Incidence and risk factors of ventilator associated pneumonia [VAP] in a medical ICU in Cairo

ABSTRACT

In Egypt, the published data concerning Ventilator-Associated Pneumonia [VAP] rates, microbiological profile, bacterial resistance or any related risk factors associated with VAP incidence are limited. To assess the incidence rate of VAP and to evaluate the associated risk factors in a medical ICU unit in a tertiary care hospital in Cairo. In this prospective study, a total of 271 patients were mechanically ventilated for 3735 days. Lower respiratory tract specimen was obtained through blind [non bronchoscopic] bronchoalveolar lavage using sterile mucous trap. The isolated microorganisms and their antimicrobial sensitivities were identified based on the standard bacteriological procedures. Of 271 patients, 69 developed VAP [25.5%]. The incidence of VAP was 18.47 per 1000 ventilation days. Seventy one isolates were isolated from 69 cases. Klebsiella pneumoniae [K. pneumoniae] was the most commonly identified organism [21.1%], followed by Staphylococcus aureus [S. aureus=19.7%], aeruginosa spp. [18.3%] and Pseudomonas acinetobacter [Ps. aeruginosa=16.9%]. The isolated organisms showed variable antimicrobial resistance patterns. Univariate analysis of risk factors for acquiring VAP; identified increased duration of mechanical ventilation [MV] and reintubation more than two times as significant risk factors [p-value<0.01]. Patients who developed VAP also had significantly longer duration of hospitalization than those who did not. Same results were confirmed by multivariate analysis. ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. Knowledge of the risk factors associated with VAP incidence may be useful in implementing simple and effective preventive measures: