1Associate Professor, Department of T.B and Chest, Veer Chandra Singh Garhwal Government Medical Science & Research Institute, Srinagar, Garhwal, Uttarakhand, India
2Associate Professor, Department of Community Medicine, Veer Chandra Singh Garhwal Government Medical Science & Research Institute, Srinagar, Garhwal, Uttarakhand, India
3Professor & Head, Department of Chest & T.B, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
*Email: deependra78@gmail.com
**Email: singh120377@yahoo.co.in
***Email: skchest@gmail.com
Ventilator-associated pneumonia (VAP) refers specifically to nosocomial pneumonia that develops in patients receiving mechanical ventilation for more than 48 h after intubation, and which was neither present nor incubating at the time of intubation. It is an important cause of mortality in mechanically ventilated patients.
The study was carried out with the aim of identifying microbial aetiology and risk factors associated with VAP.
A prospective, comparative study was carried out in the medical intensive care unit (ICU) of a tertiary care hospital. We randomly selected 50 patients who were intubated for more than 48 h and had initial endotracheal tube (ETT) aspirate culture as sterile. Patients were evaluated daily for clinical and radiological suspicion of VAP and daily ETT aspirates were sent for culture and sensitivity. We assessed association between multiple risk factors, with development of VAP, using univariate statistical analysis and odds ratio.
In the present study, the diagnosis of VAP was made in 62% of the cases on the basis of clinical, radiological and bacteriological criteria. The most common microorganisms isolated from the ETT aspirate of VAP-positive patients were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter subspecies in 32.25, 22.58 and 19.35% of cases, respectively. The most common pathogen isolated in early-onset VAP was S. aureus and that in late-onset VAP was P. aeruginosa. The risk factors significantly associated with development of VAP were Chronic obstructive pulmonary diseases (COPD), prior surgery, airway instrumentation, interval between admission in hospital and ICU, re-intubation, duration of mechanical ventilation and history of aspiration.
Incidence of VAP was 62% and most common microorganism isolated from the VAP patients was P. aeruginosa, followed by S. aureus and Acinetobacter subspecies. There was significant association between different risk factors and VAP.
Ventilator-associated pneumonia, Nosocomial pneumonia, Infections, Risk factors
