Original Research Article
Year: 2020 | Month: December | Volume: 7 | Issue: 12 | Pages: 98-107
Microbiological Profile and Clinical Outcome of Ventilator-Associated Pneumonia Patients in an Intensive Care Unit at a Tertiary Care Institute of North India
Umara1, Nargis Bali2, Roseleen Kour3, Anjum Mir4, Tufail Ahmed5, Omar Rashid6
1Assistant Prof. Department of Microbiology Govt Medical College Baramulla
2Assistant Prof. Department of Microbiology Sher-i-Kashmir Institute of Medical Sciences Soura
3Consultant. Department of Pulmonary Medicine and Critical Care Indraprastha Apollo New Delhi
4Post Graduate student Department of Microbiology Sher-i-Kashmir Institute of Medical Sciences Soura
5Senior Resident Department of Microbiology Sher-i-Kashmir Institute of Medical Sciences Soura
6Senior Resident Department of Microbiology Sher-i-Kashmir Institute of Medical Sciences Bemina
Corresponding Author: Nargis Bali
ABSTRACT
Introduction: Ventilator associated pneumonia is a serious life threatening condition and a major problem in intensive care units despite advances in diagnostic and treatment modalities. Incidence of this clinical entity varies widely based on agent, host and environment factors. An understanding of these variables in local setting is important so as to allow judicious and more effective use of antimicrobials.
Aims: To determine the incidence of VAP in the surgical intensive care unit (SICU) of the institute, to enumerate the bacterial pathogens causing it and their susceptibility profile.
Material and methods: Data of all the patients diagnosed with VAP for a period of three years (2017-2019) was analysed retrospectively and variables such as age, sex, Clinical Pulmonary Infection Score, diagnosis at the time of SICU admission, duration of ventilation, antibiotics received, sample submitted, type of organism isolated and its susceptibility profile recorded. Statistical analysis was carried out using the MedCalC and NCSS software (trial version).
Results: The incidence of VAP was found to be 33.6%. It was more common in male patients (61.4%) and the mean ± SD age was 43.4 ± 14.7. Most common diagnosis at the time of ICU admission was trauma. Late onset VAP was more common in the study group. A significant portion of patients with VAP were on mechanical ventilation >10 days. Multi-drug resistant Acinetobacter spp and Klebsiella pneumoniae were the most common Gram negative and Staphylococcus aureus and Enterococcus spp most common Gram positive organisms recovered from these patients. Cefoxitin resistance among S. aureus was 74.6% and vancomycin resistance in Enterococci was 24.1%. Mortality in VAP patients was 46.7%.
Conclusion: VAP due to multidrug resistant microorganismsis a serious problem in our hospital with late onset VAP being more common. Emergence of polymyxin B resistance in Gram negative organisms, increasing methicillin resistance in S. aureus and vancomycin resistance in Enterococcus spp is quite alarming.
Keywords: Antimicrobial resistance, Mechanical ventilation, Methicillin, Polymyxin B, Vancomycin.
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