SPECTRUM OF VENTILATOR ASSOCIATED PNEUMONIA WITH EFFECT ON INTENSIVE CARE UNIT’S PATIENT OUTCOME

Spectrum of Ventilator Associated Pneumonia

Abstract

Objective: To evaluate the spectrum of ventilator-associated pneumonia (VAP) and relation of length of intensive care unit (ICU) stay, patient’s age and gender on the likelihood of being discharged from the ICU.
Study Design: A cross sectional study.
Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan over a period of 12 months extending, from Apr 2015 to Apr 2016.
Material and Methods: We included 470 patients out of whom only 106 patients were diagnosed with VAP while on mechanical ventilation in ICU for >48 hours. A positive culture of tracheo-bronchial secretions, with any one of these; >48-h infiltrate on chest radiograph, fever of >38.3°C, leukocytosis of >12 × 109/ml and increase in tracheo-bronchial secretions established the diagnosis of VAP.
Results: The mean age of the male and female patients was 49.8 ± 18 years and 50.6 ± 21.4 years respectively with 16.6 ± 13 days as the mean duration of ICU stay. About 30.2% VAP patients had Acinetoba cterbaumanni with 96.8% sensitivity to colistin, 27.4% patients had Klebsiella pneumonia with 72% and 62% sensitivity to colistin and carbapenems respectively and 15.1% patients had methicillin-resistant Staphylococcus aureus with 100% sensitivity to vancomycin. There was an increased incidence 60.4% of late-onset VAP compared to 39.6% early onset VAP. The overall mortality in VAP patients was 28.6%.
Conclusion: We recommend the empirical combination therapy of colistin, carbapenem, and vancomycin in VAP. No statistical significant association was found between length of ICU stay and patient’s mortality. The odds of getting discharged were found to be 3.2 times greater for male participants as opposed to female patients. Decreasing age was associated with an increased likelihood of being discharged.
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