Late-onset Ventilator-associated Pneumonia Research Articles

Suction circuit flushing with chlorhexidine decreases ventilator-associated pneumonia: a quasi-experimental study.

Endotracheal suctioning of mechanically ventilated patients differs across the world. In many low and middle-income countries, endotracheal suctioning is often performed with a sterile suctioning catheter that is used for 12 h or during the length of one nursing shift. The effect of flushing multiple used endotracheal suction system with chlorhexidine after suctioning to reduce ventilator associated pneumonia (VAP) remains unclear. The aim of the study is to assess the effectiveness of flushing multiple-used open endotracheal suction catheters and suctioning system with chlorhexidine gluconate 0.2% to reduce VAP in mechanically ventilated patients in a resource-limited Intensive Care Unit (ICU). Due to the difficulty of blinding the intervention for nurses who perform endo-tracheal suction procedures, we adopted a quasi-experimental method with a randomized controlled trial design. A sample of 136 ICU patients were allocated to the intervention (n = 68) or control group (n = 68) between May and November 2020. The intervention was flushing the multiple-used suction catheter and suction system with 40ml chlorhexidine gluconate 0.2% and in the control group we used normal saline to flush the catheter and suction system. The primary outcome was incidence of VAP and the cost of the flushing solutions was the secondary outcome measure. Patients in the intervention group had a lower incidence of VAP compared to patients in the control group; 15 (22.1%) vs 29 (42.6%), p = 0.01. The incidence of late-onset VAP was 26.2% in the intervention group and 49% in the control group (p = 0.026) and the early-onset VAP was 13.2% in the intervention group and 25% in the control group (p = 0.081). Chlorhexidine gluconate 0.2% reduced the cost of suction system flushing (median: 78.4 vs 300 EGP, p < 0.001). Using chlorhexidine gluconate 0.2% to flush multiple-used suctioning catheters after every endo-tracheal suction procedure might reduce the incidence of VAP in mechanically ventilated patients. Chlorhexidine gluconate 0.2% can be a cost-effective solution for flushing the suction circuit. Nurses working in resource-limited ICUs and using suctioning catheters multiple times might consider using chlorhexidine gluconate 0.2% instead of normal saline or distilled water when flushing the suction system. ClinicalTrials.gov, identifier NCT05206721.

Pathogenic and Non-Pathogenic Microbial Presence in Ventilator Associated Pneumonia Patients in Intensive Care Unit and Safety Protocols Under Surveillance of Healthcare Provider: A Research Study

Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection that is associated with longer stays in intensive care units (ICUs) and under mechanical ventilation for more than 48 hours. This article explores the prevalence and impact of VAP on mortality and morbidity, emphasizing the microbial associations involved in hospital-acquired infections. Various infections, including Lung infections, surgical site infections, sepsis, and urinary tract infections, are discussed, along with their associated microorganisms. Diagnostic criteria for VAP and related infections are outlined, highlighting the importance of microbiological testing for accurate diagnosis. The underlying factors for VAP acquisition in ICU patients are identified, and prompt antibiotic initiation is emphasized as a critical first-line defense against VAP. In this study, we have populated data from 100 ICU patients, among which 45 were suffering from VAP. It was found that female patients (57.40%) were more affected than male patients (30.43%). The decreasing PaO2 level was seen to be the early sign of infection. It was found that the time of ventilation was the major factor influencing the VAP. The most common organism causing infection in our study was found to be Staphylococcus Aureus (45.1%). The prognosis of early-onset VAP was 35.55% while compared to Late-onset VAP 64.44%. When compared to VAP and Non-VAP patients there was not very huge difference with 55% and 45% respectively. The other factor was age and position. Implementation of Prevention strategies, such as protective environments and HEPA filtration systems, is proposed to reduce VAP incidence. Proper diagnosis, treatment, and prevention are crucial to combatting VAP and enhancing patient outcomes in hospital settings.

