Incidence, determinants and outcomes of ventilator associated pneumonia in medical intensive care unit: a prospective cohort study from South Western India

Authors

  • Shivaram Rao Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
  • Nitin Bhat Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India http://orcid.org/0000-0002-5045-6546
  • Adarsha Gopadi Krishna Bhat Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • H. Manjunatha Hande Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20211429

Keywords:

Ventilator associated pneumonia, Medical ICU, India

Abstract

Background: Ventilators are being increasingly used in developing countries as a result of which complications like ventilator associated pneumonia is also increasing. Present study is being undertaken to evaluate the impact of risk factors and their changing trends for Ventilator associated pneumonia.

Methods: A prospective observational study was conducted in mechanically ventilated patients of medical intensive care unit from October 2013 to April 2015.

Results: In present study 166 patients receiving mechanical ventilation in a medical ICU were observed. Incidence of VAP in present study is 43.5 for 1000 days of mechanical ventilation. The risk factors that were significant in the study are organ failure (p=0.001), emergency intubation (p=0.001), reintubation (p=0.023) and COPD (p=0.026). The common organisms responsible for VAP were Acinetobacter (30%), Klebsiella pneumoniae (27.1%) and Pseudomonas aeruginosa (20%). The mortality was higher in VAP group (31.3%) compared to the non VAP group (15.7%).

Conclusions: There is high incidence of VAP in the developing countries. The risk factors that were found to be associated with VAP in the present study were the presence of COPD, reintubation, organ failure and emergency intubation. VAP is associated with significantly increased duration of hospital stay, morbidity and mortality.

Author Biographies

Shivaram Rao, Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India

Senior Resident,

Department of Neurology,
Nizam institute of medical sciences

Nitin Bhat, Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Assistant professor, 

Department of Medicine

Kasturba Medical Collage

Manipal Academy of Higher Education 

Adarsha Gopadi Krishna Bhat, Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Assistant professor, 

Department of Medicine

Kasturba Medical Collage

Manipal Academy of Higher Education 

H. Manjunatha Hande, Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Professor, 

Department of Medicine

Kasturba Medical Collage

Manipal Academy of Higher Education 

References

Chastre J, Fagon J-Y. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867-903.

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(5):505-12.

Weinstein RA, Bonten MJ, Kollef MH, Hall JB. Risk factors for ventilator-associated pneumonia: from epidemiology to patient management. Clin Infect Dis. 2004;38(8):1141-9.

Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184-93.

Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665-71.

Hugonnet S, Eggimann P, Borst F, Maricot P, Chevrolet J-C, Pittet D. Impact of ventilator-associated pneumonia on resource utilization and patient outcome. Infect Control. 2004;25(12):1090-6.

Society AT, America IDSo. 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.

Control CfD, CDC/NHSN protocol clarifications. Available at: https://www.cdc.gov/nhsn/pdf/ pscmanual/protocol-clarification.pdf. Accessed on 20 January 2021.

Magiorakos AP, Srinivasan A, Carey R, Carmeli Y, Falagas M, Giske C, et al. Multi drug resistant, extensively drug resistant and pan drug resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.

Rosenthal VD, Rodriguez-Calderon ME, Rodriguez-Ferrer M, Singhal T, Pawar M, Sobreyra-Oropeza M, et al. Findings of the International nosocomial infection control consortium (INICC), Part II: Impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries. Infect Control Hosp Epidemiol. 2012;33(7):704-10.

Charles MVP, Easow JM, Joseph NM, Ravishankar M, Kumar S, Umadevi S. Incidence and risk factors of ventilator associated pneumonia in a tertiary care hospital. Aus Med J. 2013;6(4):178-82.

Jenkins AB, Furler SM, Campbell LV, Gastaldelli A, Ferrannini E, Miyazaki Y, et al. Beta cell dysfunction and glucose intolerance: results from the San Antonio metabolism (SAM) study. Diabetol. 2004;47:31-9.

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(7):681-8.

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 J. 2002;122(6):2115-21.

Hadda V, Khilnani GC, Dubey G, Nallan R, Kumar G, Guleria R. Impact of ventilator associated pneumonia on outcome in patients with chronic obstructive pulmonary disease exacerbation. Lung India. 2014;31(1):4-8.

Napolitano LM. Use of severity scoring and stratification factors in clinical trials of hospital-acquired and ventilator-associated pneumonia. Clin Infect Dis. 2010;51(Supplement 1):S67-80.

Saravu K, Preethi V, Kumar R, Guddattu V, Shastry AB, Mukhopadhyay C. Determinants of ventilator associated pneumonia and its impact on prognosis: A tertiary care experience. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2013;17(6): 337-42.

Rello J, Sa-Borges M, Correa H, Leal S-R, Baraibar J. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Respir Crit Care Med. 1999;160(2):608-13.

Kant R, Dua R, Beg M, Chanda R, Gambhir I, Barnwal S. Incidence, microbiological profile and early outcomes of ventilator associated pneumonia in elderly in a Tertiary Care Hospital in India. Afr J Medi Health Sci. 2015;14(1):66.

Brooks SE, Walczak MA, Hameed R. Are we doing enough to contain Acinetobacter infections?. Infect Control. 2000;21(05):304-9.

Dizbay M, Altuncekic A, Sezer BE, Ozdemir K, Arman D. Colistin and tigecycline susceptibility among multidrug-resistant Acinetobacter baumannii isolated from ventilator-associated pneumonia. Int J Antimicrob. 2008;32(1):29-32.

Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Outcome of ventilator-associated pneumonia: Impact of antibiotic therapy and other factors. Aus Med J. 2012;5(2):135-9.

Fagon J-Y, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993;94(3):281-8.

Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol. 2008;19(1):19-21.

Downloads

Published

2021-04-28

How to Cite

Rao, S., Bhat, N., Bhat, A. G. K., & Hande, H. M. (2021). Incidence, determinants and outcomes of ventilator associated pneumonia in medical intensive care unit: a prospective cohort study from South Western India. International Journal of Research in Medical Sciences, 9(5), 1306–1312. https://doi.org/10.18203/2320-6012.ijrms20211429

Issue

Section

Original Research Articles