.
    1. Pawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N. Ventilator-associated pneumonia: Incidence, risk factors, outcome, and microbiology. J Cardiothorac Vasc Anesth. 2003;17:22–8.
    1. Joseph NM, Sistla S, Dutta TK, Badhe AD, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: Incidence and risk factors. Eur J Inter Med. 2010;21:360–8.
    1. Combes A, Luyt CE, Fagon JY, Wolff M, Trouillet JL, Chastre J. Early predictors for infection recurrence and death in patients with ventilator-associated pneumonia. Crit Care Med. 2007;35:146–54.
    1. Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries. Am J Infect Control. 2008;36(4 Suppl):S93–100.
    1. 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.
    1. Chung DR, Song JH, Kim SH, Thamlikitkul V, Huang SG, Wang H, et al. High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. Am J Respir Crit Care Med. 2011;184:1409–17.
    1. Rello J, Ulldemolins M, Lisboa T, Koulenti D, Mañez R, Martin-Loeches I, et al. Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia. Eur Respir J. 2011;37:1332–9.
    1. Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries: A systematic review. Int J Infect Dis. 2008;12:505–12.
    1. Werarak P, Kiratisin P, Thamlikitkul V. Hospital-acquired pneumonia and ventilator-associated pneumonia in adults at Siriraj Hospital: Etiology, clinical outcomes, and impact of antimicrobial resistance. J Med Assoc Thai. 2010;93(Suppl 1):S126–38.
    1. 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.
    1. Werarak P, Waiwarawut J, Tharavichitkul P, Pothirat C, Rungruanghiranya S, Geater SL, et al. Acinetobacter baumannii nosocomial pneumonia in tertiary care hospitals in Thailand. J Med Assoc Thai. 2012;95(Suppl 2):S23–33.
    1. Panwar R, Vidya SN, Alka KD. Incidence, clinical outcome and risk stratification of ventilator-associated pneumonia: A prospective cohort study. Indian J Crit Care Med. 2005;9:211–6.
    1. Park DR. The microbiology of ventilator-associated pneumonia. Respir Care. 2005;50:742–63.
    1. Chittawatanarat K, Jaipakdee W, Chotirosniramit N, Chandacham K, Jirapongcharoenlap T. Microbiology, resistance patterns, and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit. Infect Drug Resist. 2014;7:203–10.
    1. Walkey AJ, Reardon CC, Sulis CA, Nace RN, Joyce-Brady M. Epidemiology of ventilator-associated pneumonia in a long-term acute care hospital. Infect Control Hosp Epidemiol. 2009;30:319–24.
    1. Ranjit S, Bhattarai B. Incidence and risk factor for ventilator-associated pneumonia in Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ) 2011;9:28–31.
    1. 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.
    1. Rit K, Chakraborty B, Saha R, Majumder U. Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multidrug resistant pathogens. Int J Med Public Health. 2014;4:51–6.
    1. George P, Sequiera A. Antimicrobial sensitivity pattern among organisms which were isolated from the endotracheal aspirates of patients with ventilator associated pneumonia. J Clin Diagn Res. 2010;4:3397–401.
    1. Moreira MR, Gontijo Filho PP. Multidrug-resistant pathogens causing ventilator associated pneumonia: Risk factors, empirical antimicrobial therapy and outcome of patients in an intensive care unit (ICU) of a Brazilian university hospital. Int J Med Med Sci. 2012;4:204–10.
    1. 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;18:200–4.
    1. Depuydt PO, Vandijck DM, Bekaert MA, Decruyenaere JM, Blot SI, Vogelaers DP, et al. Determinants and impact of multidrug antibiotic resistance in pathogens causing ventilator-associated-pneumonia. Crit Care. 2008;12:R142.
    1. Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Management and prevention of ventilator-associated pneumonia caused by multidrug-resistant pathogens. Expert Rev Respir Med. 2012;6:533–55.

Source: PubMed

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