Ventilator Associated Pneumonia in NICU at a Tertiary Care Centre of Surat: A cross sectional analytic study
Abstract
Ventilator associated Pneumonia (VAP) occurs in about 9-27% of intubated neonate patients and has a mortality rate of 27% to 43% depending on the causative agent. Such high mortality, increased morbidity, increased hospital stay and costs make the VAP crucial. This present study was conducted to determine the proportion of VAP among Neonatal Intensive Care Unit (NICU) with risk factors of acquiring VAP with the outcomes of these cases. This prospective observational study was conducted from October 2016 to October 2017 at a tertiary care center attached with a medical college. Total of 85 neonates of both sexes who have been intubated for >48 hours, were studied. Outcome of these patients was assessed in terms of onset of symptoms and the result of treatment given and survival of patient. In present study, 45.9% was the proportion of VAP among NICU neonates. Out of these 67% cultures were sterile while 33% showed growth. Most common causative organism being Pseudomonas (31%) followed by CONS (23%), Acinobacter, Klebsiella (15% each), E. Coli and S. Aureus (8% each). In terms of disease onset 23% subjects developed VAP within 5 days and regarding mortality 18% patients with VAP died & 72% were discharged.
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Introduction
The CDC defines Ventilator associated pneumonia (VAP) as nosocomial infection occurring in patients admitted to critical care units for more than 48 hours after endotracheal intubation and initiation of mechanical ventilation1 .
VAP occurs in 9-27% of all intubated patients. It is associated with increased morbidity, length of stay in hospital and costs. The mortality rate attributable to ventilator associated pneumonia is 27% and has been as high as 43% when the causative agent is antibiotic resistant2 . The high prevalence of VAP in the NICU compels a thorough assessment of causative agents, progress and outcomes of VAP.
Studies have also been done to determine microorganisms involved with VAP. Poonam et al (2005) studied ventilator associated pneumonia and demonstrated the high incidence of pneumonia caused by Pseudomonas spp. and E. coli spp.3 and Joseph et al (2009) showed that Pseudomonas aeruginosa, A.baumannii and Staphylococcus aureus were the most common pathogen associated with ventilator associated pneumonia. 4 Continuous meticulous collection of epidemiological data of incidence, organisms and outcomes is necessary in each ICU in order to initiate adequate antimicrobial therapy and to improve outcomes.
One significant study done on the subject by Joseph et al4 found that the crude mortality rate of patients with VAP was 16.2%. There was no statistically significant difference in mortality between VAP and non VAP groups. (16.2% vs. 20.5%). 5
Conclusion
It can be concluded from this present study that proportion of VAP among intubated neonates in the NICU was 45.9%. Low birth weight, early gestation, increased the risk of VAP was not found to be associated with VAP. No statistical significance difference was seen with respect to increased morbidity, longer duration of hospital stay and MV. No significant difference was noted in mortality between the two groups. The most common causative agents were Pseudomonas, Acinobacter, Klebsiella, E. Coli and S. Aureus.