Incidence Rate Of Ventilator-associated Pneumonia Research Articles

Data quality review of the Brazilian nosocomial infections surveillance system

BackgroundSurveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. MethodsData Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. ResultsThroughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. ConclusionsWhile adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.

7. CURRENT SITUATION OF VENTILATOR - ASSOCIATED PNEUMONIA IN DEPARTMENT OF INTENSIVE CARE AND ANTIPOISON AT PHU THO GENERAL HOSPITAL IN 2023

Objectives: Exploring current situation of ventilator - associated pneumonia (VAP) in department of intensive care and antipoison at Phu Tho general hospital in 2023. 
 Subjects and mothods: A cross-sectional descriptive study on 137 mechanically ventilated patients were treated in department of intensive care and antipoison at Phu Tho general hospital from August 2022 to May 2023. 
 Results: Male 81,8%, mean age 64,2 ± 19,8 years old, the main underlying condition requiring patients admitting and ventilating mainly were coma (37,2%) and shock (32,8%). Incidence rate of VAP was 41,6%, mortality and serious patient come back home in VAP group was 65,9% which higher than non-VAP was 34,1%. Factors including immunodeficiency increase the risk of VAP 3,2 times, reintubation increases the risk 2,2 times, tracheostomy patients increase the risk 7,5 times, and mechanical ventilation for > 10 days increases the risk. muscle increased 7,4 times. VAP group had a longer duration of mechanical ventilation, ICU stays, as well as hospitalization days compared to non-VAP group. 
 Conclusion: VAP is a common severe infection in the intensive care unit, leading to increased mortality rates and prolonged treatment duration. Immunodeficiency, reintubation, tracheotomy and mechanical ventilation for more than 10 days increase the risk of VAP.

Impact of COVID-19 pandemic on healthcare-associated infections at intensive care units in South Korea: data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS)

The coronavirus disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. To evaluate the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in intensive care units (ICUs). A retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System was conducted. Comparisons between incidence rates and micro-organism distributions of bloodstream infection (BSI), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic were performed according to hospital size. The incidence rate of BSI significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period (1.38 vs 1.23 per 10,000 patient-days, relative change -11.5%; P < 0.001). The incidence rate of VAP (1.03 vs 0.81 per 1000 device-days, relative change -21.4%; P < 0.001) significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period, whereas rates of CLABSI (2.30 vs 2.23 per 1000 device-days; P= 0.19) and CAUTI (1.26 vs 1.26 per 1000 device-days; P= 0.99) were similar between the two periods. The rates of BSI and CLABSI significantly increased during the COVID-19 pandemic compared to the pre-COVID-19 period in large-sized hospitals, whereas these rates significantly decreased in small-to-medium-sized hospitals. The rates of CAUTI and VAP significantly decreased in small-sized hospitals. There were no significant changing trends in the rates of multidrug-resistant pathogens isolated from patients with HAI between the two periods. The incidence rates of BSI and VAP in ICUs decreased during the COVID-19 pandemic compared to the pre-COVID-19 period. This decrease was mainly seen in small-to-medium-sized hospitals.

Ventilator associated pneumonia in intensive care unit patients: a systematic review.

Ventilator-associated pneumonia (VAP) is the most common ICU acquired pneumonia among patients who are invasively intubated for mechanical ventilation. Patients with VAP suffer an increased mortality risk, financial burden, and length of stay in the hospital. The authors aimed to review the literature to describe the incidence, mortality, and microbiological evidence of VAP. We selected 13 peer-reviewed articles published from 1 January 2010 to 15 September 2022 from electronic databases for studies among adult or pediatric patients diagnosed with VAP expressed per thousand days admitted in the ICU. The VAP rates ranged from 7 to 43 per thousand days, varying among different countries of the world. A significant rate of mortality was observed in 13 studies ranging from 6.3 to 66.9%. Gram-negative organisms like Acinetobacter spp., Pseudomonas aeruginosa Gram-positive organisms like Staphylococcus aureus were frequently found. Our findings suggest an alarming situation of VAP among patients admitted to the intensive care units with increasing incidence and mortality. The review also found that VAP is more common in males and that there is a significant variation in the incidence and mortality rates of VAP among different countries. The findings of this review can inform the development of infection control and prevention strategies to reduce the burden of VAP. Thus, there is a crucial need for control and preventive measures like interventional studies and educational programs on staff training, hand-hygiene, and the appropriate use of ventilator bundle approach to curb this preventable threat that is increasing at an alarming rate.

