Risk factors, pathogen profile and outcome of ventilator associated pneumonia in a Neonatal intensive care unit

Abstract

Background: Objective of current study was to know the risk factors, pathological profile and outcome of ventilator associated pneumonia in the neonatal intensive care unit. Methods: Design: Prospective observational study. Settings: A teaching, referral, neonatal intensive care unit at Srinagar, Kashmir. Participants: All ventilated neonates who required mechanical ventilation for more than 48 hours between August 2011 to July 2012. Procedure : The diagnosis of VAP was made on the basis of criteria given by National Nosocomial Infection Surveillance System (1996), paediatric modification of the original guidelines given by Centre of Disease Control & prevention (CDC). Risk factors for VAP were assessed by bivariate and multivariate analysis. Semi-quantitative culture was done using blood agar, chocolate agar and McConkey’s agar as plating media. Results: VAP developed in 32 of 96 ventilated neonates (33.34% VAP rate). Prematurity, very low birth weight, use of nasogastric tube, mean duration of mechanical ventilation, NICU stay in days and number of endotracheal tube changes were statistically significant risk factors associated with VAP. Multiple logistic regression analysis revealed that duration of mechanical ventilation (P = 0.006) and VLBW (<15000 grams) (P = 0.032) were only two single independent and statistically significant risk factors. Most common bacteria isolated from ETA was Klebsiella (37.5%). There were 9 (28.1%) mortalities in VAP group and 14 (21.8%) in non-VAP group, which was statistically insignificant. Conclusions: A number of measures is required to decrease the incidence of VAP based on the prevalent modifiable risk factors and etiological organisms in NICU. Daily assessments of readiness to wean and use of weaning protocols must be adhered to in NICUs.