Ventilator-associated pneumonia in adult intensive care unit prevalence and complications

Abstract

Background: Ventilator-associated pneumonia (VAP) remains a common cause of intensive care unit (ICU) and hospital morbidity and mortality despite advances in diagnostic techniques and management. We aimed to determine the prevalence, possible complications and in-hospital prognosis of VAP in mechanically ventilated patients. Methods: This prospective observational, case-control study, was carried out from September 2012 to August 2013. Forty-eight adult patients maintained on mechanical ventilation for more than 48 h in our ICU were enrolled in the study. VAP was diagnosed as new persistent pulmonary infiltrates on chest radiographs and, at least two of following: (1) fever of ≥38.3 °C, (2) leukocytosis of ≥12,000⧹mm3, and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples of suspected cases were collected and processed as per standard protocols. Results: The primary underlying diagnosis was acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in 25 patients, congestive heart failure in 10, pneumonia in 6, post-operative in 5, neurological diseases in 2 patients. VAP developed in 17 patients (35.4%), gram-negative agents were the major offending pathogen (Pseudomonas aeruginosa accounting for 22.9%). The length of ventilation (LOV) and the length of ICU stay (LOSICU) were significantly higher in the VAP group (P = 0.001, 0.0001 respectively). Severe sepsis/septic shock, acute respiratory distress syndrome (ARDS), atelectasis, and infection with multi-drug resistant organisms were more common in the VAP group. Conclusion: Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay, time on mechanical ventilation and different complications.

Keywords

• Bacterial pneumonia
• Mechanical ventilator
• Intensive care unit