Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units!

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection acquired by patients in the Intensive Care Unit (ICU). However, there are scarce clinical data, particularly from Indian ICUs on the occurrence of this infection.

AIMS: To collect data on the incidence, microbiological profile, and outcomes of patients with VAP.

SETTINGS AND DESIGN: Tertiary level, medical-surgical ICU; prospective, observational study.

SUBJECTS AND METHODS: All patients who were mechanically ventilated for >48 h in the ICU during the study were enrolled. VAP was diagnosed according to the Centre for Disease Control (CDC) criteria.

RESULTS: A total of 95 (38%) patients developed VAP infections, an incidence of 40.1 VAP infections/1000 mechanical ventilation days. These were predominantly caused by Gram-negative organisms, especially the Acinetobacter species (58 isolates, 53.2%). Many of the VAP-causing isolates (27.3%) demonstrated multidrug resistance. Patients with VAP infections experienced a significantly longer ICU stay (13 days [Interquartile Range (IQ) range = 10-21] vs. 6 days [IQ = 4-8], P < 0.0001) and total hospital stay (21 days [IQ = 14-33] vs. 11 days [IQ = 6-18], P < 0.0001). While the overall mortality rates were similar between patients with or without VAP infections, (68.4% vs. 61.3%, P = 0.200), on subgroup analysis, elderly patients (>60 years) and those with higher Acute Physiology and Chronic Health Evaluation II scores at admission had significantly greater mortality rates if they acquired a VAP infection (P = 0.010).

CONCLUSIONS: VAP continues to be a major threat to patients who are admitted for mechanical ventilation into the critical care unit, emphasizing the urgent need for infection control measures.