Abstract

Mishra V., Pal N., Sujatha R.* and Bhatiani A.

ABSTRACT

Hospital-acquired infections (HAI) are a significant cause of increased morbidity and mortality in hospitalized patients due to invasive devices to assist life of critically ill patients. This study was conducted to measure the incidence, associated risk factors, pathogenic microorganism and its antimicrobial sensitivity pattern in a tertiary care center. Materials & Methods: A Prospective study of 109 patients who were mechanically ventilated for more than 48 hours from July 2015 to June 2016 were observed for the development of Ventilator Associated Pneumonia (VAP). All the clinical details were monitored for Clinical Pulmonary Infection Scoring System (CPIS) and risk factors. Endotracheal aspirates or secretions were microbiologically analyzed for microbial growth and antimicrobial sensitivity testing was done. Results: Twenty three (21.1%) out of 109 patients developed ventilator associated pneumonia, majority of them were elderly (47.8%). Positions of the patients’ i.e. Supine position, comatose patients, longer duration of mechanical ventilation (>10 days) and low PaO2/FiO2 were found to be major risk factors. Nine patients (39.1%) developed early onset VAP and rest of cases, 14 patients (39.1%) developed late onset VAP. COPD (50%) was found to be the most common comorbidity followed by diabetes (40.9%), hypertension (22.7%), renal failure (1829%) and cardiovascular diseases (9.1%) among patients developed VAP. Klebsiella pneumoniae (47.8%) was the most frequent isolates followed by Acinetobacter baumannii (21.7%), Pseudomonas aeruginosa (17.4%) and Candida species (13.0%; C.albicans 4.3% and C.krusei 8.7%). Isolates were highly resistant to most of the antimicrobial Agents but showed better sensitivity to piperacillin tazobactum, cefoperazone sulbactum, Imipenem and Meropenem. All the gram negative bacilli were 100% sensitive against Polymyxins. Conclusion: Incidence of VAP in our setting is high. It is very important to treat each patient at the earliest and follow all the preventive measures through a proper Infection Prevention & Control Practices, keeping in mind the risk factors.