Published: 2018-03-21

Pattern and incidence of ventilator associated pneumonia among mechanically ventilated patients

Mukesh Dube, Shraddha Goswami, Abhishek Singh, Bhavani Mohan Raju, Pradip Dube, G. C. Bhatia


Background: Initial empirical therapy of ventilator-associated pneumonia (VAP), which is based on organisms recovered, can be modified based on the knowledge of local microbiological data, patient characteristics, and sensitivity pattern of expected pathogens at the institution. Aim of this study was conducted to observe the regional the incidence of VAP among mechanically ventilated patients.

Methods: All the patients who conformed to the inclusion criteria of the study, and who were in the ICU settings and put on ventilatory support, underwent vigorous aseptic precautions and later on developed VAP were taken into the study.

Results: Total 374 admitted patients were needed mechanically ventilation. Among 31 developed LRTI. The Overall incidence rate of VAP was computed to be 8.2% with highest rate among patients of age group 31-50 years. The incidence rates of VAP were found highest for Acinetobacter (54.8%) with second highest mortality (47%) whereas maximum mortality (66.66%) was caused by Klebsiella, the second most common incidence of VAP. Twenty-one patients developed early VAP whereas remaining 10 subjects developed late VAP. Mortality was higher between early VAP (57.14%) compared to the late VAP cases (30%). Majority of organisms were sensitive to Cefoperazone + Sulbactum (29), Imipenem (24) and Meropenem (22).

Conclusions: Despite advances in diagnostic and treatment modalities of VAP, its management still continues to be a challenge for clinicians. The findings emerging out of this investigation will help in initial selection of antibiotics for the empiric treatment of VAP. Later on, therapy can be modified based on the knowledge of pattern and profile of VAP patients along with sensitivity pattern of expected pathogens.


Intensive care unit, Mechanical ventilation, Ventilator-associated pneumonia

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Koenig SM, Truwit JD. Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention. Clin Microbiol Rev. 2006;19(4):637-57.

Davis KA. Ventilator-associated pneumonia: a review. J Intensive Care Med. 2006;21:211-26.

Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbiol Rev. 2006;19:637-57.

Masih SM, Goel S, Singh A, Tank R, Khichi SK, Singh S. Incidence and risk factors associated with development of ventilator- associated pneumonia from a tertiary care center of northern India. Int J Res Med Sci. 2016;4:1692-7.

Niederman MS, Craven DE. Guidelines for the management of adults with hospital-acquired, ventilator-associated and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388-416.

Chastre J, Combes A, Luyt CE. The invasive (quantitative) diagnosis of ventilator-associated pneumonia. Respir Care. 2005;50:797-812.

Rakshit P, Nagar VS, Deshpande AK. Incidence, clinical outcome, and risk stratification of ventilator- associated pneumonia-a prospective cohort study. Indian J Crit Care Med. 2005;9:211-6.

Panwar R, Vidya SN, Alka KD. Incidence, clinical outcome and risk stratification of ventilator- associated pneumonia: a prospective cohort study. Indian J Crit Care Med. 2005;9:211-6.

Suka M, Yoshida K, Uno H, Takezawa J. Incidence and outcomes of ventilator-associated pneumonia in Japanese intensive care units: the Japanese nosocomial infection surveillance system. Infect Control Hosp Epidemiol. 2007;28:307-13.

Thongpiyapoom S, Narong MN, Suwalak N, Jamulitrat S, Intaraksa P, Boonrat J, et al. Device-associated infections and patterns of antimicrobial resistance in a medical- surgical intensive care unit in a university hospital in Thailand. J Med Assoc Thai. 2004;87:819-24.

Cook D, Walter S, Cook R, Griffith L, Guyatt G, Leasa D, et al. Incidence and risk factors for ventilator associated pneumonia in critically ill patients. Ann Int Med. 1998;129:433-40.

Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867-903.

Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece. Respir Care. 2003;48:681-8.

Coppadoro A, Berra L, Bigatello LM. Modifying endotracheal tubes to prevent ventilator-associated pneumonia. Curr Opin Infect Dis. 2011;24(2):157-62.

Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens. J Infect Dev Ctries. 2010;4(4):218-25.

Villegas MV, Hartstein AI. Acinetobacter outbreaks, 1977-2000. Infect Control Hosp Epidemiol. 2003;24: 284-90.

Celis R, Torres A, Gatell JM, Almela M, Rodriguez RR, Vidal AA. Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest. 1988;93:318-24.

Cometta A, Baumgartner JD, Lew D, Zimmerli W, Pittet D, Chopart P, et al. Prospective randomized comparison of imipenem monotherapy with imipenem plus netilmicin for treatment of severe infections in nonneutropenic patients. Antimicrob Agents Chemother. 1994;38:1309-13.