A study on poor prognostic factors associated with ventilator associated pneumonia at a tertiary care hospital


  • Raveendra K. R. Department of Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Suraj S. Hegde Department of Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India




Clinical pulmonary infection scoring system, Hospital acquired infection, Intensive care unit, Ventilator associated pneumonia


Background: Ventilator associated pneumonia (VAP) is a hospital acquired infection (HAI) seen among critically ill patients, on mechanical ventilation, due to various causes in intensive care units (ICUs). It is associated with increased morbidity and mortality which increases the cost of health care. The aim of this study was to determine the poor prognostic factors associated with VAP.

Methods: In this cross-sectional prospective study,40 patients who developed features of ventilator associated pneumonia on a platform of mechanical ventilator for >48 hrs in ICU were included in the study. VAP was then diagnosed based on clinical pulmonary infection scoring system (CPIS) with a score of >=6. All patients were evaluated and correlated with different parameters for the treatment and outcome.

Results: Most of the patients had late onset VAP (60.7%) with average number of days being around 8 days. Pseudomonas, Acinetobacter, Enterobacteriacea, Staphylococcus aureus were commonly isolated organisms. Polymicrobial infections were not detected. Antibiotics like colistin, tigecycline and beta-lactamases are the most commonly effective antibiotics. Of the 40 VAP patients,20 patients survived and  20 died with protocol line of treatment. Following poor prognostic factors were identified-Early onset VAP (42.5%), elderly patients (>65 years) (90%), Type 2 DM (80%), hypertension (70%), prior antibiotic therapy (65%), prolonged supine position (68%) and re-intubation (75%).

Conclusions: Ventilator associated pneumonia is associated with a significant increase in length of stay in ICU, time of mechanical ventilation and different complications and certain risk factors further worsens the prognosis.


Harrison’s principles of Internal Medicine. 19th Edition, Pneumonia; chap. 257;2015:2456-2460.

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

Gupta A, Agarwal A, Mehrotra S, Singh A, Malik S, Khanna A. Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia. Indian J Crit Care Med. 2011;15:96-101.

Rit K, Chakraborty B, Saha R, Majumder U. Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multi drug resistant pathogens. Int J Med Public Health. 2014;4:51-62.

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.

Ambrose PG, Grasela DM, Grasela TH, Passarell J, Mayer HB, Pierce PE. Pharmacodynamics of fluoroquinolones against Streptococcus pneumoniae in patients with community-acquired respiratory tract infections. Antimicrob. Agents Chemother. 2001;45:2793-7.

Gardani H, Vyas A, Kar AK. A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesthesia. 2010;55:555-62.

Kanafani ZA, Kara L, Hayek S, Kanj SS. Ventilator associated pneumonia at a tertiary care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms. Infect Control Hosp Epidemiol. 2003 Nov;24(11):864-9.

Dey A, Bairy I. Incidence of multidrug resistant organisms causing ventilator associated pneumonia in a tertiary care hospital: A nine months’ prospective study. Ann Thorac Med. 2007 Apr;2(2):52-7.

Inchai J, Pothirat C, Bumroongkit C, Limsukon A. Prognostic factors associated with mortality of drug-resistant Acinetobacter baumanni ventilator-associated pneumonia. J Intensive Care. 2015;3:330-5.

Walaszek M, Rozanska A, Walaszek MZ. Epidemiology of Ventilator-Associated pneumonia, microbiological diagnosis and the length of antimicrobial treatment in the Polish Intensive Care Units in the years 2013-2015. BMC infectious diseases. 2018;18:308.

Chang L, Dong Y, Zhou P, Investigation on risk factors of Ventilator-associated pneumonia in acute cerebral haemorrhage patients in Intensive care unit. Critical Care Clinics. 2017;33:293-310.

Elkolaly R, Bahr H, El-Shafey B. Incidence of Ventilator-Associated pneumonia:Egyptian study. Egyptian J Bronchol. 2019;13:258-66.

Chastre, J. Conference summary: ventilator-associated pneumonia. Respir Care. 2005;50:975-83.






Original Research Articles