Ventilator-associated pneumonia in a tertiary care hospital in India: incidence and risk factors.
BACKGROUND
Knowledge of the incidence of ventilator-associated pneumonia (VAP) and its associated risk factors is imperative for the development and use of more effective preventive measures.


METHODS
We performed a prospective study over a period of 15 months to determine the incidence and the risk factors for development of VAP in critically ill adult patients admitted in different intensive care units (ICUs) of Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), a tertiary care hospital in Pondicherry, India.


RESULTS
The incidence of VAP was 30.67 and 15.87 per 1,000 ventilator days in the two different ICUs. In our study 58.3% of the cases were late-onset VAP, while 41.7% were early-onset VAP. Univariate analysis indicated that the following were significantly associated with VAP: impaired consciousness, tracheostomy, re-intubation, emergency intubation, and nasogastric tube. Emergency intubation and intravenous sedatives were found to be the specific risk factors for early onset VAP, while tracheostomy and re-intubation were the independent predictors of late-onset VAP by multivariate logistic regression analysis.


CONCLUSIONS
Knowledge of these risk factors may be useful in implementing simple and effective preventive measures including non-invasive ventilation, precaution during emergency intubation, minimizing the occurrence of reintubation, avoidance of tracheostomy as far as possible, and minimization of sedation.
Joseph
Noyal Mariya
NM
Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. noyaljoseph@yahoo.com
Sistla
Sujatha
S
Dutta
Tarun Kumar
TK
Badhe
Ashok Shankar
AS
Parija
Subhash Chandra
SC
D000328:Adult; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000009:adverse effects