A Study on risk factors and Microbial profile of Ventilator associated Pneumonia in Intensive care units of a Tertiary care centre

  • Sanmath K Shetty Department of Internal medicine, KMC Mangalore, India.
  • Kiran VH Department of Internal medicine, KMC Mangalore, India.
  • Raghavendra V Bhat Department of Internal medicine, KMC Mangalore, India.
  • Alam Nawaz Department of Internal medicine, KMC Mangalore, India.
Keywords: Ventilator associated pneumonia, ICU, Pnemonia

Abstract

Background: Ventilator associated pneumonia is a major cause of in hospital mortality and morbidity in our ICUs and it has received more importance with the advent of drug resistance. The knowledge of local antibiotic susceptibility patterns would guide the physician in the early empirical treatment of VAP. Our aim was to know the risk factors and microbial profile of Ventilator Associated Pneumonia patients.

Methodology: We randomly studied 120 patients on ventilator in the 3 ICUs of KMC, Mangalore. VAP was diagnosed according to the case definition of VAP. The risk factors were analyzed and microbiological profile of patients who developed VAP was studied.

Results: OF the 120 patients, 59 developed VAP. Prolonged ventilation and reintubation were the risk factors most significantly associated with the development of VAP. Gram negative organisms (acinetobacter, pseudomonas, klebsiella) were the most commonly isolated organisms from specimens of VAP cases and there was high prevalence of multidrug resistance. Carbapenem resistant Acinetobacter baumanii was an important pathogen in the ICU of University Medical Centre Mangalore. Vancomycin was sensitive against most gram positive isolates whereas amikacin and cefaperazone sulbactum was showing acceptable sensitivity to gram negative isolates except for Acinetobacter species. Colistin may be useful as a rescue antibiotic in carbapenem resistant Acinetobacter VAP.

Conclusion: Incidence of VAP is directly proportional to duration of mechanical ventilation and Reintubation is a strong risk factor for development of VAP. Therefore, administering a proper weaning protocol and titrating sedation regimens as per the need of the patients is of utmost importance.

Downloads

Download data is not yet available.

References

1. 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 Feb 15;171(4):388-416.

2. Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbiol Rev. 2006 Oct;19(4):637-57.

3. Ulldemolins et al. Appropriateness is Critical. Crit Care Clin 2011Jan;27(1):35–51.

4. Davis KA. Ventilator-associated pneumonia: a review. J Intensive Care Med. 2006 Jul-Aug;21(4):211-26.

5. Morehead RS, Pinto SJ. Ventilator-associated pneumonia. Arch Intern Med. 2000 Jul 10;160(13):1926-36.

6. Arindam Dey, Indira Bairy. Incidence of multidrugresistant organisms causing Ventilator associated pneumonia in a tertiary care hospital: A nine months’ prospective study. Ann Thorac Med 2007 AprJun;2(2):52-7.

7. Jakribettu RP, Boloor R. Characterisation of aerobic bacteria isolated from Endotracheal aspirate in adult patients with suspected ventilator associated pneumonia in a tertiary care centre in Mangalore. Saudi J Anaesth 2012 Apr; 6(2):115-9.

8. Torres A, Gatell JM, Aznar E, el-Ebiary M, Puig de la Bellacasa J, Gonzalez J, et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J RespirCrit Care Med 1995 Jul; 152(1):137–41.

9. Hina g, arun vyas, akshay k kar. A study of ventilatorassociated pneumonia: incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesth. 2010 Nov-Dec; 54(6):535-40.

10. Vasudev G, Chiranjay Mukhopadhyay, Kavitha S, PreethI V, Rishikesh K,Anathakrishna B ShastrY. Determinants of Ventilator Associated Pneumonia and its
impact on prognosis: A tertiary care experience.Indian J Crit Care Med. 2013 Nov-Dec;17(6)337-42.

11. Joseph NM, Sistla S, Dutta T K, Badhe A S, Rasitha D, Parija S C.Ventilator-Associated Pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens. J Infect Dev Ctries 2010;4(4):218-225.
Published
2015-06-30
How to Cite
Sanmath K Shetty, Kiran VH, Raghavendra V Bhat, & Alam Nawaz. (2015). A Study on risk factors and Microbial profile of Ventilator associated Pneumonia in Intensive care units of a Tertiary care centre. Biomedical Review: Journal of Basic and Applied Medical Sciences (JBAMS), 2(2), 23-29. Retrieved from https://biomedical.medresearch.in/index.php/jbams/article/view/11
Section
Original Article