PURPOSE: This prospective study was done over a period of two years in a medical-surgical ICU to establish the microbiological diagnosis in patients with ventilator associated pneumonia and drug sensitivity patterns.
METHODS: A total of forty patients were included, 29 males and 11 females.All patients on mechanical ventilation for more than 48 hours endotracheal tube or tracheostomy were evaluated for the development of VAP. Data regarding clinical suspicion of pneumonia were recorded. Patients more than 18 years who had no signs and symptoms of pneumonia at the time of admission and at the time of VAP suspicious chest radiograph changes with 2 out of 3 other criteria should be present.BAL was performed in an area of localized pulmonary infiltration, if present, if diffuse. All the statistical data was arranged serially to get clear results. The statistical analysis was done in the form of student's t test, Chi square test and canonical correlation.
RESULTS: Median age of the study group was 53.5 years. The incidence of early onset VAP was 25% (10/40) and late VAP was 75% (30/40). Mean duration of VAP was 3.2 days and late VAP was 13.1 days. In the early onset VAP 30% cases grew no organisms, 30% grew Pseudomonas sp, 10% each grew polymicrobial organisms including Klebsiella, Escherischia coli, Acinetobacter spp, and Candida spp. caused 20%. In late onset VAP, 36.3% episodes were due to polymicrobial pathogen followed by Pseudomonas species in 19.8% cases. Most commonly used antibiotics in the ICU were cephalosporins active against Pseudomonas and fluroquinolones. Among the sensitivity pattern of various organisms, maximum sensitivity was found for carbapenems, Tazobactum-Piperacillin and colistin groups of antibiotics. Empiric antibiotics matched significantly with the BAL culture sensitivity group.
CONCLUSION: Most common organisms causing VAP were polymicrobials followed by Pseudomonas species. All the VAP pathogens and empiric therapy in VAP cases matched significantly with BAL culture and sensitivity results.
CLINICAL IMPLICATIONS: Empiric therapy in VAP in accordance with the treatment guidelines is good enough to treat VAP.
DISCLOSURE: Pratibha Gogia, No Financial Disclosure Information; No Product/Research Disclosure Information