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Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units!
Ashu Sara Mathai1, Atul Phillips1, Rajesh Isaac1
1Department of Anesthesiology, Christian Medical College, Ludhiana, Punjab, India.
Background:
Ventilator-associated pneumonia (VAP) is the most common nosocomial infection acquired by patients in the Intensive Care Unit (ICU). However, there are scarce clinical data, particularly from Indian ICUs on the occurrence of this infection.
Aims:
To collect data on the incidence, microbiological profile, and outcomes of patients with VAP.
Settings And Design:
Tertiary level, medical-surgical ICU; prospective, observational study.
Subjects And Methods:
All patients who were mechanically ventilated for >48 h in the ICU during the study were enrolled. VAP was diagnosed according to the Centre for Disease Control (CDC) criteria.
Results:
A total of 95 (38%) patients developed VAP infections, an incidence of 40.1 VAP infections/1000 mechanical ventilation days. These were predominantly caused by Gram-negative organisms, especially the Acinetobacter species (58 isolates, 53.2%). Many of the VAP-causing isolates (27.3%) demonstrated multidrug resistance. Patients with VAP infections experienced a significantly longer ICU stay (13 days [Interquartile Range (IQ) range = 10-21] vs. 6 days [IQ = 4-8], P < 0.0001) and total hospital stay (21 days [IQ = 14-33] vs. 11 days [IQ = 6-18], P < 0.0001). While the overall mortality rates were similar between patients with or without VAP infections, (68.4% vs. 61.3%, P = 0.200), on subgroup analysis, elderly patients (>60 years) and those with higher Acute Physiology and Chronic Health Evaluation II scores at admission had significantly greater mortality rates if they acquired a VAP infection (P = 0.010).
Conclusions:
VAP continues to be a major threat to patients who are admitted for mechanical ventilation into the critical care unit, emphasizing the urgent need for infection control measures.
Insights
Ventilator-associated pneumonia (VAP) is a common ICU infection, predominantly caused by multidrug-resistant Gram-negative bacteria in India. VAP significantly increases patient length of stay and mortality, especially in elderly patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Hospital Epidemiology
Background:
- Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in Intensive Care Units (ICUs).
- Limited clinical data exist regarding VAP incidence and characteristics in Indian ICUs.
Purpose of the Study:
- To determine the incidence and microbiological profile of VAP.
- To evaluate the outcomes of VAP in critically ill patients.
Main Methods:
- A prospective, observational study was conducted in a tertiary medical-surgical ICU.
- Patients mechanically ventilated for over 48 hours were enrolled and diagnosed with VAP using CDC criteria.
Main Results:
- The incidence of VAP was 40.1 per 1000 mechanical ventilation days, with 95 patients (38%) developing VAP.
- Acinetobacter species were the predominant pathogens (53.2%), with 27.3% of isolates showing multidrug resistance.
- VAP significantly prolonged ICU and hospital stays (P < 0.0001).
- While overall mortality was similar, elderly patients and those with higher APACHE II scores had increased mortality with VAP (P = 0.010).
Conclusions:
- VAP remains a significant threat in critical care settings, necessitating robust infection control strategies.
- The high incidence of multidrug-resistant organisms highlights the need for targeted antimicrobial stewardship.
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