Open AccessA STUDY OF BACTERIAL PATTERN OF VENTILATOR ASSOCIATED PNEUMONIA AT A TERTIARY CARE CENTRE OF WESTERN INDIA
Author(s) -
Sunil Mahavar,
Madhulata Agarwal,
Radhey Shyam Chejara,
Navya Sharma,
Sudhir Bhandari
Publication year - 2021
Publication title -
global journal for research analysis
Language(s) - English
DOI - 10.36106/paripex/1507826
Subject(s) - medicine , ventilator associated pneumonia , pneumonia , incidence (geometry) , intensive care , antibiotic sensitivity , observational study , inclusion and exclusion criteria , bacterial pneumonia , mortality rate , mechanical ventilation , sepsis , population , intensive care medicine , emergency medicine , antibiotics , pathology , physics , alternative medicine , microbiology and biotechnology , environmental health , optics , biology
Background: Ventilator associated pneumonia (VAP) remains the commonest co-morbid infection in patients admittedto ICU leading to increased morbidity and mortality, despite the technological advancements in health care. Hence, astudy of the local bacterial pattern of VAP along with antibiotic sensitivity is essential to frame institutional antibiogramsto ensure appropriate empirical treatment of VAP.Aim:The present study aims to study the bacterial pattern of VAP in medical ICUs in a tertiary care center along with theantibiotic sensitivity of the isolates.Method: A descriptive, observational, cross-sectional study was conducted in combined 45 bedded, medical ICUs, atSawai Man Singh Medical College and Hospital, from March 2020 to 2021. A total of 105 cases were enrolled afterapplication of appropriate exclusion and inclusion criteria from patients on mechanical ventilation for > 48 hourswithout prior evidence of pneumonia or sepsis. Data regarding demographic and clinical features, laboratoryparameters, culture and sensitivity and outcome in terms of death or discharge were collected in a pre-structuredproforma and analyzed.Results: Out of the 105 patients evaluated in the study, 71(67.6%) were males. The mean age of the study population was45.1 years (45.1 17.57) with a range of 18-85 years. Majority were below the age of 40 years (46.7%) followed by thoseabove 60 years (26.7%). The incidence of VAP in the study was 49.5%. Most common co-morbidities underlying patientsof VAP was chronic obstructive pulmonary disease (14.3%), coronary artery disease (13.3%), and chronic kidneydisease (10.5%). Patients of VAP had a mean temperature of 101.1F (Mean ± SD; 101.1 0.99), along with leukocytosis(Mean ± SD;14399 5373), elevated serum creatinine (Mean ± SD; 1.9 5.9), alanine aminotransferase (Mean ± SD; 84.4153.7), aspartate aminotransferase (Mean ± SD; 128.7 238.4), and LDH (Mean ± SD; 861.6 690.2), and decreased serumalbumin(Mean ± SD; 3.0 0.5). The predominant isolate from endotracheal aspirate culture was Enterobacter species(17.2%), followed by Pseudomonas (15.2), Klebsiella (6.7%), Acinetobacter species (6.7%), and E. coli (4.9%). Thoseisolated from blood were Enterobacter species (17.2%), followed by Pseudomonas (6.7%), Klebsiella (6.7%),Enterococcus species (5.7%), and coagulase positive S.aureus (5.7%). The antibiotic sensitivity in the study revealedsensitivity predominantly to polymyxin (57.9%) and tigecycline (52.6%) followed by piperacillin-tazobactam (47.4%)and aztreonam (23.7%). The mortality observed in the study was 46.7%.Conclusion: The incidence of VAP in our study was 49.5% attributed to the use of microbiological definition to selectcases of VAP and to lack of adequate nursing staff. Most of the isolated organisms isolated from endotracheal aspiratewere multidrug resistant organisms sensitive to polymyxin and tigecycline. The mortality observed was also high due toprevalence of multi drug resistance and polymicrobial infection and delay in institution of appropriate antibiotics. Largemulticentric studies with large sample size are needed to study the risk factors and their relation in causation of VAP.