Effects of the Selective Decontamination of the Digestive Tract (SDD) on Pulmonary Secondary Infections in Patients with COVID-19 Acute Respiratory Distress Syndrome: A Retrospective Single Centre Experience

Definitive data on the incidence rate of ventilator-associated pneumonia (VAP) in COVID-19 are still lacking, ranging from 29 to 58%. To date, most of the existing literature refers to patients who are not subjected to VAP prevention with selective decontamination of the digestive tract (SDD). We retrospectively collected data on all COVID-19 patients admitted to our ICU during the second phase of the pandemic with the aim of assessing the occurrence of VAP and the related mortality at 30 days and comparing our findings with the available literature. Of 213 patients, only 74 were eligible for the analysis. An incidence of 6.90 VAP per 1000 days of mechanical ventilation was detected. Apart from a smoking habit (0% vs. 10%, p &lt; 0.005) and diabetes (14% vs. 54%, p = 0.026), patients who developed VAP did not differ significantly from those who did not regarding comorbidities, steroid use, and the severity of COVID-19. VAP were predominantly caused by mono-microbial Gram-negative or fungal infections. Mortality was significantly higher in those who developed VAP (86 vs. 33%, p = 0.002). Our evidence aligned with the available literature in assuming a possible role of SDD in reducing the incidence of VAP in COVID-19 patients, with a possible impact on related mortality and costs.

Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network

Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and the determinants that potentially affect mortality are poorly evaluated. We assessed the prognosis of VAP in severe COVID-19 cases and the impact of relapse, superinfection, and treatment failure on 60-day mortality. Methods: We evaluated the incidence of VAP in a multicenter prospective cohort that included adult patients with severe COVID-19, who required mechanical ventilation for ≥48 h between March 2020 and June 2021. We investigated the risk factors for 30-day and 60-day mortality, and the factors associated with relapse, superinfection, and treatment failure. Results: Among 1424 patients admitted to eleven centers, 540 were invasively ventilated for 48 h or more, and 231 had VAP episodes, which were caused by Enterobacterales (49.8%), P. aeruginosa (24.8%), and S. aureus (22%). The VAP incidence rate was 45.6/1000 ventilator days, and the cumulative incidence at Day 30 was 60%. VAP increased the duration of mechanical ventilation without modifying the crude 60-day death rate (47.6% vs. 44.7% without VAP) and resulted in a 36% increase in death hazard. Late-onset pneumonia represented 179 episodes (78.2%) and was responsible for a 56% increase in death hazard. The cumulative incidence rates of relapse and superinfection were 45% and 39.5%, respectively, but did not impact death hazard. Superinfection was more frequently related to ECMO and first episode of VAP caused by non-fermenting bacteria. The risk factors for treatment failure were an absence of highly susceptible microorganisms and vasopressor need at VAP onset. Conclusions: The incidence of VAP, mainly late-onset episodes, is high in COVID-19 patients and associated with an increased risk of death, similar to that observed in other mechanically ventilated patients. The high rate of VAP due to difficult-to-treat microorganisms, pharmacokinetic alterations induced by renal replacement therapy, shock, and ECMO likely explains the high cumulative risk of relapse, superinfection, and treatment failure.