Ventilator-associated pneumonia in an academic intensive care unit in Johannesburg, South Africa

Background. Ventilator-associated pneumonia (VAP) has an estimated incidence of 10 - 41.5 events per 1 000 ventilator days in developing countries, and carries high mortality. Little is known about the incidence and outcomes of VAP in Johannesburg, South Africa. Objectives. To describe VAP in a tertiary public hospital in Johannesburg, assess the microbiological pathogens associated with VAP (both early and late), and outline the outcomes of these patients. Methods. The study was a retrospective record review of patients admitted to the Helen Joseph Hospital intensive care unit (ICU) between March 2013 and January 2016. Results. VAP developed in 24/842 ventilated patients (2.9%; 95% confidence interval (CI) 1.8 - 4.2), with an incidence of 23 events per 1 000 ventilator days, during the study period. Of these patients, one-third (29.2%) died and 70.8% were discharged from the ICU. Late-onset VAP (onset ≥5 days after intubation, incidence 45.8%) was associated with higher mortality (54.6%) than early-onset VAP (onset within 4 days after intubation, incidence 54.2% and mortality 7.7%). Commonly isolated organisms were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. There was a trend towards an increased risk of multidrug-resistant organisms with late-onset VAP (adjusted relative risk 2.26; 95% CI 0.92 - 5.57; p=0.077) and airway access through a tracheostomy (relative risk 1.68; 95% CI 0.78 - 3.57). Conclusion. The study showed a low to moderate incidence of VAP of 23 events per 1 000 ventilator days. A tracheostomy and late-onset VAP were associated with infection by drug-resistant organisms. The mortality rate was 29.2% in this setting, with a seven-fold increase in mortality with late-onset VAP.

Late-onset ventilator-associated pneumonia due to Mycobacterium chelonae and an unusual transmission pathway.

Late-onset ventilator-associated pneumonia due to Mycobacterium chelonae and an unusual transmission pathway.

CLINICAL CHARACTERISTICS AND OUTCOME OF VENTILATOR ASSOCIATED PNEUMONIA IN PATIENTS WITH RENAL FAILURE

Background: Ventilator associated pneumonia (VAP) causes significant morbidity and mortality. Data from patients with preexisting renal failure is limited. Our aim was to evaluate the clinical characteristics and outcome of VAP in patients with renal failure and/or on maintenance hemodialysis. Material and Methods: A prospective observational study was conducted from February 2022 to February 2023. Patients &gt;18 years, on mechanical ventilation (MV) for &gt;48 hours, having underlying deranged renal function and who developed VAP were included. Demographics, cause of intubation, day of onset of VAP, clinical features, laboratory parameters and tracheal cultures were noted. Patients were followed till day 14 of VAP for mortality. Results: Out of 165 MV patients, 67 (40.60%) developed VAP, 33 (49.25%) in ≤ 4 days. The cause of intubation was respiratory distress in 58(86.8%) patients. In 61(91%) patients tracheal cultures were positive with Acinetobacter species (64%) as the most common organism and 93% of which were carbapenem resistant. Carbapenem resistant organisms were more frequently in case of late onset VAP (91.2% versus 72.7% p=0.049). A total of 42 patients (62%) died, 76 % within 7 days of VAP and 13 patients (19.40%) recovered with successful extubation. There was no significant difference in 14 days mortality between early or late VAP. Conclusion: VAP rates in patients with preexisting renal failure were 40%. Half of them developed in &lt;4 days. Acinetobacter spp. was the predominant causative agent. Attributed mortality was high at 63% where two thirds of patients died within 14 days. Keywords: Outcome, Renal failure, Ventilator associated pneumonia, Mechanical ventilator

