A PROSPECTIVE OBSERVATIONAL STUDY ON ANTIBIOTIC USAGE TRENDS, RISK FACTORS AND28 DAYS MORTALITY RATE ASSOCIATED WITH VENTILATOR-ASSOCIATED PNEUMONIA AMONG MEDICAL ICU PATIENTS: INSIGHTS FROM A TERTIARY CARE HOSPITAL

RAMA PARTHASARATHY; ANITA ANN SUNNY

doi:10.22159/ijpps.2024v16i8.51599

Authors

RAMA PARTHASARATHY Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore-641004, Tamil Nadu, India
ANITA ANN SUNNY Department of Neurology, PSG Hospitals, Coimbatore-641004, Tamil Nadu, India https://orcid.org/0000-0003-0088-9113

DOI:

https://doi.org/10.22159/ijpps.2024v16i8.51599

Keywords:

Ventilator-associated Pneumonia, Mortality rate, Antibiotics, Prescribing pattern, Risk factors

Abstract

Objective: This study was conducted to investigate the antibiotic usage, risk factors and mortality associated with the development of VAP(Ventilator Associated Pneumonia).

Methods: An open–labelled, prospective, observational (case-control) study was carried out for 6 months in the Department of Critical Care Medicine. Initial screening was done based on inclusion and exclusion criteria and 58 patients were found eligible. The statistical analysis was done using the Chi-Square test and t-test.

Results: The incidence of VAP in our study was 6.07%.Prolonged hospitalisation (p=0.00) and ICU stay (p=0.00) showed a statistically significant association with the development of VAP and they possessed a high risk of carbapenem-resistant organisms in the age group more than 60 years. Colistin therapy alone and/or combined with tigecycline therapy showed 100% survival. SOFA(Sequential Organ Failure Assessment) scoring done before and after VAP diagnosis showed a significant difference (p<0.005). Our study revealed that mortality was high in patients with SOFA score range of 7-9.

Conclusion: The lower incidence of VAP points out the good infection control practices in the ICU(Intensive Care Unit). Late-onset VAP was more prevalent with Acinetobacter baumannii. Prolonged hospitalisation and ICU stay were the significant risk factors. Colistin therapy alone and/or in combination with tigecycline was the most effective treatment.

Downloads

Download data is not yet available.

References

Mathai AS, Phillips A, Isaac R. Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units! Lung India. 2016 Sep-Oct;33(5):512-6. doi: 10.4103/0970-2113.188971. PMID: 27625445; PMCID: PMC5006331.

Abban MK, Ayerakwa EA, Mosi L, Isawumi A. The burden of hospital-acquired infections and antimicrobial resistance. Heliyon. 2023 Oct 2;9(10):e20561. doi: 10.1016/j.heliyon.2023.e20561. PMID: 37818001; PMCID: PMC10560788.

Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vésin A, Garrouste-Orgeas M, Decruyenaere J, Clec'h C, Azoulay E, Benoit D; Outcomerea Study Group. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med. 2011 Nov 15;184(10):1133-9. doi: 10.1164/rccm.201105-0867OC. PMID: 21852541.

Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014 Mar 18;18(2):208. doi: 10.1186/cc13775. Erratum in: Crit Care. 2016 Jan 28;20:29. doi: 10.1186/s13054-016-1206-8. Zai, Wendy [corrected to Ziai, Wendy]. PMID: 25029020; PMCID: PMC4056625.

Nguyen M, Joshi SG. Carbapenem resistance in Acinetobacter baumannii, and their importance in hospital-acquired infections: a scientific review. J Appl Microbiol. 2021 Dec;131(6):2715-2738. doi: 10.1111/jam.15130. Epub 2021 May 21. PMID: 33971055.

Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, Mohan A, Dixit S, Guleria R, Bhattacharya P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian J Crit Care Med. 2019 Jan;23(Suppl 1): S1-S63. doi: 10.5005/jp-journals-10071-23101. PMID: 31516211; PMCID: PMC6734471.

Luna CM, Vujacich P, Niederman MS, Vay C, Gherardi C, Matera J, Jolly EC. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest. 1997 Mar;111(3):676-85. doi: 10.1378/chest.111.3.676. PMID: 9118708.

Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbiol Rev. 2006 Oct;19(4):637-57. doi: 10.1128/CMR.00051-05. PMID: 17041138; PMCID: PMC1592694.

Karakike E, Kyriazopoulou E, Tsangaris I, Routsi C, Vincent JL, Giamarellos-Bourboulis EJ. The early change of SOFA score as a prognostic marker of 28-day sepsis mortality: analysis through a derivation and a validation cohort. Crit Care. 2019 Nov 29;23(1):387. doi: 10.1186/s13054-019-2665-5. PMID: 31783881; PMCID: PMC6884794.

Swanson JM, Wells DL. Empirical Antibiotic Therapy for Ventilator-Associated Pneumonia. Antibiotics (Basel). 2013 Jul 4;2(3):339-51. doi: 10.3390/antibiotics2030339. PMID: 27029307; PMCID: PMC4790268.

Timsit JF, Esaied W, Neuville M, Bouadma L, Mourvllier B. Update on ventilator-associated pneumonia. F1000Res. 2017 Nov 29;6:2061. doi: 10.12688/f1000research.12222.1. PMID: 29225790; PMCID: PMC5710313.

Gunasekera P, Gratrix A. Ventilator-associated pneumonia. BJA Education. 2016 Jun;16(6):198–202. https://doi.org/10.1093/bjaed/mkv046

Semet C. The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit. Infect Prev Pract. 2023 Oct 31;5(4):100320. doi: 10.1016/j.infpip.2023.100320. PMID: 38028359; PMCID: PMC10663678.

Ranjan N, Chaudhary U, Chaudhry D, Ranjan KP. Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality. Indian J Crit Care Med. 2014 Apr;18(4):200-4. doi: 10.4103/0972-5229.130570. PMID: 24872648; PMCID: PMC4033852.

Sangale A, Vivek B, Kelkar R, Biswas S. Microbiology of Ventilator-associated Pneumonia in a Tertiary Care Cancer Hospital. Indian J Crit Care Med. 2021 Apr;25(4):421-428. doi: 10.5005/jp-journals-10071-23790. PMID: 34045810; PMCID: PMC8138642.

Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020 May;46(5):888-906. doi: 10.1007/s00134-020-05980-0. Epub 2020 Mar 10. PMID: 32157357; PMCID: PMC7095206.

Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens. J Infect Dev Ctries. 2010 May 1;4(4):218-25. doi: 10.3855/jidc.634. PMID: 20440059.

R, S., S. R, A. A, C. R. P, and L. J. “Detection Of Extended Spectrum Beta Lactamases-Producing Klebsiella Pneumoniae Isolates In Chronic Obstructive Pulmonary Diseases Patients”. Asian Journal of Pharmaceutical and Clinical Research, vol. 16, no. 8, Aug. 2023, pp. 64-67, doi:10.22159/ajpcr.2023.v16i8.47740.doi: https://doi.org/10.22159/ajpcr.2023.v16i8.47740

Gadani H, Vyas A, Kar AK. A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesth. 2010 Nov;54(6):535-40. doi: 10.4103/0019-5049.72643. PMID: 21224971; PMCID: PMC3016574.

Charles MP, Kali A, Easow JM, Joseph NM, Ravishankar M, Srinivasan S, Kumar S, Umadevi S. Ventilator-associated pneumonia. Australas Med J. 2014 Aug 31;7(8):334-44. doi: 10.4066/AMJ.2014.2105. PMID: 25279009; PMCID: PMC4157153.

MARION, M., L. M. MATHIAS, L. LALU, and A. S ARJUN. “A Study Of Ventilator-Associated Pneumonia, Surgical Site Infection And Central Line-Associated Bloodstream Infection: Incidence, Outcome, Risk Factors And Measures To Be Taken For Prevention In A Tertiary Care Teaching Hospital”. Asian Journal of Pharmaceutical and Clinical Research, vol. 14, no. 9, Sept. 2021, pp. 130-5, doi:10.22159/ajpcr.2021.v14i9.42323.doi: https://doi.org/10.22159/ajpcr.2021.v14i9.42323

Gutiérrez JMM, Borromeo AR, Dueño AL, Paragas ED Jr, Ellasus RO, Abalos-Fabia RS, Abriam JA, Sonido AE, Hernandez MA, Generale AJA, Sombillo RC, Lacanaria MGC, Centeno MM, Laoingco JRC, Domantay JAA. Clinical epidemiology and outcomes of ventilator-associated pneumonia in critically ill adult patients: protocol for a large-scale systematic review and planned meta-analysis. Syst Rev. 2019 Jul 20;8(1):180. doi: 10.1186/s13643-019-1080-y. PMID: 31325967; PMCID: PMC6642735.