Impact of Structured Teaching Program on ICU Nurses’ Knowledge and Practice in Prevention of Ventilator Associated Pneumonia in Khartoum, Sudan

Background: Ventilator-Associated Pneumonia (VAP) is a prevalent hospital-acquired infection associated with increased mortality rates. Nurses play a significant role in preventing VAP by providing round-the-clock care to critically ill patients. This study aimed to evaluate the effectiveness of a Structured Teaching Program (STP) on ICU nurses’ knowledge and practices regarding VAP prevention in Khartoum. Methods: A quasi-experimental study with comparison groups (intervention and control) was conducted using purposive sampling. Data on knowledge and skills were collected from 120 ICU nurses using a structured knowledge questionnaire and direct observation checklist. The STP was implemented, followed by a post-test and final assessment after two weeks, using the same questionnaire and checklist. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) program version 20. Results: The overall mean pre-test knowledge scores on VAP prevention were 17.95 out of 40 for the intervention group and 18.5 out of 40 for the control group, with a statistically insignificant difference (p=0.617&gt;0.05). The post-test scores were 32.05 out of 40 for the intervention group and 20.83 out of 40 for the control group, showing a statistically significant difference (p=0.000&lt;0.05). The overall mean initial assessment of practice compliance was 9.27 out of 20 for the intervention group and 4.97 out of 20 for the control group, with a statistically significant difference (p=0.000&lt;0.05). In the final assessment, the mean scores were 12.77 out of 20 for the intervention group and 5.7 out of 20 for the control group, also showing a statistically significant difference (p=0.000&lt;0.05). The VAP incidence rate during the pre-intervention phase was 54.4 cases per 1000 ventilator days for the intervention group and 40.35 cases per 1000 ventilator days for the control group. In the post-intervention phase,the rates were 39.6 cases per 1000 ventilator days for the intervention group and 64.9 cases per 1000 ventilator days for the control group. Conclusion: The findings indicate a knowledge deficit and inadequate practice compliance among ICU nurses regarding VAP prevention before the intervention. The structured teaching program effectively improved their knowledge and practice compliance, resulting in a reduction in VAP incidence rates.

Bacteriological Profile and Antibiotic Susceptibility Pattern of Pathogens Isolated in Ventilator-associated Pneumonia – A Single-center Study

Abstract Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in people receiving mechanical ventilation. VAP developed during the first 4 days of mechanical ventilation is early-onset, usually less severe, mostly caused by antibiotic-sensitive bacteria, and has a better prognosis. On the other hand, late-onset VAP develops five or more days after the initiation of mechanical ventilation, is caused by multidrug-resistant pathogens, and is usually associated with increased morbidity and mortality. VAP may be caused by a wide spectrum of bacterial pathogens that may be polymicrobial and are rarely due to viral or fungal pathogens in immunocompetent hosts. Methods: Data were collected retrospectively from case files of the medical records department corresponding to the identified clinical isolates. The study included a total of 143 ventilated patients of both sexes who were admitted to intensive care units (ICUs) and fulfilled the criteria of VAP as well as non-VAP. Results: A total of 102 patients suffered from VAP. The number of ventilator days was calculated to be 2940 days. With the estimated VAP cases to be 102, the VAP rate was calculated to be 34.69/1000 ventilator days. The commonly isolated organisms were Acinetobacter species, Pseudomonas aeruginosa, and Klebsiella pneumoniae, which showed proportions of 39.5%, 28.1%, and 15.3%, respectively. Conclusion: Our study highlights the organism distribution, antibiotic susceptibility patterns, and the VAP incidence rate in our center. These findings, if replicated across centers, can potentially inform the management of VAP.

2041. Impact of Coronavirus Disease 2019 pandemic on healthcare-associated infections at intensive care unit in South Korea: Data from Korean National Healthcare-associated Infections Surveillance System (KONIS)

Abstract Background Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit. Methods We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic. Results The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days; P &amp;lt; 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days; P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days; P &amp;lt; 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly. Conclusion The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals. Disclosures All Authors: No reported disclosures.

