Abstract
Epidemiologic data regarding health care acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) from Nepal are negligible. We conducted a prospective observational cohort study in the intensive care unit (ICU) of a major tertiary hospital in Nepal between April 2016 and March 2018, to calculate the incidence of VAP, and to describe clinical variables, microbiological etiology, and outcomes. Four hundred and thirty-eight patients were enrolled in the study. Demographic data, medical history, antimicrobial administration record, chest X-ray, biochemical, microbiological and haematological results, acute physiology and chronic health evaluation II score and the sequential organ failure assessment scores were recorded. Categorical variables were expressed as count and percentage and analyzed using the Fisher's exact test. Continuous variables were expressed as median and interquartile range and analyzed using Kruskal-Wallis rank sum test and the pairwise Wilcoxon rank-sum test. 46.8% (205/438) of the patients required intubation. Pneumonia was common in both intubated (94.14%; 193/205) and non-intubated (52.36%; 122/233) patients. Pneumonia developed among intubated patients in the ICU had longer days of stay in the ICU (median of 10, IQR 5-15, P< 0.001) when compared to non-intubated patients with pneumonia (median of 4, IQR 3-6, P< 0.001). The incidence rate of VAP was 20% (41/205) and incidence density was 16.45 cases per 1,000ventilator days. Mortality was significantly higher in patients with pneumonia requiring intubation (44.6%, 86/193) than patients with pneumonia not requiring intubation (10.7%, 13/122, p<0.001, Fisher's exact test). Gram negative bacteria such as Klebsiella and Acinetobacter species were the dominant organisms from both VAP and non-VAP categories. Multi-drug resistance was highly prevalent in bacterial isolates associated with VAP (90%; 99/110) and non-VAP categories (81.5%; 106/130). HAP including VAP remains to be the most prevalent hospital-acquired infections (HAIs) at Patan hospital. A local study of etiological agents and outcomes of HAP and VAP are required for setting more appropriate guidelines for management of such diseases.
Highlights
Pneumonia is clinically defined as the presence of a new lung infiltrate with evidence that the infiltrate is triggered by an infectious agent such as, the new onset of fever, purulent sputum, or leukocytosis [1]
Pneumonia developed among intubated patients in the intensive care units (ICUs) had longer days of stay in the ICU when compared to non-intubated patients with pneumonia
Epidemiologic data regarding Healthcare acquired pneumonia (HAP) in Asia are scarce; the incidence of HAP is predicted to be high across Asia and especially problematic in intensive care units (ICUs), where the proportion of ICU-acquired respiratory infections ranges from 9% to 23% of admissions [6]
Summary
Pneumonia is clinically defined as the presence of a new lung infiltrate with evidence that the infiltrate is triggered by an infectious agent such as, the new onset of fever, purulent sputum, or leukocytosis [1]. Healthcare acquired pneumonia (HAP) is an infection of the pulmonary parenchyma that develops>48 hours of admission to a health care facility and is commonly caused by pathogens that circulate in hospital settings [2]. HAP is suspected when a patient presents with fever, impaired oxygenation, and suppurative secretions [3]. HAP is an important infectious disease worldwide and is associated with high morbidity, mortality, and additional health system expenditure [4]. Epidemiologic data regarding HAP in Asia are scarce; the incidence of HAP is predicted to be high across Asia and especially problematic in intensive care units (ICUs), where the proportion of ICU-acquired respiratory infections ranges from 9% to 23% of admissions [6]
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