INCIDENCE AND CLINICAL EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED PNEUMONIA IN A TERTIARY CARE HOSPITAL IN CENTRAL INDIA
Main Article Content
Keywords
Ventilator-associated pneumonia, Device-associated infection, ICU, Ventilator utilization ratio, Surveillance, Infection control
Abstract
Background: Ventilator-associated pneumonia (VAP) is a major healthcare-associated infection in intensive care units (ICUs) with substantial morbidity, mortality, and financial burden. It occurs ≥48 hours after initiation of mechanical ventilation. Developing nations frequently report higher VAP incidence due to varying infection control practices.
Objectives: To determine the incidence of VAP, analyse clinical epidemiology, and evaluate VAP-related ICU metrics in a tertiary care hospital in Central India.
Materials and Methods: A prospective cross-sectional study was conducted over one year in Medicine, Surgery, and Obstetrics ICUs at a tertiary-care hospital. A total of 200 mechanically ventilated patients (>48 hours ventilation) were enrolled. Diagnosis was based on CDC-NHSN criteria. VAP incidence rate per 1000 ventilator-days and device utilization ratio (DUR) were calculated.
Results: Among 200 ventilated patients, 52 developed VAP (26%). Total ventilator-days were 2100. The calculated VAP rate was 24.8 per 1000 ventilator-days. Device utilization ratio was 0.62. Late-onset VAP accounted for 61.5% of cases. Increased VAP rates correlated with prolonged ventilation (>7 days), re-intubation, comorbidities, and higher ICU stay. Mortality among VAP patients was higher compared to non-VAP ventilated cases.
Conclusion: The high VAP incidence observed indicates a need for stronger VAP prevention and surveillance strategies, strict adherence to ventilator bundles, and responsible antimicrobial stewardship. Continuous infection control interventions with targeted staff education may significantly reduce VAP burden.
References
2. American Thoracic Society. Guidelines for HAP and VAP. Am J Respir Crit Care Med. 2005;171:388-416. doi:10.1164/rccm.200405-644ST
3. Haley RW, et al. Device-associated infections in ICU. Am J Infect Control. 1985;13:69-78. doi:10.1016/0196-6553(85)90026-4
4. Richards MJ, et al. VAP mortality impact. Crit Care Med. 1999;27:887-892. doi:10.1097/00003246-199905000-00031
5. Klompas M. Clinical challenges in VAP diagnosis. BMJ. 2007;335:496-502. doi:10.1136/bmj.39315.467361.BE
6. Torres A, et al. VAP pathogenesis. Intensive Care Med. 1992;18:353-358. doi:10.1007/BF01706122
7. Fagon JY, et al. Daily VAP risk. Am J Respir Crit Care Med. 1994;150:1375-1382. doi:10.1164/ajrccm.150.5.7952552
8. Kollef MH, et al. MDR risk in VAP. Chest. 1999;115:462-474. doi:10.1378/chest.115.2.462
9. Ibrahim EH, et al. VAP risk factors. Chest. 2001;120:198-204. doi:10.1378/chest.120.1.198
10. Kalil AC, et al. IDSA Guidelines for HAP/VAP. Clin Infect Dis. 2016;63:e61-e111. doi:10.1093/cid/ciw353.
11. Rosenthal VD, et al. INICC device-associated infection rates. Am J Infect Control. 2008;36:627-637. doi:10.1016/j.ajic.2008.03.003
12. Luna CM, et al. Antibiotic strategies in VAP. Chest. 1997;111:676-685. doi:10.1378/chest.111.3.676
13. Kollef MH. Broad-spectrum antibiotic hazards. Chest. 2003;123:552-560. doi:10.1378/chest.123.2.552
14. Iregui M, et al. Early therapy improves outcome. Chest. 2002;122:262-268. doi:10.1378/chest.122.1.262
15. Resar R, et al. VAP bundle impact. Jt Comm J Qual Patient Saf. 2005;31:243-248. doi:10.1016/S1070-3241(05)31030-8
16. CDC-NHSN Surveillance Manual. 2023.
17. WHO. Healthcare-associated infection burden. 2011.
18. WHO Global Report on Infection Prevention. 2022.
19. Allegranzi B, et al. HAI impact. Lancet. 2011;377:228-241. doi:10.1016/S0140-6736(10)61458-4
20. Pittet D. IPC program outcomes. Lancet Infect Dis. 2008;8:597-607. doi:10.1016/S1473-3099(08)70202-1
21. Chastre J, Fagon JY. HAP epidemiology. Am J Respir Crit Care Med. 2002;165:867-903. doi:10.1164/ajrccm.165.7.2105078
22. Melsen WG, et al. Mortality in VAP. Lancet Infect Dis. 2013;13:665-671. doi:10.1016/S1473-3099(13)70036-3
23. Irwin RS. Mechanical ventilation fundamentals. Chest. 2008;133:539-548. doi:10.1378/chest.07-0551
24. Koenig SM, Truwit JD. VAP burden. Nat Rev Microbiol. 2006;4:972-983. doi:10.1038/nrmicro1553
25. Koulenti D, et al. Pathogen variation in VAP. Intensive Care Med. 2009;35:1319-1327. doi:10.1007/s00134-009-1506-9
26. Conway Morris A, et al. Immune dysfunction in ICU. Thorax. 2013;68:121-127. doi:10.1136/thoraxjnl-2012-201781
27. Bassi GL, et al. Prevention strategies. Lancet Respir Med. 2017;5:919-928. doi:10.1016/S2213-2600(17)30346-5
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Anil Kumar
Research Scholar & Professor Department of Microbiology, Index Medical College Hospital & Research Centre, Indore, India
Dr. Ramanath K
Research Scholar & Professor Department of Microbiology, Index Medical College Hospital & Research Centre, Indore, India
