title: Determinants of ventilator associated pneumonia and its impact on prognosis: A tertiary care experience.
abstract: BACKGROUND
  Ventilator associated pneumonia (VAP) is a major cause of poor outcome among patients in the intensive care units (ICU) world-wide. We sought to determine the factors associated with development of VAP and its prognosis among patients admitted to different ICUs of a Tertiary Care Hospital in India.
  
  
  METHODS
  We did a matched case control study during October 2009 to May 2011 among patients, ≥18 years with mechanical ventilation. Patients who developed pneumonia after 48 h of ventilation were selected in the case group and those who did not develop pneumonia constituted the control group. Patients' history, clinical and laboratory findings were recorded and analyzed.
  
  
  RESULTS
  There were 52 patients included in each group. Among cases, early onset ventilator associated pneumonia (EVAP) occurred in 27 (51.9%) and late onset ventilator associated pneumonia (LVAP) in 25 (48.1%). Drug resistant organisms contributed to 76.9% of VAP. Bacteremia (P = 0.002), prior use of steroid/immunosuppressant (P = 0.004) and re-intubations (P = 0.021) were associated with the occurrence of VAP. The association of Acinetobacter (P = 0.025) and Pseudomonas (P = 0.047) for LVAP was found to be statistically significant. Duration of mechanical ventilation (P = 0.001), ICU stay (P = 0.049) and requirement for tracheostomy (P = 0.043) were significantly higher in VAP. Among each case and control groups, 19 (36.5%) expired.
  
  
  CONCLUSIONS
  We found a higher proportion of LVAP compared with EVAP and a higher proportion of drug resistant organisms among LVAP, especially Pseudomonas and Acinetobacter. Drug resistant Pseudomonas was associated with higher mortality.
authors: Department of Medicine, Kasturba Medical College, Karnataka, India.
authors: Kavitha
authors: K
authors: Saravu
authors: Department of Medicine, Kasturba Medical College, Karnataka, India.
authors: V
authors: V
authors: Preethi
authors: Department of Medicine, Kasturba Medical College, Karnataka, India.
authors: Rishikesh
authors: R
authors: Kumar
authors: Department of Biostatistics, Manipal University, Manipal, Karnataka, India.
authors: Vasudev
authors: V
authors: Guddattu
authors: Department of Medicine, Kasturba Medical College, Karnataka, India.
authors: Ananthakrishna Barkur
authors: AB
authors: Shastry
authors: Department of Microbiology, Kasturba Medical College, Karnataka, India.
authors: Chiranjay
authors: C
authors: Mukhopadhyay
keywords: Hospital acquired pneumonia; India; multidrug resistant organism; ventilator associated pneumonia