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Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain: Prevalence and antibiotics
Mohamed Eliwa Hassan1, Safaa Abdulaziz Al-Khawaja2, Nermin Kamal Saeed3,4
1Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain.
Background:
Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that. It is the most common infection encountered among intubated patients. VAP incidence showed wide variability between countries.
Aim:
To define the VAP incidence in the intensive care unit (ICU) in the central government hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.
Methods:
The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020. It included adult and adolescent patients (> 14 years old) admitted to the ICU and required intubation and mechanical ventilation. VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score, which considers the clinical, laboratory, microbiological, and radiographic evidence.
Results:
The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155. Forty-six patients developed VAP during their ICU stay (29.7%). The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period, with a mean age of 52 years ± 20. Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96 ± 6.55. Gram-negative contributed to most VAP cases in our unit, with multidrug-resistant Acinetobacter being the most identified pathogen.
Conclusion:
The reported VAP rate in our ICU was relatively high compared to the international benchmark, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.
Insights
Ventilator-associated pneumonia (VAP) incidence in Bahrain
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Respiratory Medicine
Background:
- Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in intubated patients.
- VAP incidence varies significantly across different geographical regions.
- Early detection and prevention are crucial for managing VAP.
Purpose of the Study:
- To determine the incidence of VAP in a central government hospital ICU in Bahrain.
- To identify risk factors associated with VAP development.
- To characterize the prevalent bacterial pathogens and their antibiotic resistance patterns.
Main Methods:
- Prospective, cross-sectional observational study conducted over six months.
- Inclusion of adult and adolescent patients (>14 years) requiring intubation and mechanical ventilation.
- VAP diagnosis based on the clinical pulmonary infection score after 48 hours of mechanical ventilation.
Main Results:
- A VAP incidence of 29.7% was observed, with a rate of 22.14 events per 1000 ventilator days.
- The majority of VAP cases were late-onset, with a mean of 9.96 ICU days prior to diagnosis.
- Multidrug-resistant Acinetobacter was the most frequently identified pathogen, primarily Gram-negative bacteria.
Conclusions:
- The VAP rate in this Bahraini ICU is higher than international benchmarks.
- Urgent implementation of VAP prevention strategies is recommended.
- Targeted antimicrobial stewardship is necessary due to prevalent multidrug-resistant organisms.
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