Incidence, bacteriology, and clinical outcome of ventilator-associated pneumonia at tertiary care hospital

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most frequent Intensive Care Unit acquired infection. AIMS: The aim is to determine the incidence, bacteriology and factors affecting VAP and to determine the multi-drug resistant (MDR) pathogens. SETTINGS AND DESIGN: This was a prospective observational study conducted over a period of 1 year from April 1, 2011, to March 31, 2012. MATERIALS AND METHODS: The patients fulfilling criteria of VAP were included in this study. STATISTICAL ANALYSIS: This was performed using SPSS trial version 11.0 software (SPSS Inc., Chicago, Illinois, USA) and the values of P < 0.05 were considered statistically significant. RESULTS: Totally 74 (27.71%) patients were developed VAP. Of total 74 patients with VAP 53 (71.62%) were females and 21 (28.37%) were females (P < 0.0001). Total 13 (17.56%) patients had early-onset VAP and 61 (82.43%) had late-onset VAP (P < 0.0001). The overall incidence of VAP rate per 1000 ventilator days was 39.59. Total 126 bacterial isolates found in 74 patients with VAP. Predominant isolates were Gram-negative 52 (70.27%). Total 41 (55.40%) patients had polymicrobial VAP, and 33 (44.59%) had single isolate. Total 55 (43.65%) isolates were MDR organisms. Total 22 patients with VAP succumbed during treatment with overall case fatality rate of 29.72%. Of total 55 MDR isolates in VAP, 13 (26.63%) were Klebsiella spp., 11(20%) Pseudomonas aeruginosa, 14 (25.45%) Acinetobacter, 8 (14.54%) Escherichia coli, and 9 (16.36%) coagulase positive Staphylococcus aureus. Total 12 (21.41%) patients succumbed among MDR isolates. CONCLUSIONS: There was a high incidence of MDR pathogens in late-onset VAP. The Gram-negative organisms Klebsiella, Pseudomonas E. coli and Acinetobacter were the most commonly isolated organisms with high mortality rates.