Microbial profile of early and late onset ventilator associated pneumonia in the intensive care unit of a tertiary care hospital in bangalore, India

Abstract

Introduction: Ventilator-associated pneumonia (VAP), an important form of hospital-acquired pneumonia (HAP), specifically refers to pneumonia developing in a patient on mechanical ventilator for more than 48 h after intubation or tracheostomy. Despite the advancements in antimicrobial regimes, VAP continues to be an important cause of morbidity and mortality. VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, as there is adverse effect of inadequate antibiotic treatment on patients' prognosis and the emergence of multidrug-resistant (MDR) pathogens.

Aims: The present study was undertaken to assess the etiological agents of early-onset and late-onset VAP and to know their sensitivity pattern.

Material and methods: VAP data over a period of 12 months (February 2012 -February 2013) in a tertiary care ICU was retrospectively analysed. The patients were stratified by age, sex, duration of VAP (Early/Late onset) and the identified pathogens with their sensitivity pattern.

Results: Incidence of VAP was found to be 35.14%, out of which 44.23% had early-onset (<4 days MV) VAP and 55.77% had late-onset (>4 days MV) VAP. The most common organisms isolated in early onset and late onset VAP was Pseudomonas aeruginosa, E.coli and Acinetobacter baumanii. All enterobacteriaceal isolates were extended spectrum beta lactamase (ESBL) producing organisms and all Staphylococcus aureus isolates except one were methicillin resistant. The incidence of Multidrug resistant (MDR) Pseudomonas aeruginosa and Acinetobacter were 40% and 37.5% respectively.

Conclusion: Due to the increasing incidence of multidrug-resistant organisms in our ICU, early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment and cure. Hence, knowing the local microbial flora causing VAP and effective infection control practices are essential to improve clinical outcomes.

Keywords: Hospital-acquired pneumonia; Intensive care unit; Multidrug resistant pathogens; Ventilator associated pneumonia.

[Table/Fig-2b]:

Age-wise distribution of VAP cases (Graphicalrepresentation)

[Table/Fig-3b]:

Gender distribution of VAP cases (Pie-chart)

[Table/Fig-4b]:

Distribution of early and late onset VAP cases(Pie-chart)

[Table/Fig-5b]:

Organisms isolated from early and late onset VAP cases(Graphical representation)