Ventilator associated pneumonia in intensive care unit of a secondary care industrial hospital

Abstract

Abstract Aims and objectives To study incidence, etiology, risk factors, and outcome of ventilator-associated pneumonia (VAP). Study design Cross-sectional study using data from intensive care unit (ICU) inpatients database. Patients 913 patients admitted to our ICU between April 2010 and April 2011. Methods All ICU patients requiring mechanical ventilation for more than 48 h formed the study group. We used clinical pulmonary infection score of more than 6 to diagnose VAP. Statistical analysis was done with SPSS version 16. Tests used were descriptive statistics, Student's t -test, and chi-square test. Results Out of 240 patients fulfilling the study criteria, VAP developed in 36 patients i.e. 15%. Identified independent risk factors for VAP were male sex and medical illness as admission diagnosis. In contrast to other studies, Klebsiella pneumoniae was the most common causative agent (52.4%) in our study. Patients with COPD (23 out of 36 i.e. 63.9% vs. 13 out of 36 i.e. 36.1%) ( p value 0.006) and diabetes (22 out of 36 i.e. 61.1% vs. 14 out of 36 i.e. 38.9%, with p value of 0.001) had higher incidence of VAP as compared to non-COPD and non-diabetic patients. VAP was associated with increased mean hospital expenses of Rs. 34,415 INR (104,380 ± 42,931 vs. 69,965 ± 15,325, p value of 0.001) compared to patients who did not develop VAP. VAP was also associated with higher mortality (20 out of 36 i.e. 55% vs. 71 out of 204 i.e. 34% with p value of 0.025) in ICU patients. Conclusion VAP is responsible for increased hospital mortality and healthcare expenses to the patients. Male patients and those with COPD and diabetes are at higher risk of developing VAP. Hence judicious use of assisted invasive ventilation and implementation of preventive strategies is of immense importance to reduce the incidence of VAP, especially in high risk patients.