Ecological effects of selective oral decontamination on multidrug-resistance bacteria acquired in the intensive care unit: a case–control study over 5 years

PurposeThis case–control study investigated the long-term evolution of multidrug-resistant bacteria (MDRB) over a 5-year period associated with the use of selective oropharyngeal decontamination (SOD) in the intensive care unit (ICU). In addition, effects on health care-associated infections and ICU mortality were analysed.MethodsWe investigated patients undergoing mechanical ventilation > 48 h in 11 adult ICUs located at 3 campuses of a university hospital. Administrative, clinical, and microbiological data which were routinely recorded electronically served as the basis. We analysed differences in the rates and incidence densities (ID, cases per 1000 patient-days) of MDRB associated with SOD use in all patients and stratified by patient origin (outpatient or inpatient). After propensity score matching, health-care infections and ICU mortality were compared.Results5034 patients were eligible for the study. 1694 patients were not given SOD. There were no differences in the incidence density of MDRB when SOD was used, except for more vancomycin-resistant Enterococcus faecium (0.72/1000 days vs. 0.31/1000 days, p < 0.01), and fewer ESBL-producing Klebsiella pneumoniae (0.22/1000 days vs. 0.56/1000 days, p < 0.01). After propensity score matching, SOD was associated with lower incidence rates of ventilator-associated pneumonia and death in the ICU but not with ICU-acquired bacteremia or urinary tract infection.ConclusionsComparisons of the ICU-acquired MDRB over a 5-year period revealed no differences in incidence density, except for lower rate of ESBL-producing Klebsiella pneumoniae and higher rate of vancomycin-resistant Enterococcus faecium with SOD. Incidence rates of ventilator-associated pneumonia and death in the ICU were lower in patients receiving SOD.

Ventilator-Associated Pneumonia in Neonates Admitted to a Tertiary Care NICU in Bulgaria.

Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection (HAI) among neonatal patients in the intensive care units (ICUs) and is a serious challenge for neonatologists because it affects critically ill patients who need prolonged mechanical ventilation. In Bulgaria, there is no detailed data at regional and national levels on the characteristics of VAP in newborns, which imposes a necessity for specific studies of risk factors and etiology of VAP. The aim of the study was to analyze the frequency, characteristics and risk factors for the occurrence of VAP in newborns hospitalized in intensive care unit. This was a prospective study, conducted between January 2017 and June 2018 in the NICU of University Hospital “St. George” Plovdiv, Bulgaria. The sample consisted of 507 neonates, followed up prospectively, 107 of whom were placed on mechanical ventilation for ≥48 h. VAP was diagnosed in 33 out of 107 neonates (31%). The VAP incidence rate was 35.06/1.000 ventilator days. We confirmed differences between the median birth weight (1,310 vs. 1,690 g, p = 0.045) and average gestational age (31.08 g.w. vs. 33.08 g.w, p = 0.04) of the patients with and without VAP. The average stay of patients with VAP in the NICU was statistically significantly longer than the hospital stay of non-VAP patients (35.70 ± 21.84 days vs. 21.77 ± 17.27 days (t = 3.241, p = 0.002). In neonates with VAP, the duration of mechanical ventilation was statistically significantly longer compared with non-VAP patients (16.88 ± 11.99 vs. 5.42 ± 4.48; t = 5.249, p = 0.000). A statistically significant prevalence of Gram-negative bacteria among VAP patients was demonstrated (91%) compared to the Gram-positive (9%), p < 0.05. The leading causative agent of VAP was Klebsiella pneumoniae ESBLs + (27%), followed by Acinetobacter baumannii (14%), Pseudomonas aeruginosa (12%) and Escherichia coli (12%). In multivariate logistic regression, mechanical ventilation >7 days was established as an independent risk factor for VAP (OR 3.6; 95% CI: 1.7–6.5, p = 0.003). VAP remains a serious and outstanding issue in pediatric and neonatal intensive care units. The findings of the current study emphasize that the birth weight, gestational age, and duration of hospital stay have a significant association with ventilator-associated pneumonia.

