RESUMO
Objective: To evaluate the spectrum of ventilator-associated pneumonia [VAP] and relation of length of intensive care unit [ICU] stay, patient's age and gender on the likelihood of being discharged from the ICU
Study Design: A cross sectional study
Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan over a period of 12 months extending, from Apr 2015 to Apr 2016
Material and Methods: We included 470 patients out of whom only 106 patients were diagnosed with VAP while on mechanical ventilation in ICU for >48 hours. A positive culture of tracheo-bronchial secretions, with any one of these; >48-h infiltrate on chest radiograph, fever of >38.3[degree]C, leukocytosis of >12 x 10[9]/ml and increase in tracheo-bronchial secretions established the diagnosis of VAP
Results: The mean age of the male and female patients was 49.8 +/- 18 years and 50.6 +/- 21.4 years respectively with 16.6 +/- 13 days as the mean duration of ICU stay. About 30.2% VAP patients had Acinetobacterbaumanni with 96.8% sensitivity to colistin, 27.4% patients had Klebsiella pneumonia with 72% and 62% sensitivity to colistin and carbapenems respectively and 15.1% patients had methicillin-resistant Staphylococcus aureus with 100% sensitivity to vancomycin. There was an increased incidence 60.4% of late-onset VAP compared to 39.6% early onset VAP. The overall mortality in VAP patients was 28.6%
Conclusion: We recommend the empirical combination therapy of colistin, carbapenem, and vancomycin in VAP. No statistical significant association was found between length of ICU stay and patient's mortality. The odds of getting discharged were found to be 3.2 times greater for male participants as opposed to female patients. Decreasing age was associated with an increased likelihood of being discharged
RESUMO
Intensive Care Units [ICUs] experience higher infection rates due to the severity of illness and frequent use of invasive devices. Use of personal protective equipment reduces the risk of acquiring an infection. This study has been conducted to determine the role of using shoe covers by medical staff and visitors on infection rates, mortality and length of stay in ICU. It is a descriptive study, performed in Shifa International Hospital, Islamabad from January 2012 to July 2012. The rates of infection [by checking patients for common ICU pathogens], mortality and length of stay of patients admitted in MICU and SICU from January 2012 to March 2012 were measured. Use of shoe covers was abandoned during this period. The same parameters were measured for the patients admitted from May, 2012 to July, 2012; the period during which shoe covers were strictly used by all the staff members and visitors. The data was then analyzed and compared using chi-square test with significance value at p < 0.05. A total of 1151 patients were studied in 06 months period. Among the two groups of patients, managed with and without using shoe covers in ICU, statistically significant decrease was seen in terms of length of ICU stay[as P value is less than 0.05] in patients managed in duration of shoe covers. However, the time period in which shoe covers were used the infections with three common ICU pathogens MRSA, VRE and acinetobacter were statistically significant more than the periods in which shoe covers were not used. There was no significant difference in mortality for both groups [P value = 0.146]. Use of shoe covers in critical care area is not helpful in preventing infections of common ICU pathogens and length of stay in ICU patients; nor has it decreased the mortality