Luo W, Xing R, Wang C. The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days. BMC Infect Dis. 2021 Jul 15;21(1):684. doi: 10.1186/s12879-021-06383-2. PMID: 34266399; PMCID: PMC8280627.

Rizk MAS, Saad-eldeen SM, Helmy HM, Sokkary RHE. Clinical and Microbiological Characteristics of Ventilator-Associated Pneumonia Patients at Surgical Intensive Care Unit. Anaesthesia. 2020;26(1).

Wong D, Nielsen TB, Bonomo RA, Pantapalangkoor P, Luna B, Spellberg B. Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges. Clin Microbiol Rev. 2017 Jan;30(1):409-447. doi: 10.1128/CMR.00058-16. PMID: 27974412; PMCID: PMC5217799.

Vijayakumar S, Biswas I, Veeraraghavan B. Accurate identification of clinically important Acinetobacter spp.: an update. Future Sci OA. 2019 Jun 27;5(6):FSO395. doi: 10.2144/fsoa-2018-0127. PMID: 31285840; PMCID: PMC6609899.

Patil HV, Patil VC. Incidence, bacteriology, and clinical outcome of ventilator-associated pneumonia at tertiary care hospital. J Nat Sci Biol Med. 2017 Jan-Jun;8(1):46-55. doi: 10.4103/0976-9668.198360. PMID: 28250674; PMCID: PMC5320823.

Alnimr A. Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy. Infect Dis Ther. 2023 Jun;12(6):1527-1552. doi: 10.1007/s40121-023-00820-2. Epub 2023 Jun 5. PMID: 37273072; PMCID: PMC10240484.

Tripathi PC, Gajbhiye SR, Agrawal GN. Clinical and antimicrobial profile of Acinetobacter spp.: An emerging nosocomial superbug. Adv Biomed Res. 2014 Jan 9;3:13. doi: 10.4103/2277-9175.124642. PMID: 24600597; PMCID: PMC3929011.

Townsend J, Park AN, Gander R, Orr K, Arocha D, Zhang S, Greenberg DE. Acinetobacter infections and outcomes at an academic medical centre: a disease of long-term care. Open Forum Infect Dis. 2015 Mar 12;2(1):ofv023. doi: 10.1093/ofid/ofv023. Erratum in: Open Forum Infect Dis. 2015 Mar 12;2(1):ofv041. doi: 10.1093/ofid/ofv041. PMID: 26034772; PMCID: PMC4438902.

Abushanab D, Nasr ZG, Al-Badriyeh D. Efficacy and Safety of Colistin versus Tigecycline for Multi-Drug-Resistant and Extensively Drug-Resistant Gram-Negative Pathogens-A Meta-Analysis. Antibiotics (Basel). 2022 Nov 15;11(11):1630. doi: 10.3390/antibiotics11111630. PMID: 36421274; PMCID: PMC9686723.

Kharel S, Bist A, Mishra SK. Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review. PLoS One. 2021 Mar 9;16(3):e0247832. doi: 10.1371/journal.pone.0247832. PMID: 33690663; PMCID: PMC7942996.

Ranzani OT, Niederman MS, Torres A. Ventilator-associated pneumonia. Intensive Care Med. 2022 Sep;48(9):1222-1226. doi: 10.1007/s00134-022-06773-3. Epub 2022 Jun 30. PMID: 35771252; PMCID: PMC9245883

Wu D, Wu C, Zhang S, Zhong Y. Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Front Pharmacol. 2019 May 9;10:482. doi: 10.3389/fphar.2019.00482. PMID: 31143118; PMCID: PMC6521332.