Impact of dexamethasone on the incidence of ventilator-associated pneumonia in mechanically ventilated COVID-19 patients: a propensity-matched cohort study

ObjectiveTo assess the impact of treatment with steroids on the incidence and outcome of ventilator-associated pneumonia (VAP) in mechanically ventilated COVID-19 patients.DesignPropensity-matched retrospective cohort study from February 24 to December 31, 2020, in 4 dedicated COVID-19 Intensive Care Units (ICU) in Lombardy (Italy).PatientsAdult consecutive mechanically ventilated COVID-19 patients were subdivided into two groups: (1) treated with low-dose corticosteroids (dexamethasone 6 mg/day intravenous for 10 days) (DEXA+); (2) not treated with corticosteroids (DEXA−). A propensity score matching procedure (1:1 ratio) identified patients' cohorts based on: age, weight, PEEP Level, PaO2/FiO2 ratio, non-respiratory Sequential Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), C reactive protein plasma concentration at admission, sex and admission hospital (exact matching).InterventionDexamethasone 6 mg/day intravenous for 10 days from hospital admission.Measurements and main resultsSeven hundred and thirty-nine patients were included, and the propensity-score matching identified two groups of 158 subjects each. Eighty-nine (56%) DEXA+ versus 55 (34%) DEXA− patients developed a VAP (RR 1.61 (1.26–2.098), p = 0.0001), after similar time from hospitalization, ICU admission and intubation. DEXA+ patients had higher crude VAP incidence rate (49.58 (49.26–49.91) vs. 31.65 (31.38–31.91)VAP*1000/pd), (IRR 1.57 (1.55–1.58), p < 0.0001) and risk for VAP (HR 1.81 (1.31–2.50), p = 0.0003), with longer ICU LOS and invasive mechanical ventilation but similar mortality (RR 1.17 (0.85–1.63), p = 0.3332). VAPs were similarly due to G+ bacteria (mostly Staphylococcus aureus) and G− bacteria (mostly Enterobacterales). Forty-one (28%) VAPs were due to multi-drug resistant bacteria. VAP was associated with almost doubled ICU and hospital LOS and invasive mechanical ventilation, and increased mortality (RR 1.64 [1.02–2.65], p = 0.040) with no differences among patients' groups.ConclusionsCritically ill COVID-19 patients are at high risk for VAP, frequently caused by multidrug-resistant bacteria, and the risk is increased by corticosteroid treatment.Trial registration: NCT04388670, retrospectively registered May 14, 2020.

Ventilator-associated Events Surveillance in a Trauma Intensive Care Unit: A Prospective Study of Incidence, Predictive Values, Sensitivity, Specificity, Accuracy, and Concordance with Ventilator-associated Pneumonia.

IntroductionThe Centres for Disease Control and Prevention (CDC) introduced a new definition of ventilator-associated events (VAEs) in 2013 in place of longstanding ventilator-associated pneumonia (VAP) definition. Three entities under VAE, ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and possible ventilator-associated pneumonia (PVAP), were introduced.ObjectivesTo assess the incidence of all VAEs in a tertiary care trauma ICU and to find the predictive value of VAE and sensitivity of VAE definitions for VAP.DesignCohort prospective study at trauma intensive care unit (ICU) of PGIMER, Chandigarh, from July 2018 till June 2019.Materials and methodsPatients admitted in trauma ICU were checked for VAP and VAE criteria defined by CDC.ResultsFour hundred and sixty five patients were observed. Around 378 patients were included in the study with 4046 patient days and 3031 mechanical ventilation (MV) days. Incidence rate of PVAP, IVAC, VAC, and VAP was 2.97, 6.60, 10.23, and 9.24 per 1000 ventilator days, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of diagnosing VAP were 0.61, 0.97, 0.68, and 0.97 for VAC; 0.80, 0.97, 0.57, and 0.99 for IVAC; and 0.78, 0.94, 0.25, and 0.9 for PVAP, respectively. Kendall's W test showed that there was very poor concordance between VAP and VAE.How to cite this articleKaur K, Jain K, Biswal M, Dayal SK. Ventilator-associated Events Surveillance in a Trauma Intensive Care Unit: A Prospective Study of Incidence, Predictive Values, Sensitivity, Specificity, Accuracy, and Concordance with Ventilator-associated Pneumonia. Indian J Crit Care Med 2022;26(5):584–590.