A Clinical Study of Ventilator Associated Pneumonia

Background: Ventilator Associated Pneumonia is a significant cause of mortality and morbidity in the critical care setting. Ventilator Associated Pneumonias are highly preventable owing to identification of risk factors, causes and best practices in the ICU.Aims and Objectives :The present study is aimed at determining the incidence of Ventilator Associated Pneumonia and their associated risk factors.Materials and Methods: The present hospital based observational study included 50 cases on ventilator support from the ICU of Apna Hospital, Hyderabad. All the cases were included after consent and underwent detailed history taking, relevant clinical examinations and necessary laboratory investigations. The incidence of VAP’s was determined and the data was analysed to find the related factors. Data was collected in MS Excel, presented in as numbers and percentages in the form of tables and charts.Results: The incidence of Ventilator Associated Pneumonia was found to be 38%. Early Onset VAP was estimated to be 47.3%, Late Onset VAP to be 52.7%. There was male predominance(64%) in our study group. Age groups 40-60 years contributed the most of the study population. Diabetes, Hypertension, CVD, alcoholism and tobacco use were associated in VAP cases.Conclusion :There is a high incidence of Ventilator Associated Pneumonia in the critical care setting. Further research should be conducted to evaluate the causes and detailed risk factors as Ventilator Associated Pneumonia are a major cause of mortality, morbidity and increase the financial burden of the patient and the hospital.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain: Prevalence and antibiotics susceptibility pattern.

Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that. It is the most common infection encountered among intubated patients. VAP incidence showed wide variability between countries. To define the VAP incidence in the intensive care unit (ICU) in the central government hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern. The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020. It included adult and adolescent patients (> 14 years old) admitted to the ICU and required intubation and mechanical ventilation. VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score, which considers the clinical, laboratory, microbiological, and radiographic evidence. The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155. Forty-six patients developed VAP during their ICU stay (29.7%). The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period, with a mean age of 52 years ± 20. Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96 ± 6.55. Gram-negative contributed to most VAP cases in our unit, with multidrug-resistant Acinetobacter being the most identified pathogen. The reported VAP rate in our ICU was relatively high compared to the international benchmark, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Early- vs Late-onset Ventilator-associated Pneumonia in Critically Ill Adults: Comparison of Risk Factors, Outcome, and Microbial Profile.

Ventilator-associated pneumonia (VAP) is one of the most frequent hospital-acquired infections, which develops in mechanically ventilated patients after 48 hours of mechanical ventilation. The purpose of this study was to determine the incidence rate, various risk factors, microbiological profile, and outcome of early- vs late-onset ventilator-associated pneumonia (VAP) in medical intensive care unit (MICU). This prospective study was conducted on 273 patients admitted to the MICU in JIPMER, Puducherry, from October 2018 to September 2019. The incidence of VAP was 39.59 per 1000 ventilation days of MICU patients (93/273). Of these, 53 (56.9%) patients had early-onset VAP and 40 (43.1%) had late-onset VAP. Multiple logistic regression analysis showed that steroid therapy, supine head position, coma or impaired unconsciousness, tracheostomy, and re-intubation were found to be independent predictors of early- and late-onset VAP, respectively. Most cases of VAP were caused by Gram-negative bacteria (90.6%), with nonfermenters contributing to 61.8%. The most frequent pathogens causing early-onset VAP were Acinetobacter baumannii (28.9%) and Pseudomonas aeruginosa (20.6%), while in late-onset VAP, A. baumannii (32.9%) and Klebsiella pneumoniae (21.9%) were the most common. Maximum death rate was seen in patients infected with Escherichia coli (50%) and Stenotrophomonas maltophilia (38.5%). There was no significant association between the presence of VAP and mortality among the studied population. The incidence of VAP in our study was high. There were no significant differences in the prevalence of pathogens associated with early-onset or late-onset VAP. Our study shows that early-onset and late-onset VAP have different risk factors, highlighting the need for developing different preventive and therapeutic strategies. Gunalan A, Sastry AS, Ramanathan V, Sistla S. Early- vs Late-onset Ventilator-associated Pneumonia in Critically Ill Adults: Comparison of Risk Factors, Outcome, and Microbial Profile. Indian J Crit Care Med 2023;27(6):411-415.

[Regularity of ventilator-associated pneumonia induced by three common pathogens].

