Ventilator associated pneumonia: incidence and risk factors in a tertiary care hospital

Manish Rathor; Neetu Sharma

doi:10.18203/2349-3291.ijcp20190741

Authors

Manish Rathor Department of Pediatrics, G. R. M. C, Gwalior, Madhya Pradesh, India
Neetu Sharma Department of Pediatrics, G. R. M. C, Gwalior, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20190741

Keywords:

ETA, Mechanical ventilation, Outcome, VAP

Abstract

Background: The objective of this study is to find the occurrence and contributing risk factor of ventilator associated pneumonia (VAP) in 2 months-5 years age group.

Methods: This was a prospective, observational, hospital-based study carried out in a tertiary care setting hospital. All patients between 2 months-5 years age admitted in the ICU who had undergone MV were included in the study. Inclusion criteria includes patients who developed pneumonia after the 48 hours of mechanical ventilation and those patients were excluded who developed pneumonia within 48 hours of mechanical ventilation and having respiratory system findings /involvement prior to the MV. After recruiting patients baseline clinical characteristics (age, sex, diagnosis, duration of MV) were taken, monitored and diagnosed VAP using CDC guidelines until they were discharged or deceased. The parameters such as fever, oxygenation, leucocytosis, other risk factors. chest X-ray and ETA>10⁵CFU/ML or microscopy (grain stain>l bacteria/>10 polymorphonuclear cells) were collected every 48 hours.

Results: This study was done in 133 patients while 42 patients (31.58%) developed VAP during their ICU stay. Early onset VAP occurred in 34 (80.9%) while late onset VAP was observed in the remaining 8 (19.1%) patients. In ETA culture CFU>10⁵ Klebsiella (38%) was the predominant isolate followed by Pseudomonas (23%), Acinetobacter (17%), Staphylococcus (13%) and Citrobacter (10%) are offending organism responsible for VAP in MV patient in present study. On analysis (univariate) reintubation, altered sensorium at intubation and use of antacid are found significantly associated risk factors with the development of VAP. Multivariate analysis revealed that reintubation was an important risk factor for the development of the VAP.

Conclusions: The various risk factors can be minimized for better outcome of patients undergoing mechanical ventilation. Risk factors such as reintubation, altered sensorium at intubation and use of antacid are associated with VAP and also the physician treating must have knowledge and awareness about prevention of these risk factor to improve the outcome of patients.

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