Effectiveness of Educational Intervention in Preventing Ventilator Associated Pneumonia in Neonatal Intensive Care Unit: A Cohort Study

Background: Despite improvement in overall survival, neonatal period is not free of complications. Ventilator associated Pneumonia (VAP) is a serious complication and account for 6.8 - 32.2 % of healthcare associated infections among neonates. Objective: The objective of the study was to document the effectiveness of an educational programme for neonatal intensive care (NICU) service provider in preventing occurrence of ventilator associated pneumonia in NICU. Methods: It was a prospective cohort study compared with historical control taken from the hospital records. All neonates admitted to the NICU during 12 months period from May 2019 to April 2020 were enrolled. Prospective enrollment of ventilated baby after educational interventions was subjected to the VAP educational care bundle. Eligible neonates who spent more than 48 h on MV were followed up and monitored closely for the development of VAP. Detail history, thorough clinical examination, relevant investigation including chest radiography were carried out on all enrolled infants. Results: A total of 54 neonates ventilated newborn, 41 met the inclusion criteria and were enrolled in the current study; 22 cases in pre-intervention phase and 19 cases in the post- intervention phase. Among enrolled mechanically ventilated newborn, 18 patients (18/41, 44%) developed at least single episode of VAP during the ventilated period. Baseline characteristics were comparable in both the groups. The primary indication of mechanical ventilation was sepsis related complications during both the phases (9/22, 41% and 8/19, 42.1%). Next to sepsis, perinatal asphyxia (5/22, 22.7%) was the indication of MV in pre-intervention period whereas respiratory distress syndrome (7/19, 36.8%) was the second leading causes of MV during post-intervention period. Significant reduction in VAP incidence rate was observed after implementation of VAP interventions, as 13/22, 59 % episodes of VAP were diagnosed in pre-intervention period compared to 5/19, 26.3% were diagnosed during implementation period. (p = 0.035). Non-significant reduction in mean duration of MV days was observed in the post-intervention period when compared to pre-intervention counterpart (7.23±4.48 days versus 5.16±2.77 days, p = 0.089). There was no significant reduction in NICU length of stay (13.05±8.16 versus 11.58±7.75 days in pre and post intervention period respectively, p = 0.56). The difference in overall mortality rates between the two phases were 15/22, 68.18% and 10/19, 52.63% respectively and found to be non- significant. Gram negative bacteria were the most commonly isolated micro-organisms, Acinetobacter was the leading causative pathogen. Conclusion: It demonstrates that an educational program including bundle of infection control practice can reduce the occurrence of VAP during ventilation period. These educational programs for NICU care providers can be expanded to other NICU s of the country to prevent ventilator associated pneumonia. Bangladesh Med Res Counc Bull 2021; 47(2): 143-150