To investigate the incidence and infection regularity of ventilator-associated pneumonia (VAP) in patients undergoing tracheal intubation and to provide reference for the prevention and treatment of VAP infection in the future. A retrospective study was conducted to collect the microbial data of airway secretion cultures from 72 patients with endotracheal intubation admitted to the emergency ward of Shanghai Fifth People's Hospital from May 2020 to February 2021, and the species of microorganisms and intubation time were statistically analyzed. Among 72 patients with endotracheal intubation, males were more than females (58.33% vs. 41.67%); Patients over 60 years old accounted for 90.28%; pneumonia was the main primary disease, accounting for 58.33%. Pathogenic tests showed that: (1) 72 patients were infected with Acinetobacter baumannii (AB), Klebsiella pneumoniae (KP), and Pseudomonas aeruginosa (PA) 48 hours after intubation, 51.39% (37/72), 27.78% (20/72), and 26.39% (19/72), respectively. The infection rate of AB was significantly higher than that of KP and PA. Within 48 hours of intubation, the infection rates of AB, KP, and PA were 20.83% (15/72), 13.89% (10/72), and 4.17% (3/72), respectively. Of the 42 patients with primary pneumonia, 61.90% (26/42) were infected with one or more of the three pathogenic bacteria AB, KP, and PA 48 hours after intubation, indicating a change in the etiology of the pathogenic bacteria, with the main pathogenic bacteria transitioning from other pathogenic bacteria to AB, KP, and PA. (2) AB, KP, and PA were prone to cause late onset VAP (i.e., intubation ≥ 5 days). Respectively, among VAP patients infected with AB, late onset VAP accounted for 59.46% (22/37). Among patients infected with KP, 75.00% (15/20) had late onset VAP. Among patients infected with PA, late onset VAP accounted for 94.74% (18/19), indicating a higher proportion of late onset VAP caused by PA and KP. (3) Infection was closely related to intubation time, and the pipeline can be replaced according to the peak period of infection. AB and KP infections peaked within 4 days after intubation, reaching 57.69% (30/52) and 50.00% (15/30), respectively. It is recommended to replace the tubes or undergo sensitive antimicrobial therapy around 3-4 days after starting the machine. The proportion of PA infection after 7 days of intubation was 72.73% (16/22), and it was considered to replace the pipeline after 7 days. (4) Most of the three pathogenic bacteria, AB, KP, and PA were carbapenem resistant pathogens with multiple drug resistance. Except for PA, the infection rate of carbapenem resistant bacteria (CRAB, CRKP) was significantly higher than that of non-carbapenem resistant bacteria (AB, KP), accounting for 86.54% (45/52) and 66.67% (20/30) of the corresponding infection cases, respectively, while CRPA only accounts for 18.18% (4/22). The main differences in VAP infection caused by AB, KP, and PA pathogens are infection time, infection probability, and carbapenem resistance. Targeted prevention and treatment measures can be implemented for patients with intubation.

Detection of Pathogens and Antimicrobial Resistance Genes in Ventilator-Associated Pneumonia by Metagenomic Next-Generation Sequencing Approach.

The early identification of pathogens and their antibiotic resistance are essential for the management and treatment of patients affected by ventilator-associated pneumonia (VAP). However, microbiological culture may be time-consuming and has a limited culturability of many potential pathogens. In this study, we developed a rapid nanopore-based metagenomic next-generation sequencing (mNGS) diagnostic assay for detection of VAP pathogens and antimicrobial resistance genes (ARGs). Endotracheal aspirate (ETA) samples from 63 patients with suspected VAP were collected between November 2021 and July 2022. Receiver operating characteristic (ROC) curves were established to compare the pathogen identification performance of the target pathogen reads, reads percent of microbes (RPM) and relative abundance (RA). The evaluation of the accuracy of mNGS was performed comparing with the gold standard and the composite standard, respectively. Then, the ARGs were analyzed by mNGS. ROC curves showed that RA has the highest diagnostic value and the corresponding threshold was 9.93%. The sensitivity and specificity of mNGS test were 91.3% and 78.3%, respectively, based on the gold standard, while the sensitivity and specificity of mNGS test were 97.4% and 100%, respectively, based on the composite standard. A total of 13 patients were virus-positive based on mNGS results, while the coinfection rate increased from 27% to 46% compared to the rate obtained based on clinical findings. The mNGS test also performed well at predicting antimicrobial resistance phenotypes. Patients with a late-onset VAP had a significantly greater proportion of ARGs in their respiratory microbiome compared to those with early-onset VAP (P = 0.041). Moreover, the median turnaround time of mNGS was 4.43 h, while routine culture was 72.00 h. In this study, we developed a workflow that can accurately detect VAP pathogens and enable prediction of antimicrobial resistance phenotypes within 5 h of sample receipt by mNGS.

