Ventilator Associated Pneumonia in Intensive Care Units of a Tertiary Care Hospital in Nepal

Shakya R*, Shrestha RR**, Manandhar S***

Abstract


Introduction: Ventilator-associated pneumonia (VAP) is a major cause of morbidity in the Intensive Care Unit (ICU). Data from developing countries reveal an incidence ranging from 15.87% to 30.67%. The objective of this study was to find the incidence, organisms involved, associated risk factors and outcomes of VAP.


Method: It was a prospective observational study conducted among mechanically ventilated 102 patients. Clinical Pulmonary Infection Score (CPIS) was used to diagnose VAP. Data was subjected to univariate analysis using chi-square and z-test. Level of significance was set at 0.05.


Result: Thirty-nine (38.23%) patients developed VAP. Acinetobacter calcacaetricus baumannii complex (37.93%) was the predominant organism. Use of steroids (Relative risk (RR) = 8.07), reintubation (RR=2.04), H2 blocker (RR=1.62) and vasopressors (RR=1.40) were identified as major risk factors. Mean length of stay in ICU was 19.07 ± 8.53 days in VAP group and 8.14 ±2.48 days in
non VAP group (P value 0.0001). Mean duration in mechanical ventilation (MV) was 16.05 ±8.87 days in VAP group and 6.95± 2.35 days in non VAP group (P value 0.0001). Mortality (53.84%) was significantly high in patients who developed VAP. (P value <0.05)


Conclusion: The incidence of VAP is high. Acinetobacter
alcacaetricus baumannii complex is the commonest organism involved. Use of steroids is the commonest risk factor for VAP. Duration of mechanical ventilation, duration of ICU stay and mortality in patients who developed VAP is also high. Strategies to reduce VAP should be implemented to improve the patient outcome.


Key words: Clinical Pulmonary Infection Score, Intensive Care Unit, Ventilator Associated Pneumonia.

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