• Logo
  • SBMUJournals

Ventilator-Associated Pneumonia and Its Responsible Germs; an Epidemiological Study

Rama Bozorgmehr, Vanousheh Bahrani, Alireza Fatemi
PDF

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common hospital infections and a side effect of lengthy stay in intensive care unit (ICU). Considering the ever-changing pattern of common pathogens in infectious diseases and the raise in prevalence of hospital infections, the present study was designed aiming to determine the prevalence of VAP and its bacterial causes. Methods: In this cross-sectional study, the medical profiles of all the patients under mechanical ventilation, who had no symptoms of pneumonia at the time of intubation and developed new infiltration in chest radiography after 48 hours under mechanical ventilation along with at least 2 of the symptoms including fever, hypothermia, leukocytosis, leukopenia, or purulent discharge from the lungs, were evaluated. Demographic data, clinical and laboratory findings, and final outcome of the patients were extracted from the patient’s clinical profile and reported using SPSS version 20 and descriptive statistics.Results: 518 patients with the mean age of 62.3 ± 20.8 years were evaluated (50.9% female). Mean time interval between intubation and showing symptoms was 10.89 ± 12.27 days. Purulent discharges (100%), leukocytosis (71.9%), fever (49.1%), hypothermia (12.3%), and leukopenia (8.8%) were the most common clinical and laboratory symptoms and acinetobacter baumannii (31.58%) and klebsiella pneumoniae (29.82%) were the most common germs growing in sputum cultures. 19 (33.3%) cases of pan drug resistance (PDR) and 10 (17.5%) cases of extensive drug resistance (XDR) were seen. Mortality due to VAP was 78.9% and there was no significant correlation between age (p = 0.841), sex (p = 0.473), ICU admission (p = 0.777), duration of hospitalization (p = 0.254), leukocytosis (p = 0.790), leukopenia (p = 0.952), fever (p = 0.171), hypothermia (p = 0.639), type of culture (p = 0.282), and type of antibiotic resistance (p = 0.066) with mortality. Conclusion: Prevalence of VAP and its associated mortality were 11% and 78.9%, respectively. The most common symptoms and signs were purulent discharge, leukocytosis, and fever. Acinetobacter baumannii and klebsiella pneumoniae were the most common germs in sputum cultures with 50% resistance to commonly used antibiotics.


Keywords

Pneumonia, ventilator-associated; cross infection; drug resistance, microbial; intensive care units

References

Nseir S, Zerimech F, Fournier C, Lubret R, Ramon P, Durocher A, et al. Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients. American journal of respiratory and critical care medicine. 2011;184(9):1041-7.

Chastre J, Fagon J-Y. Ventilator-associated pneumonia. American journal of respiratory and critical care medicine. 2002;165(7):867-903.

Vallés J, Mesalles E, Mariscal D, del Mar Fernández M, Peña R, Jiménez JL, et al. A 7-year study of severe hospital-acquired pneumonia requiring ICU admission. Intensive care medicine. 2003;29(11):1981-8.

Sopena N, Sabrià M. Multicenter study of hospital-acquired pneumonia in non-ICU patients. Chest Journal. 2005;127(1):213-9.

Vincent J-L, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. Jama. 2009;302(21):2323-9.

Gupta A, Agrawal A, Mehrotra S, Singh A, Malik S, Khanna A. Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia. Indian Journal of Critical Care Medicine. 2011;15(2):96.

Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. Jama. 2009;301(20):2120-8.

Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Critical care medicine. 2005;33(10):2184-93.

Nomellini V, Chen H. Murray and Nadel’s Textbook of Respiratory Medicine. Academic Press; 2012.

Doré P, Robert R, Grollier G, Rouffineau J, Lanquetot H, Charrière J-M, et al. Incidence of anaerobes in ventilator-associated pneumonia with use of a protected specimen brush. American journal of respiratory and critical care medicine. 1996;153(4):1292-8.

Resende MM, Monteiro SG, Callegari B, Figueiredo PM, Monteiro CR, Monteiro-Neto V. Epidemiology and outcomes of ventilator-associated pneumonia in northern Brazil: an analytical descriptive prospective cohort study. BMC infectious diseases. 2013;13(1):1.

Japoni A, Vazin A, Davarpanah MA, Ardakani MA, Alborzi A, Japoni S, et al. Ventilator-associated pneumonia in Iranian intensive care units. The Journal of Infection in Developing Countries. 2011;5(04):286-93.

Hamishekar H, Shadvar K, Taghizadeh M, Golzari SE, Mojtahedzadeh M, Soleimanpour H, et al. Ventilator-Associated Pneumonia in Patients Admitted to Intensive Care Units, Using Open or Closed Endotracheal Suctioning. Anesthesiology and pain medicine. 2014;4(5).

Afhami S, Hadadi A, Khorami E, Seifi A, Bazaz NE. Ventilator-associated pneumonia in a teaching hospital in Tehran and use of the Iranian Nosocomial Infections Surveillance Software. Eastern Mediterranean Health Journal. 2013;19(10):883.

Bennett JE, Dolin R, Blaser MJ. Principles and practice of infectious diseases: Elsevier Health Sciences; 2014.

Nadi E, Nekoie B, Mobaien A, Moghimbeigi A, Nekoie A. Evaluation of the Etiology of Nosocomial Pneumonia in the ICUs of the Teaching Hospitals of Hamadan University of Medical Sciences. Scientific Journal of Hamadan University of Medical Sciences. 2011;18(1):26-32.

Carlson KK, Louis S. Advanced critical care nursing. St Louis. 2009.

Sabery M, Shiri H, Moradiance v, Taghadosi M, Gilasi HR, Khamechian M. The frequency and risk factors for early-onset ventilator-associated pneumonia in intensive care units of Kashan Shahid-Beheshti hospital during 2009-2010. KAUMS Journal ( FEYZ ). 2013;16(6):560-9.

Chung DR, Song J-H, Kim SH, Thamlikitkul V, Huang S-G, Wang H, et al. High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. American journal of respiratory and critical care medicine. 2011;184(12):1409-17.

Klompas M, Kleinman K, Khan Y, Evans RS, Lloyd JF, Stevenson K, et al. Rapid and reproducible surveillance for ventilator-associated pneumonia. Clinical infectious diseases. 2012;54(3):370-7.

Zarinfar N, Sharafkhah M, Bayat B, sgharFarazi A, MasoomehSoofian. Epidemiological Factors of Ventilator-Associated Pneumonia (VAP)

among ICU patients in Valiasr Hospital of Arak. 2012. Iranian Journal of Infectious Diseases and Tropical Medicine. 2014;19(64).

Nateghian A, Omrani A, Alipour Z, Haerinejad M. Causes of ventilator associated pneumonia in pediatrics ICU. Iranian South Medical Journal. 2016;19(1):98-105.




DOI: http://dx.doi.org/10.22037/emergency.v5i1.14521

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.