Pneumonia in the Early Post-Lung Transplant Period: A Prospective Study

<h3>Purpose</h3> Hospital- (HAP) and Ventilator-associated pneumonia (VAP) are important complications early (<30 days) after lung transplantation (LT). However, current incidence, risk factors at LT and outcomes are not well reported. <h3>Methods</h3> We included all recipients who underwent LT 07/2019-02/2020 at our institution. We prospectively collected epidemiological and microbiological data in the first 30 days post-LT. We assessed incidence and presentation of HAP/VAP as per ISHLT criteria and evaluated the impact of pre specified risk factors using logistic regression models. As well as the impact of HAP/VAP on ICU and hospital length of stay. <h3>Results</h3> In the first 30 days post LT 9/119 (7.5%) recipients were diagnosed with at least one episode of HAP/VAP. VAP incidence rate was 9.6/1000 ventilator days (95% CI 5.0-18.1). Characteristics of recipients at LT are shown in Table 1A. Median time to HAP/VAP was 11 days (IQR 8-15), most episodes included gram negative pathogens 7/8 (88%). Associated pathogens were de novo acquisitions in 7/8 (88%) cases. Leukocytosis (5/9, 56%) and fever (2/9, 22%) were rare at diagnosis of HAP/VAP. Recurrence of HAP/VAP occurred in 2/9 (22%) cases during the first 30 days. Diabetes mellitus at baseline was the only risk factor associated with HAP/VAP post LT in the univariable analysis (p=0.025); Table 1B. In recipients with HAP/VAP vs. without, median ICU (18d [IQR 11-26] vs. 7d [IQR 6-8] p<0.001]) and hospital stay (29d [IQR 27-31] vs. 20d [IQR 18-22] <0.02) were longer. Among patients at risk for VAP (duration of mechanical ventilation (MV) >48h), median duration of MV was longer in recipients with VAP compared to those without (20d [IQR 11-28] vs. 8d [IQR 6-10] p<0.001). No death occurred in the first 30 days. <h3>Conclusion</h3> Prospectively assessed early HAP/VAP incidence was low in our cohort at 7.5%. Associated pathogens were mainly not donor- or recipient-derived but rather de novo acquisitions. HAP/VAP occurrence was associated with increased duration of ICU and hospital length of stay, without effect on 30-day mortality.

Efficacy of modified ventilator-associated pneumonia prevention bundles on ventilator-associated pneumonia incidence rate in the intensive care unit: A pilot study

Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops in an intubated patient after 48 h of mechanical ventilation. In India, there is a paucity of literature in terms of compliance to VAP prevention bundles and their benefits. The aim of this study was to compare the reduction of VAP incidence rates amongst patients who received existing VAP prevention bundles and modified VAP prevention bundles. This pilot study was conducted in the adult intensive care unit of a tertiary care hospital. There were 60 patients in all, 30 patients in each group. The diagnosis of VAP was based on the clinical presentation and correlation with Clinical Pulmonary Infection Score. The incidence of VAP was 3/435 ventilator days (6.80%) in the patients receiving a modified VAP prevention bundle. In the conventional VAP prevention bundle group, the incidence of VAP was six episodes per 439 ventilator days (13.60%). Our study concluded that the modified VAP prevention bundle is effective in reducing the incidence of VAP amongst intubated patients.

783. Impact of Universal Decolonization on Intensive Care Unit Bloodstream Infections

Abstract Background Interventions used to reduce the incidence of hospital-acquired infections (HAIs) include hand hygiene, isolation, and decolonization. The routine use of chlorhexidine gluconate (CHG) and nasal mupirocin ointment has been shown to be an effective universal decolonization option to reduce bacterial transmission and prevent HAIs. The objective of this study is to compare the pre- and post-intervention of universal decolonization among ICU patients at Desert Regional Medical Center, an acute care Level II trauma center. Methods The first part of this study is a retrospective chart review of all ICU patients from June 2020 to August 2020. The second part of this research is a prospective study from December 2020 to March 2021. The prospective study will include all patients admitted to the ICU who completed the decolonization regimen of mupirocin for 5 days and daily CHG baths. In the intervention phase, all ICUs patients will be decolonized with nasal mupirocin twice daily for 5 days and CHG baths daily for the entire ICU stay. The primary outcome is the number of ICU bloodstream infections (BSIs). Secondary outcomes include the number of ICU-related central line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator associated pneumonia (VAP). An infection attributed to ICU stay is defined as an infection onset occurring more than 48 hours after ICU admission. Fisher’s exact and chi square test was used for the statistical analysis. Results A total of 130 patients were included in this study. Universal decolonization resulted in a reduction in overall ICU infections in the baseline group vs intervention group using a p-value of 0.05 (ICU-BSI 5 vs 4, p=0.73; CLABSI 2 vs 1, p=0.56; CAUTI 4 vs 2, p=0.41; VAP 23 vs 17, p=0.25). Conclusion Patients in the intervention group had a lower incidence of ICU infections compared to the baseline group. These findings suggest that universal decolonization may be an effective strategy in reducing ICU incidence rates of BSI, CLABSI, CAUTI, and VAP. Further studies need to be conducted to validate this finding with a greater population enrolled to achieve adequate power. Disclosures All Authors: No reported disclosures

Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients.

Purpose of reviewWe conducted a systematic literature review to summarize the available evidence regarding the incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because of acute respiratory distress syndrome secondary to SARS-CoV-2 infection (C-ARDS).Recent findingsSixteen studies (6484 patients) were identified. Bacterial coinfection was uncommon at baseline (<15%) but a high proportion of patients developed positive bacterial cultures thereafter leading to a VAP diagnosis (range 21–64%, weighted average 50%). Diagnostic criteria varied between studies but most signs of VAP have substantial overlap with the signs of C-ARDS making it difficult to differentiate between bacterial colonization versus superinfection. Most episodes of VAP were associated with Gram-negative bacteria. Occasional cases were also attributed to herpes virus reactivations and pulmonary aspergillosis. Potential factors driving high VAP incidence rates include immunoparalysis, prolonged ventilation, exposure to immunosuppressants, understaffing, lapses in prevention processes, and overdiagnosis.SummaryCovid-19 patients who require mechanical ventilation for ARDS have a high risk (>50%) of developing VAP, most commonly because of Gram-negative bacteria. Further work is needed to elucidate the disease-specific risk factors for VAP, strategies for prevention, and how best to differentiate between bacterial colonization versus superinfection.

Epidemiology, etiology, and diagnosis of health care acquired pneumonia including ventilator-associated pneumonia in Nepal.

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.

Investigating patient outcomes and healthcare costs associated with ventilator-associated pneumonia.

Ventilator-associated pneumonia is the most frequent infection seen in intensive care units. Of those patients with an endotracheal tube, many will develop ventilator-associated pneumonia within 48 hours of being mechanically ventilated. There are many issues related to mechanical ventilation including costs, patient outcomes and the amount of suffering patients experience during the process. To determine the relationship between development of ventilator-associated pneumonia and patient outcomes and costs, including length of stay on mechanical ventilation, in intensive care units (ICU) and in hospital, and mortality rates and to compare results between ventilator-associated pneumonia and non-ventilator-associated pneumonia groups. Cross-sectional, observational design. A convenience sample of 151 patients on mechanical ventilation (101 with ventilator-associated pneumonia and 50 with non-ventilator-associated pneumonia) were recruited from ICUs in two public hospitals in Jordan. APACHE-II scores, SOFA scores and clinical pulmonary infection scores (CPIS) were assessed. The incidence rate of ventilator-associated pneumonia was 50.9/1000 mechanical ventilation days and the cumulative incidence rate was 66.9% among patients on mechanical ventilation. The mean score of hospital length of stay and CPIS was significantly higher in the ventilator-associated pneumonia than the non-ventilator-associated pneumonia group. Higher disease severity and higher organ failure scores increase the risk of mortality in patients with ventilator-associated pneumonia. A high ventilator-associated pneumonia incidence rate is associated with increased mechanical ventilation, ICU and hospital length of stays, higher mortality and attributed costs. There is a need for continuing education and training for ICU staff to reduce ventilator-associated pneumonia incidence in ICUs.