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.

Ventilator-associated pneumonia: Study of clinical outcome

Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia that develops within 48 hours or more of mechanical ventilation. It is also associated with significant morbidity including increased ventilatory days, intensive care unit (ICU) stay and higher medical cost that leads to high mortality rate in ICU. Aim: To evaluate the clinical outcome of the patients diagnosed with VAP and also to identify the risk factors for VAP. Methodology: This retrospective study included 27 patients admitted in Medical and casualty ICU's from August 2013 to April 2014 who were diagnosed with various diseases and later developed VAP. The patient's demographic data and diagnosis based on Centres for Disease Control and prevention (CDC) criteria were collected. Results: Among 27 patients, 20 were male patients and 7 were female patients. The order of organism according to the frequency in the current study was found to be Acinectobacter, Klebsiella, Pseudomonas aeruginosa, methicillin resistant Staphylococcus aureus, Streptococcus pneumonia, Hemophilus influenza, Enterobacter sp. Twenty two patients had late onset VAP and five patients had early onset VAP. Overall the survival was 52%. Conclusion: The incidence and the mortality of VAP are high in the current ICU setup. The mortality rate in the current study was 48% and the patients who survived had a longer ICU stay due to ventilator dependence.

A STUDY ON THE INCIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA IN THE ICU OF A TERTIARY CARE HOSPITAL

Ventilator Associated Pneumonia (VAP) is dened as pneumonia that occurs 48 h or more after endotracheal intubation or tracheostomy, caused by infectious agents not present or incubating at the time mechanical ventilation was started. VAP increases the length of ICU stay of a patient by around 28% and doubles the risk of mortality as compared with patients without VAP. The aim of the present study is to nd the incidence of VAP in ICU patients and the association of the causative organism. Out of 1429 patients on mechanical ventilation, 107(7.48%) fullled the criteria for VAP, out of which 45 were of early onset and 62 were of late onset VAP. The causative organisms were predominantly gram negative bacilli like Klebsiella pneumonia, Pseudomonas and Acinetobacter and few Gram positive cocci like Staphylococcus aureus and Enterococcus. VAP is a signicant problem as it leads to prolonged hospitalization and its implicated nancial burden. Prevention strategies and proper bundle care helps in mitigating these problems.

Microbial Pattern and their Sensitivity of Ventilator Associated Pneumonia in an Intensive Care Unit of a Ter-tiary Care Hospital in Dhaka

Background: ICU admission imposes great risk of nosocomial infections on the patients due to various invasive interventions. Patients treated in these units receive invasive procedures such as endotracheal intubation and mechanical ventilation which predispose to a nosocomial pneumonia of a special entity named as ‘Ventilator Associated Pneumonia’. Almost half of all the cases of hospital acquired pneumonia are due to VAP and about half of all antibiotics administration in ICU are for treatment of Ventilator Associated Pneumonia. Objectives: objective of the current study was to study the local microbiological profile of ventilator associated pneumonia and their sensitivity pattern in the Critical Care department of BIRDEM general hospital. Design: Cross-sectional study. Setting: ICU of an academic tertiary care hospital in the period of July 2017 to June 2018. Methods: All consecutive patients who were intubated and mechanically ventilated for a period of at least 48 hours within the study period were evaluated for the selection criteria of the study. The included study participants were followed up daily for signs of development of VAP. Once VAP was suspected pertinent investigations were sent to confirm the diagnosis. Tracheal aspirate was collected using conventional specimen trap and aseptic endotracheal suctioning technique and sent for Gram staining and culture and sensitivity testing. Results: In this study total 92 patients out of 625 intubated patients during the study period after fulfilling the inclusion criteria were selected as study participants. 35 participants out of 92developed VAP. Only 1 (2.9 %) patient did not yield any microbial growth in the tracheal aspirate sample and 34 (97.2 %) participants had growth of organisms in their tracheal aspirate samples. Total growths of 45 organisms were found in respiratory secretions of 34 VAP patients. The commonest organism was Acinetobacter which was grown in 21 (46.7%) samples followed by Pseudomonas in 10 (22.2%) samples; Klebsiella in 8 (17.8%) samples; Staphylococcus aureus in 3 (6.7%) samples; Candida in 2 (4.4%) and Enterococcus in 1 sample (2.2%). Most of the bacteria grown in the tracheal aspirates of VAP positive participants were sensitive to less than three antibiotic classes. Conclusion: Multidrug resistant organisms are mostly responsible for both early and late onset VAP in ICU. Bangladesh Crit Care J September 2022; 10(2): 122-126

