TO ASSESS THE RISK FACTORS AND TO IDENTIFY THE CAUSATIVE ORGANISM AND OUTCOME ASSOCIATED WITH VENTILATOR ASSOCIATED PNEUMONIA IN A TERTIARY CARE RESPIRATORY ICU
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Keywords
Klebsiella; Acinetobacter; Pseudomonas; Type 2 Diabetes Mellitus; Coronary artery disease; Ventilator associated pneumonia.
Abstract
Background: Mechanical ventilation is a crucial intervention in intensive care units (ICUs) to save lives of critically ill patients. However, Ventilator Associated Pneumonia (VAP) remains a prevalent infection among patients intubated for over 48 hours.
Aim: To assess the risk factors and to identify the causative organism and outcome associated with Ventilator associated Pneumonia.
Materials & methods: This study was conducted in a 10-bedded Respiratory Intensive Care Unit (RICU) at S.C.B Medical College and Hospital, Cuttack, Odisha, from June 2021-Oct 2022. The study included 50 patients aged over 18 years and those on mechanical ventilation for over 48 hours. Patients were monitored for VAP diagnosis and classification into Early onset pneumonia and Late onset pneumonia. The Modified Clinical Pulmonary Infection Score was used to diagnose VAP, and APACHE II scores were calculated within 24 hours of ICU admission. Endotracheal aspirate samples were collected from patients requiring mechanical ventilation for over 48 hours.
Results: Steroid therapy before intubation and emergency intubation are associated with a high incidence of VAP, with most patients undergoing reintubation. Type 2 Diabetes Mellitus and coronary artery disease are risk factors for VAP. Mortality associated with VAP is 64.5%, with total recovery in 44% of patients. Common organisms isolated were Klebsiella, Acinetobacter, Pseudomonas, Citrobacter, E. coli, Acinetobacter Klebsiella, Enterococcus, and methicillin sensitive staphylococcus aureus. Out of 19 patients, 57.9% recovered, while 35.5% were recovered in the VAP group. Mortality in early onset VAP was 57.2%, while late onset VAP had a higher mortality rate. Conclusion: The study reveals that VAP increases with mechanical ventilation duration, with late-onset cases and highly resistant strains being common. Males have higher mortality rates. Future research should guide antibiotic therapy to reduce mortality and prevent resistant strains.
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Bikram Swain
SENIOR RESIDENT, DEPARTMENT OF RESPIRATORY MEDICINE, SHRI JAGANNATH MEDICAL COLLEGE AND HOSPITAL, PURI
Gourab Nayak
ASSISTANT PROFESSOR, DEPARTMENT OF PULMONARY MEDICINE, IMS AND SUM HOSPITAL, BHUBANESWAR
Priyajit Jena
ASSISTANT PROFESSOR, DEPARTMENT OF RESPIRATORY MEDICINE, MKCG MEDICAL COLLEGE AND HOSPITAL.BERHAMPUR
Sudarsan Pothal
PROFESSOR AND HOD, DEPARTMENT OF RESPIRATORY MEDICINE, SHRI JAGANNATH MEDICAL COLLEGE AND HOSPITAL, PURI
Manoranjan Pattanaik
PROFESSOR AND HOD, DEPARTMENT OF PULMONARY MEDICINE, SCB MEDICAL COLLEGE AND HOSPITAL, CUTTACK