Nosocomial pneumonia in medical intensive care unit.

ABSTRACT

OBJECTIVES: This study was undertaken to determine incidence, clinical features, microbiological flora and prognosis of patients with nosocomial pneumonia (NP) in medical intensive care unit (ICU). Also to study impact of comorbid illnesses, intubation and mechanical ventilation on outcome. METHODS: In this prospective study over a period of one year 89 patients were detected to have nosocomial pneumonia amongst 948 total admissions in ICU. All these 89 patients were investigated radiologically, microbiologically and biochemically. Mortality in these patients was correlated with various factors using chi-square test. RESULTS: Incidence of NP was 9.38%. Enteric gram-negative organisms were commonest isolates (61.9%), followed by Staph aureus (29.8%). Sixty five (73%) patients had severe pneumonia, 47 (52.8%) required intubation and 42 (47.2%) mechanical ventilation. Total mortality was 19 out of 89 (21.3%). High mortality was associated with habits like smoking (33.3%), age group over 60 years (27.3%), presence of comorbid illness like DM and COAD (38.5%), complications like ARDS (61.3%, p < 0.001) or sepsis with end organ failure (73.7%, p < 0.001) and need of intubation (36.2%) or mechanical ventilation (40.5%, p < 0.005). CONCLUSION: Nosocomial pneumonias constitute important problem in medical ICU and are associated with high mortality. Patients with advanced age, co-morbid illness, ARDS and end organ failure are at high risk for mortality. However with intensive supportive care and appropriate antibiotics many such lives can be saved.