Microbiological and Antibiotic Profile of Broncho-Alveolar Lavage Aspirate in Mechanically Ventilated Patients in a Tertiary Care Hospital

Introduction: VAP increases the patient stay in the ICU and indirectly increases the cost of patient management. Based on the time of onset of VAP, it can be divided into two types. Early-onset VAP occurs during the first four days of mechanical ventilation and is usually caused by antibiotic sensitive bacteria. Late-onset VAP develops five or more days after initiation of MV and is caused by multidrug-resistant (MDR) pathogens.5 Early diagnosis of VAP with appropriate antibiotic therapy can reduce the emergence of resistant organisms. Methods: This cross-sectional study was done in College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan after taking clearance from the institutional review committee. Study included all the patients who required mechanical ventilation for more than 72 hoursAll the included patients had their endotracheal tube aspirated using an ambu bronchoscope and sent to microbiology department for culture and sensitivity. The reports were collected after 72. Results: The most common organism grown during culture and gram staining were Acinetobacter Baumannii (81), followed by Klebsiella Peumoniae (44) than Pseudomonas Aeroginosa (32).. We observed a higher rate of culture positivity from the samples of male patients than those obtained from the female patients. Similar findings were observed by Morehead et al13and debjita debnath et al12 . In our study, gram-negative bacilli were the most commonly isolated pathogen from BAL which is similar to studies done by, debjita debnath, Fagon et al14 and Şimşek et al15. In our study, Acinetobacter Baumannii (81) was the most common  followed by Klebsiella Peumoniae (44) than Pseudomonas Aeroginosa (32),first line of antibiotics in patients who were mechanically ventilated were piperacillin plus tazobactam, meropenem,cotrimoxazole, amikacin and gentamicin. The second line drugs were polymyxin B, colistimethate and tigecycline. Conclusions: Acinetobactor Baumanni is the most common causative organism of ventilator associated pneumonia. In most of the cases first line antibiotics ( meropenem, amikacin and clotrimoxazole) are sensitive. Among the second line antibiotics, Polymyxin B was found to be most effective.

Frequency and Outcome of Ventilator Associated Pneumonia in an Intensive Care Unit of a Tertiary Care Hospital in Dhaka

Background: Intubation and mechanical ventilation are integral parts of critical care management. Though a lifesaving intervention, invasive mechanical ventilation imposes a great risk of nosocomial pneumonia to the patient. Ventilator associated pneumonia rates in an ICU is a predictor of successful infection control strategy. Objectives: objective of the current study was to study the frequency of ventilator associated pneumonia and its outcome in the critical care setting. Methods: This prospective observational cross-sectional study was done in department of critical care medicine of BIRDEM General Hospital for the period of 1st July, 2017 to 30th June, 2018. All consecutive patients who were intubated and mechanically ventilated for a period of at least 48 hours within the study period were evaluated for the selection criteria of the study. The included study participants were followed up daily for signs of development of VAP. Once VAP was suspected pertinent investigations were sent to confirm the diagnosis. Study participants were observed regularly to identify signs of pulmonary infection. The microbiological tests were done in the Department of Microbiology of BIRDEM. Quantitative culture was done (expressed as CFU/ml) and antibiotic sensitivity was done by standard disc diffusion method. A cutoff value of 105 CFU/ml was taken as a positive culture. CPIS score was calculated to diagnose VAP .The study participants were followed up to transfer to step down unit/ward or death to see the outcome. Data were collected in preformed data collection sheet and analyzed by the statistical packages for social sciences (SPSS) software version 22. Results: In this study total 92 patients out of 625 intubated patients during the study period after fulfilling the inclusion criteria were selected as study participants. The mean age of the the participants who developed VAP was 65.05±14.79 years with a range of 27 to 101 years. 62.9% (n=22) were female and 37.1% (n=13) were male. In this study DM, HTN &amp; Renal disease were the most common co-morbidities. Among the 35 VAP positive participants 51.4% (n=18) developed early onset VAP and 48.6% (n=17) developed late onset VAP. Among the VAP positive participants 31.4% were survivors and 68.6% were non-survivors and among the VAP negative participants 68.4% were survivors and 31.6% were non survivors (p=0.001). Conclusion: Frequency of VAP was 5.6% in the study. It was associated with significantly prolonged length of mechanical ventilation and length of ICU stay and high mortality. Bangladesh Crit Care J March 2022; 10 (1): 43-47

Risk Factors and Protective Factors against Ventilator-Associated Pneumonia-A Single-Center Mixed Prospective and Retrospective Cohort Study.

Introduction: Understanding the factors associated with the development of ventilator-associated pneumonia (VAP) in critically ill patients in the intensive care unit (ICU) will allow for better prevention and control of VAP. The aim of the study was to evaluate the incidence of VAP, as well as to determine risk factors and protective factors against VAP. Design: Mixed prospective and retrospective cohort study. Methods: The cohort involved 371 critically ill patients who received standard interventions to prevent VAP. Additionally, patients in the prospective cohort were provided with continuous automatic pressure control in tapered cuffs of endotracheal or tracheostomy tubes and continuous automatic subglottic secretion suction. Logistic regression was used to assess factors affecting VAP. Results: 52 (14%) patients developed VAP, and the incidence density of VAP per 1000 ventilator days was 9.7. The median days to onset of VAP was 7 [4; 13]. Early and late onset VAP was 6.2% and 7.8%, respectively. According to multivariable logistic regression analysis, tracheotomy (OR = 1.6; CI 95%: 1.1 to 2.31), multidrug-resistant bacteria isolated in the culture of lower respiratory secretions (OR = 2.73; Cl 95%: 1.83 to 4.07) and ICU length of stay >5 days (OR = 3.32; Cl 95%: 1.53 to 7.19) were positively correlated with VAP, while continuous control of cuff pressure and subglottic secretion suction used together were negatively correlated with VAP (OR = 0.61; Cl 95%: 0.43 to 0.87). Conclusions: Tracheotomy, multidrug-resistant bacteria, and ICU length of stay >5 days were independent risk factors of VAP, whereas continuous control of cuff pressure and subglottic secretion suction used together were protective factors against VAP.

Emergence of blaNDM-1 and blaVIM producing Gram-negative bacilliin ventilator-associated pneumonia at AMR Surveillance Regional Reference Laboratory in India.

