DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161251

Incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center of northern India

Sanjay Melville Masih, Shewtank Goel, Abhishek Singh, Rakesh Tank, Sanjeev Kumar Khichi, Sudhir Singh

Abstract


Background: The incidence of VAP varies among different studies, depending on the definition, the type of hospital or ICU, the population studied, and the level of antibiotic exposure. This study was planned to ascertain and analyse the incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center.

Methods: In this retrospective study, all the adult patients on mechanical ventilation (MV) for more than 48 hours in the Medicine Intensive Care Unit (MICU) and the Critical Care Unit (CCU) during September 2015 to February 2016 were included in the current study. Patients diagnosed with pneumonia prior to MV or within 48 hours of MV were excluded from the study. Patients’ records served as study tools. Medical records department (MRD) was approached and data was collected on all patients who received mechanical ventilation during the study period. The relevant data were recorded from medical records, bedside flow sheets, radiographic reports, and reports of microbiological studies of the patients. The chi-square (χ²) test or Fisher’s exact test was used to compare different groups. Univariate and multivariate logistic regression analysis was performed to identify risk factors associated with development of ventilator-associated pneumonia.

Results: Overall incidence of VAP was 23.54 per 1,000 ventilator days. The incidence of VAP in MICU and CCU were 31.77 and 16.47 per 1,000 ventilator days respectively. 60% of the cases were late-onset VAP, while 40% were early-onset VAP. The most common organism isolated was Pseudomonas aeruginosa followed by Methicillin-resistant Staphylococcus aureus (MRSA). Impaired consciousness, tracheostomy, re-intubation, emergency intubation, and nasogastric tube were significantly associated with VAP. On multivariate analysis, impaired consciousness, emergency intubation and tracheostomy were independent risk factor for VAP among study subjects.  

Conclusions: Data thus generated can be used to plan and modulate the potential intervention measures while managing VAP. Knowledge of the important risk factors predisposing to VAP may prove to be useful in implementing effective preventive measures.

 


Keywords


Incidence, Risk factors, Ventilator-associated pneumonia, ICU

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References


Davis KA. Ventilator-associated pneumonia: a review. J Intensive Care Med. 2006;21:211-26.

Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867-903.

Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Healthcare infection control practices advisory committee, centers for disease control and prevention. Guidelines for preventing health-care- associated pneumonia, 2003: Recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53:1-36.

Rello J, Ollendorf DA, Oster G, Montserrat V, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122:2121.

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.

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.

Kollef MH. Ventilator-associated pneumonia. A multivariate analysis. JAMA. 1993;270:1965-70.

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.

Porzecanski I, Bowton DL. Diagnosis and treatment of ventilator-associated pneumonia. Chest. 2006;130:597-604.

Mackie TJ, McCartney JE. Practical medical microbiology, 14th edition. New York: Churchill Livingstone; 1996: 978.

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.

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.

Thongpiyapoom S, Narong MN, Suwalak N, Jamulitrat S, Intaraksa P, Boonrat J, Kasatpibal N, Unahalekhaka A. Device-associated infections and patterns of antimicrobial resistance in a medical-surgical intensive care unit in a university hospital in Thailand. J Med Assoc Thai. 2004;87:819-24.

Suka M, Yoshida K, Uno H, Takezawa J. Incidence and outcomes of ventilator-associated pneumonia in Japanese intensive care units: the Japanese nosocomial infection surveillance system. Infect Control Hosp Epidemiol. 2007;28:307-13.

Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece. Respir Care. 2003;48:681-8.

Hunter JD. Ventilator associated pneumonia. Postgrad Med J. 2006;82:172-8.