STUDY OF CLINICAL AND MICROBIOLOGICAL PROFILE OF VENTILATOR ASSOCIATED PNEUMONIA
Abstract
Ventilator associated pneumonia (VAP) is defined as pneumonia occurring more than 48hours after endotracheal intubation/initiation of
mechanical ventilation or pneumonia developing even after extubation. VAP developed during the first 4 days of mechanical ventilation is early
onset, usually less severe mostly caused by antibiotic sensitive bacteria's and with better prognosis. Whereas late onset VAP develops 5 or more
days after the initiation of mechanical ventilation, and is due to multidrug resistant (MDR) pathogens and is usually associated with increased
morbidity and mortality. Common pathogens causing VAP includes Pseudomonas Spp. Escherichia coli, Klebsiella pneumonia and
Staphylococcus aureus with varying prevalence. Due to the increased incidence of MDR organisms in intensive care units(ICU), early and correct
diagnosis of VAP is mandatory for optimal antibiotic therapy. The present study was conducted on 50 patients with clinically suspected as VAP
admitted to critical care unit of Sir T. General hospital, Bhavnagar under medicine department during one year period. This study will helps to
detect pathogens commonly associated in causation of VAP, also to determine their antibiotic susceptibility pattern. This study will also help to
decrease the complications associated with VAP in critical care units.
SUMMARY
Ÿ Out of 198 patients, 50 patients admitted to the critical care unit of Sir T, General hospital, Bhavnagar under medicine department on
mechanical ventilation more than 48 hour were studied, of which 38 patients developed VAP.
Ÿ Detailed history, physical examination was done and patient was investigated with chest x ray, endotracheal aspirate culture and various blood
reports.
Ÿ Incidence of VAP in our study is 19%.
Ÿ 22 out of 29 males and 16 out of 21 females develops VAP in present study.
Ÿ VAP was more common in age group of 46-55 year attributable to more number of cases admissions of that age group and underlying comorbid
conditions.
Ÿ 14 (36.8%) patients had early onset VAP and 24 (63.1%) patients had late onset VAP.
Ÿ The prevalence of VAP was greater in patients with disease necessitating prolonged mechanical ventilation like poisoning, stroke, liver
disease, COPD etc.
Ÿ The most common risk factors for VAP in our study were use of antacids, aspiration and chronic lung disease.
Ÿ Most common clinical features of VAP in our study were fever, crepitation and tachypnoea.
Ÿ The most common offending organisms isolated in our patients were Klebsiella (31.6%), Escherichia coli (23.7%) and Pseudomonas (18.4%).
Ÿ Most of the organisms showed resistance to commonly used antibiotics like Cephalosporins and Penicillins. They were sensitives to broad
spectrum antibiotics like Meropenem (84.2%), Gentamycin (76.3%) and Amikacin (71%).
Ÿ The outcome of VAP patients was good after the change of antibiotics based on culture sensitivity report.
Ÿ Most of the patients with VAP had poor clinical outcome when compared to non VAP patients.
Ÿ 71.4 % patients with early onset VAP showed recovery but 28.6 % patients expired. 58.3 % patients with late onset VAP showed recovery and
41.6 % expired.
Ÿ Overall 63.2 % patients of VAP were recovered. 36.8 % patients of VAP were expired.
Ÿ Preventive strategies should be followed in critical care units to decrease the prevalence of VAP.
Full Text:
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