IntroductionVentilator-associated pneumonia (VAP) may be a life threatening nosocomial infection encountered in intensive care units. Currently the emergence of carbapenem-resistant Gram-negative pathogens has become worrisome threat worldwide.Material and methodsEndotracheal aspirates samples were collected from patients who were under mechanical ventilation for > 48 h. The bacterial isolates were identified by MALDI-TOF-MS and antibiotic susceptibility testing performed. All carbapenem resistant isolates were tested by Modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and EDTA-CIM (eCIM) and PCR were performed to detect blaIMP, blaVIM and blaNDM producing MBL genes.ResultsVAP occurred in 172/353(48.7%), 23.3% had early-onset VAP and 76.7% had late-onset VAP. Males (69.2%) were found to suffer more from VAP. Prior antibiotic therapy, CPI>6, prior surgery and tracheostomy were associated with VAP. The mortality in VAP (58.1%) contrasted with non-VAP (40%). 99/169 (58.6%) Gram-negative isolates were resistant to carbapenems. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were common pathogens found in late onset VAP, whereas K. pneumoniae, A. baumannii and Staphylococcus aureus were common in early onset VAP. The PCR results detected blaNDM in 37/172(21.5%) and blaVIM in 30/172(17.4%); 15/172(8.7%) isolates carried both genes.ConclusionThe blaNDM-1 and blaVIM genes are the main antibiotic-resistance genes that induce resistance patterns to carbapenems in VAP, highlighting CRE strains of potential public health concern and therapeutic challenge. Diagnostic laboratories in India must get on high caution for early MBL detection as it may limit the wide dispersal of MBL genes.

Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is associated with increased hospital stay and high morbidity and mortality in critically ill patients. The aims of this study were to (i) determine the incidence of multidrug-resistant (MDR) pathogens in the first episodes of VAP and to assess potential differences in bacterial profiles of subjects with early- versus late-onset VAP. This was a retrospective cohort study over a period of 18 months including all patients who had a first episode of VAP confirmed by positive bacterial culture. Subjects were distributed into two groups according to the number of intubation days: early-onset VAP (<5 days) or late-onset VAP (≥5 days). The primary endpoint was the nature of causative pathogens and their resistance profiles. Sixty patients were included, 29 men and 31 women, with an average age of 38 ± 16 years. The IGS 2 at admission was 40.5 [32–44] and APACHE was 19 [15–22]. Monomicrobial infections were diagnosed in 77% of patients (n = 46). The most frequently isolated bacteria were A. baumannii, 53% (n = 32); P. aeruginosa in 37% (n = 22); Enterobacterales in 28% (n = 17) and S. aureus in 5% (n = 3). Ninety-seven percent of the bacteria were MDR. The VAP group comprised 36 (60%) episodes of early-onset VAP and 24 (40%) episodes of late-onset VAP. There was no significant difference in the distribution of the bacterial isolates, nor in terms of antibacterial resistances between early- and late-onset VAPs. Our data support recent observations that there is no microbiological difference in the prevalence of potential MDR pathogens or in their resistance profiles associated with early- versus late-onset VAPs, especially in countries with high rates of MDR bacteria.

Evaluation of Bacteria Causing Ventilator-Associated Pneumonia in Patients Admitted to Internal ICUs and Internal Wards at Shiraz Teaching Hospitals, 2017 - 2018

Background: Ventilator-associated pneumonia (VAP), a subset of hospital infections, occurs in patients who have been mechanically ventilated for at least 48 hours. Objectives: Our study aimed at determining the frequency and antibiotic susceptibility patterns of bacteria causing VAP in teaching hospitals of Shiraz. Methods: This was a descriptive cross-sectional study conducted in Shiraz for eight months (November 2017 to June 2018). Samples were detected according to diagnostic bacteriologic tests, and antibiotic susceptibility tests were performed by the disk diffusion (Kirby-Bauer) method based on the Clinical and Laboratory Standards Institute (CLSI). Results: A total of 51 patients with VAP were examined, of whom 10 and eight patients had a chronic obstructive pulmonary disease and acute respiratory distress syndrome, respectively. The late-onset VAP rate (61.7%) was higher than the early-onset VAP rate (38.3%). In our study, 45.2% of patients with VAP received antibiotics before the incidence of pneumonia, of whom 31.6% died. Of the remaining 54.8%, only 8.7% died. In other words, patients who received antibiotics before the incidence of pneumonia had higher mortality. The most frequently used antibiotics were meropenem (76.6%) and vancomycin (78.7%). Among 59 bacteria isolated, Acinetobacter and Pseudomonas were the most prevalent organisms. Conclusions: Our results showed that most of the isolates (40%) belonged to multi-drug resistant (MDR) pathogens. Probably, antimicrobial treatment before the onset of VAP led to the selection of these MDR pathogens.