Incidence and attributable costs of ventilator-associated pneumonia [VAP] in a tertiary-level intensive care unit [ICU] in northern India

Ventilator-associated pneumonia [VAP] is the most common nosocomial infection acquired by patients in the intensive care unit [ICU]. However, the economic effects of such infections remain unclear particularly in developing countries. Patients who were mechanically ventilated for more than 48 h in the ICU were studied for the occurrence of VAP. Total drug costs and hospital costs were noted, and attributable costs were calculated after adjusting for potential confounders. Ninety-five [38%] patients who were ventilated for more than 48 h developed VAP, which resulted in an incidence of 40.1 VAP infections/1000 mechanical ventilation days. The patients with VAP experienced significantly longer hospital stay [21 [IQ = 14-33] days versus 11 [IQ = 6-18] days, P < 0.0001]] and incurred greater hospital costs [USD $6250.92 [IQ = 3525.39-9667.57] versus $2598.84 [IQ = 1644.33-4477.65], P < 0.0001]. Multiple regression analysis revealed that the cost-driving factors in our study population were the occurrence of VAP infections [P < 0.0001] and the duration of hospital stay [P < 0.0001]. The attributable cost of VAP infection was calculated to be USD $5200 [95% CI = 3245-7152]. We conclude that VAP significantly increases the costs of treatment in low-income developing countries. This study highlights the need to implement urgent measures to reduce the incidence of this disease in ICUs

Acinetobacter infections in a tertiary level intensive care unit in northern India: epidemiology, clinical profiles and outcomes

Nosocomial Acinetobacter infections are an increasing concern in intensive care units [ICU]. To study the demographic and clinical characteristics and the outcomes of ICU patients with Acinetobacter infections. A retrospective, 1-year audit of all Acinetobacter infections diagnosed in ICU patients between January 1 and December 31, 2009. Acinetobacter infection occurred in 94 patients [108 episodes]. The most common site of infection was the respiratory tract [83 patients, 76.85%], with medical patients being more susceptible than surgical patients to Acinetobacter lung infections [P = 0.04], particularly late-onset ventilator-associated pneumonia [VAP] [P = 0.04]. The majority [63.8%] of infections were acquired in the ICU, and patients with ICU acquired infections were intubated significantly longer than the other patients [P = 0.02]. Seventy percent of the infections were caused by multidrug-resistant [MDR] strains, and the overall crude mortality rate was over 70%. The most important factors affecting mortality were the duration of intubation [P = 0.001] and the inappropriate use of antibiotics [P = 0.021] after diagnosis of the infection. Acinetobacter infections are highly prevalent in the ICU, with medical patients being more susceptible to lung infections, particularly late-onset VAP. The early and appropriate selection of antibiotics is the most important determinant of survival among these patients