A Prospective Observational Study of Ventilator-Associated Pneumonia in a Tertiary Care Centre, KGH, Visakhapatnam

Abstract

BACKGROUND Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia1 in mechanically ventilatedchildren that develops after 48 hrs of initiation. It is one of the leading causes of morbidity and mortality among hospital-acquired infections.2,3 VAP complicates 8-28 % of the children receiving mechanical ventilation. The incidence of VAP is estimated to be 3 to 10 % of the ventilated PICU children in developed countries. Studies from India have shown a contrastingly high range of VAP rates of 6 % to 46 %. The mortality rate with VAP considerably increased, varying from 24 to 50 % and can reach as high as 76 % when high-risk pathogens cause lung infection.4 Several risk factors predispose to VAP development during mechanical ventilation, as shown in different studies. Most of the risk factors are preventable, which can reduce the incidence of VAP when appropriately managed. As there is an increased use of mechanical ventilation in developing countries like India because of delays in reaching the hospital, the condition of the child is critical. The poor living conditions of the children who come to the tertiary care centres from remote rural areas often present with poor general conditions. We wanted to know about the risk factors, organisms causing VAP, their antibiotic sensitivity, and for optimal VAP management to reduce health care costs, guide antibiotic therapy, and reduce the morbidity and mortality associated with the VAP. METHODS A prospective observational study was done at PICU, King George Hospital, Visakhapatnam from December 2018 to July 2020 for a period of 20 months on children aged > 1 month to 12 years, who were kept more for than 48 hours in PICU. The sample size was 126. RESULTS All PICU children between theage group of > 1 month and < 12 years who received mechanical ventilation (MV) for > 48 hours were consecutively enrolled in the study. A total of 126 children were enrolled during the study period. CONCLUSIONS VAP is an important nosocomial infection in PICU with an incidence of 26 % and was associatedwith a high mortality rate of 38.5 %. Gram-negative bacilli (acinetobacter and klebsiella) were the important causative agents that were nearly resistant to commonly used antibiotics. KEY WORDS ARDS, BAL, CPIS, ETA, VAP, MDR, MASA. HF, PAWP.