PURPOSE: The recognition, diagnosis and treatment of Ventilator-Associated Pneumonia (VAP) rely on the understanding of its incidence, risk factors, etiology, and prognosis. We reviewed our cases at our Intensive Care (ICU) and Coronary Care Units (CCU) to define the local epidemiology of VAP.
METHODS: Retrospective cohort of all patients > 16 years of age admitted in the ICU and CCU who required mechanical ventilation > 48 hours from July 1, 2003 to July 31, 2004. Patients were excluded if there was any clinical evidence of bacterial or aspiration pneumonia at the time of admission. Case definition for VAP was based on the modified Clinical Pulmonary Infection Score. The incidence of VAP and its risk factors were determined. Tracheal aspirate isolates and sensitivity patterns were recorded.
RESULTS: VAP developed in 34.2% (n=39) of 114 mechanically ventilated patients. Significant risk factors to VAP were concurrent neurological disorder (RR, 1.7, 95% CI, 1.1-2.9) and tracheostomy (RR, 2.5, 95% CI 1.7-3.9). Use of proton-pump inhibitors was significantly protective against VAP (RR, 0.17, 95% CI, 0.05-0.68). The occurrence of VAP was significantly associated with longer duration of mechanical ventilation (10 vs. 5 days, p <0.001) and hospital stay (21 vs. 12, p=0.004). The presence or absence of VAP did not significantly change the mortality rate (38% vs. 40%, p= 0.52) The most common tracheal isolates were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumanii. Sensitivity was highest to imipenem and lowest for cefuroxime.
CONCLUSION: The incidence of VAP in our setting is high. Its presence did not increase mortality but was associated with a longer duration of mechanical ventilation and hospital stay. Concurrent neurological disorders and tracheostomy were associated with increased risk while the use of proton-pump inhibitor was associated with protection against VAP.
CLINICAL IMPLICATIONS: Our incidence of VAP is high and programs to its prevention need to be implemented. Our data suggests that the use of proton-pump inhibitor seems to be protective against VAP albeit further studies are needed.
DISCLOSURE: Aileen Michelle Vidal, None.