Ventilator-associated pneumonia: Incidence, risk factors, outcome, and microbiology.
OBJECTIVE
To determine the incidence, risk factors, outcome, and pathogens of ventilator-associated pneumonia (VAP) in a cardiac surgical intensive care unit (ICU).


METHODS
Prospective study.


METHODS
Escorts Heart Institute and Research Centre, New Delhi, India.


METHODS
Nine hundred fifty-two consecutive patients undergoing cardiac operations who received intermittent positive-pressure ventilation (IPPV).


METHODS
All patients were assigned into VAP (n = 25) and non-VAP (n = 927) groups.


RESULTS
Risk factors and other variables were analyzed with univariate and multivariate analysis. Of the 952 patients studied, 25 (2.6%) had VAP. On univariate analysis, significant risk factors were emergency surgery, chronic obstructive pulmonary disease (COPD), reintubation, coma, steroid treatment, intra-aortic balloon counterpulsation (IABC), enteral feedings, tracheostomy, acute physiology, age, and chronic health evaluation (APACHE II) score, prior antibiotics, and IPPV hours. On multivariate analysis, IPPV hours (153.75 +/- 114.44 v 19.65 +/- 7.99; p < 0.001) and steroids (20% v 0%; p < 0.001) were independent predictors of VAP. The most common pathogens isolated were Pseudomonas aeruginosa (22), Escherichia coli (10), Klebsiella pneumoniae (4), Staphylococcus species (4), and Acinetobacter species (2). The mortality rate in VAP was 16% as compared with 0.2% in non-VAP cases (p < 0.001).


CONCLUSIONS
These data suggest that by univariate analysis the risk factors for VAP were emergency surgery, COPD, reintubation, coma, steroid treatment, IABC, enteral feedings, tracheostomy, APACHE II score, prior antibiotics, and IPPV hours. On multivariate analysis, only IPPV hours and steroids were independent predictors of VAP. Pseudomonas aeruginosa is the most common pathogen associated with VAP, and the mortality is increased with VAP.
Pawar
Mandakini
M
Department of Anaesthesiology and Microbiology, Escorts Heart Institute and Research Centre, New Delhi, India.
Mehta
Yatin
Y
Khurana
Poonam
P
Chaudhary
Anshumali
A
Kulkarni
Vinay
V
Trehan
Naresh
N
D006348:Cardiac Surgical Procedures; D003325:Coronary Care Units / Q000706:statistics & numerical data; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D011446:Prospective Studies; D013210:Staphylococcus / Q000302:isolation & purification; D013256:Steroids / Q000627:therapeutic use; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D012122:Ventilators, Mechanical / Q000009:adverse effects*
D013256:Steroids