A Prospective Study of Incidence, Outcome and Risk Factors of Ventilator-Associated Pneumonia in Tertiary Care Institution

BACKGROUND: Bacterial pneumonia developed in patients who have been mechanically ventilated for a duration of more than 48 h. VAP incidence is about 6 to 52% and can reach 76%. Hospital-acquired pneumonia (HAP) is the pneumonia after 48 h or more after admission, which did not appear to be incubating at the time of admission. The presence of VAP increases hospital stay by an average of 7–9 days per patient, also imposes an extra financial burden to the hospital. Lack of a gold standard for diagnosis-major culprit of poor outcome of VAP. METHODS: A total of 80 patients who are to be kept on mechanical ventilator are randomly selected. Selection criteria has both inclusion criteria and exclusion criteria. Inclusion criteria are .Both sexes-age >15 year son mechanical ventilator >48 h. Exclusion criteria are those died or developed pneumonia within 48 hrs. Those who are admitted with pneumonia at the time of admission. The study to be conducted over a period of 1 year from April 2018 to May 2019.Sputum-collected from the tip of the suction catheter and transported to the laboratory in a sterile tube. Patients were monitored from the date of inclusion in the study to the final outcome in the ICU. VAP was diagnosed on clinical grounds based on the modified CPIS system VAP group-classified into two group Early-onset type (within 48– 96hrs), Late-onset type (>96 h). Once the clinical suspicion was established, empirical antibiotic therapy was initiated based on guidelines prescribed by the American Thoracic Society.Patients were routinely screened by arterial blood gas (ABG) analysis every 12 hourly and appropriate steps were taken to correct any change. RESULTS: In our study, total patients around 80, out of which males 59 (73.8%), females 21 (26.3%). Alive patients at the end were 21(36%). Dead patients were around 38(64%). In our study, more death occurred in emergency intubation group (61%) alive patients are about (38%). From our study, distribution of organisms in order, Pseudomonas (36 patients) 45% MRSA (17 patients) 21.3% Aceinobacter Bauman(8 patients) 10% Polymicrobial(8 patients) 10%E.coli (6 patients) 7.5% Klebsiella (5 patients) 6.3%. CONCLUSION: The incidence of VAP is directly proportional to the duration of Mechanical ventilation. Aspiration is a foremost precipitating factor for developing VAP and diabetes mellitus carries an important risk factor in its causation. There is a high incidence of MDR organisms in patients with VAP contrasting from community acquired pneumonia. The major aims of VAP management are early, appropriate antibiotics in adequate doses followed by de-escalation based on microbiological culture results and clinical response. Pseudomonas is the most common organism isolated from in our set up. so we will use antibiotics covering these group. Age, sex, onset of VAP, involvement of organism, have a significant association with the mortality in VAP