Introduction: Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in mechanically ventilated patients, leading to increased mortality, ICU stays, and healthcare costs. VAP is primarily caused by the aspiration of oropharyngeal organisms into the distal bronchi, either directly or via reflux from the stomach. Less common routes include hematogenous spread from remote infections or contamination from medical equipment. The incidence of VAP ranges from 6.8% to 44%, significantly impacting hospital stay length, mortality rates, and financial burden. Effective preventive strategies are crucial in managing this condition.
Methods: This study was conducted in SGRDIMSR, Vallah, Amritsar. Patients were selected from ICUs based on inclusion and exclusion criteria. Clinically suspected patients, according to CDC criteria, were scored using the Chronic Pulmonary Infection Score (CPIS), considering clinical, microbiological, and radiological signs. Variables noted for each patient included age, gender, CPIS, diagnosis at ICU admission, duration of ventilation, antibiotics received, samples submitted for confirmation of etiological agents, endotracheal aspirate, suction tip culture, type of organism recovered, susceptibility profile, and clinical outcome.
Results: Out of 362 patients, 231 (63.8%) were males and 131 (36.2%) were females, with a male-to-female ratio of 1.76:1. The most common comorbidities observed were hypertension (53.9%), type 2 diabetes mellitus (52.8%), coronary artery disease (19.06%), obstructive sleep apnea (14.08%), cerebrovascular accident (6.4%), chronic obstructive pulmonary disease (4.14%), and bronchial asthma (3.59%). Supine position was a risk factor in 99.7% of patients, with nasogastric tube use at 99.44%, and sedation at 98.1%. While 39.2% of patients had a CPIS score greater than 6, the majority (60.8%) had a CPIS score less than 6. Among the patients, 39.23% developed VAP after being intubated and mechanically ventilated for 48 hours or more. The majority of isolates obtained were gram-negative bacteria (98.44%), with only 1.56% being gram-positive. Among the 128 organisms isolated, the most common was Klebsiella Pneumoniae (41.40%), followed by Acinetobacter Baumannii (21.09%). Among the 142 patients who developed VAP, 42.25% had successful outcomes, while 57.74% did not survive. The most common clinical features of VAP included fever, crepitation, and tachypnea. The mean duration of mechanical ventilation for patients who developed VAP was 9.09 ± 2.747 days, compared to those who did not develop VAP. Patients with VAP had notably longer ICU and hospital stays compared to those without VAP.
Conclusion: This study provides a comprehensive analysis of ventilator-associated pneumonia (VAP), including its epidemiology, microbial etiology, antibiotic resistance, and patient outcomes. Key prognostic indicators such as body temperature, total leukocyte count (TLC), inotropic support, tracheal secretion characteristics, and the presence of VAP are identified. The findings underscore the importance of tailored prevention and management strategies to improve patient outcomes and advocate for ongoing surveillance and evidence-based approaches to address this challenging infection.
DOI: 10.5281/zenodo.