Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia

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Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 3,715 words
Lexile Measure: 1410L

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Byline: Alok. Gupta, Avinash. Agrawal, Sanjay. Mehrotra, Abhishek. Singh, Shruti. Malik, Arjun. Khanna

Background: The initial empirical therapy of Ventilator Associated Pneumonia (VAP) modified based on the knowledge of local microbiological data is associated with decreased morbidity and mortality. The objective was to find the incidence and risk factors associated with VAP, the implicated pathogens and their susceptibility pattern as well as to assess the final clinical outcome in VAP. Materials and Methods: This was a prospective cohort study of 107 patients taken on ventilatory support for two or more days and those not suffering from pneumonia prior were to be taken on ventilator. The study was done over a period of one year. VAP was diagnosed using clinical pulmonary infection score of >6. The mortality, incidence of VAP, frequency of different pathogens isolated, their antibiotic sensitivity pattern, duration of mechanical ventilation and duration of hospital stay were assessed. Statistical Analysis: Univariate analysis, ?[sup]2 test and paired t-test. Results: The incidence of VAP was 28.04%. Mortality in VAP group was 46.67%, while in the non-VAP group was 27.28%. High APACHE II score was associated with a high mortality rate as well as increased incidence of VAP. The most common organisms isolated from endotracheal aspirate of patients who developed VAP were Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae and Acinetobacter baumannii. Most strains of Pseudomonas (55.56%) were resistant to commonly used beta-lactam antibiotics known to be effective against Pseudomonas. All strains of Staphylococcus aureus were MRSA and most isolates of K. pneumoniae (85.71%) were extended-spectrum beta-lactamase producing. About 50% isolates of Acinetobacter were resistant to carbapenems. Mortality was highest for infections caused by A. baumannii (83.33%) and K. pneumoniae (71.42%). Conclusions: APACHE II score can be used to stratify the risk of development of VAP and overall risk of mortality. Drug-resistant strains of various organisms are an important cause of VAP in our setting.

Introduction

Ventilator Associated Pneumonia (VAP) refers to a type of pneumonia that occurs more than 48-72 hours after endotracheal intubation, and is one of the most common nosocomial infections in patients receiving mechanical ventilation. [sup][1],[2] VAP occurs in 9-27% of all intubated patients. [sup][3],[4] Delay in initiating appropriate antibiotic therapy can increase the mortality associated with VAP, and thus therapy should not be postponed for the purpose of performing diagnostic studies. [sup][5],[6] This initial empirical therapy can be modified based on the knowledge of local microbiological data, patient characteristics, and sensitivity pattern of expected pathogens at the institution. One of the consequences of increasing antimicrobial resistance is an increased probability of inappropriate initial empiric antimicrobial treatment of infections. [sup][7] The aim of this study was to find the incidence of VAP and mortality associated with VAP at our institution. We also aimed to find the proportion of various bacterial pathogens isolated from tracheal aspirate of patients with VAP, their antibiotic sensitivity pattern and patient outcome in terms of duration of mechanical ventilation and hospital stay. This information will help us in formulating an institutional antimicrobial policy....

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Gale Document Number: GALE|A261918375