A study on poor prognostic factors associated with ventilator associated pneumonia at a tertiary care hospital

Background: Ventilator associated pneumonia (VAP) is a hospital acquired infection (HAI) seen among critically ill patients, on mechanical ventilation, due to various causes in intensive care units (ICUs). It is associated with increased morbidity and mortality which increases the cost of health care. The aim of this study was to determine the poor prognostic factors associated with VAP.Methods: In this cross-sectional prospective study,40 patients who developed features of ventilator associated pneumonia on a platform of mechanical ventilator for >48 hrs in ICU were included in the study. VAP was then diagnosed based on clinical pulmonary infection scoring system (CPIS) with a score of >=6. All patients were evaluated and correlated with different parameters for the treatment and outcome.Results: Most of the patients had late onset VAP (60.7%) with average number of days being around 8 days. Pseudomonas, Acinetobacter, Enterobacteriacea, Staphylococcus aureus were commonly isolated organisms. Polymicrobial infections were not detected. Antibiotics like colistin, tigecycline and beta-lactamases are the most commonly effective antibiotics. Of the 40 VAP patients,20 patients survived and 20 died with protocol line of treatment. Following poor prognostic factors were identified-Early onset VAP (42.5%), elderly patients (>65 years) (90%), Type 2 DM (80%), hypertension (70%), prior antibiotic therapy (65%), prolonged supine position (68%) and re-intubation (75%).Conclusions: Ventilator associated pneumonia is associated with a significant increase in length of stay in ICU, time of mechanical ventilation and different complications and certain risk factors further worsens the prognosis.

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Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India

Tropical Doctor ◽

10.1177/0049475520982457 ◽

2020 ◽

pp. 004947552098245

Author(s):

Pooja Kumari ◽

Priya Datta ◽

Satinder Gombar ◽

Deepak Sharma ◽

Jagdish Chander

Keyword(s):

Mechanical Ventilation ◽

Tertiary Care Hospital ◽

Late Onset ◽

Tertiary Care ◽

Control Measures ◽

North India ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Infection Control Measures ◽

Utilisation Rate

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

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Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183264 ◽

2018 ◽

Vol 6 (8) ◽

pp. 2754

Author(s):

David D. M. Rosario ◽

Anitha Sequeira

Keyword(s):

Mechanical Ventilation ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Early Tracheostomy ◽

Hospital Acquired Infection ◽

Total Incidence ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

Background: Pneumonia is the most common hospital acquired infection in the intensive care unit. One of the causes for hospital acquired pneumonia is ventilator associated pneumonia. Tracheostomy is known to prevent occurrence of ventilator associated pneumonia as it decreases the respiratory dead space, assists in better clearance of secretions and prevents chances of aspiration. Generally, tracheostomy is done after 2 weeks of endotracheal intubation to prevent tracheal complications. The aim of this study is to identify the incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients and to see if early tracheostomy can prevent development of ventilator associated pneumonia.Methods: The study was conducted at a tertiary care hospital during a period of four years. 100 patients who were on mechanical ventilation for more than 7 days where taken up for the study. APACHE 4 scoring system was used. The incidence of Ventilator associated pneumonia in tracheostomised and non tracheostomised patients was studied.Results: In our study the total incidence of VAP was 44 %. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia. Among the non-tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia. In our study the incidence of ventilator associated pneumonia was much lesser (12%) in patients who underwent tracheostomy in the period 7 to 10 days after mechanical ventilation, whereas in those who underwent tracheostomy after 11 days incidence of ventilator associated pneumonia was much higher.Conclusions: Our study showed that the incidence of ventilator associated pneumonia was much higher among non tracheostomised patients compared to patients who underwent tracheostomy. Hence patients undergoing earlier tracheostomy had a clear advantage than those undergoing tracheostomy late or non tracheostomised patients in preventing ventilator associated pneumonia.

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Prevalence of Ventilator Associated Pneumonia in Neonates in A Tertiary Care Hospital in Western Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.4295 ◽

2019 ◽

Vol 57 (216) ◽

Author(s):

Anita Lamichhane ◽

Aparna Mishra

Keyword(s):

Sample Size ◽

Neonatal Intensive Care ◽

Tertiary Care Hospital ◽

Late Onset ◽

Tertiary Care ◽

Cross Sectional Study ◽

Point Estimate ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Cross Sectional

Introduction: Ventilator-associated pneumonia is a serious problem which needs to be addressed for a better outcome of the ventilated babies. The present study is undertaken to find out the prevalence of ventilator-associated pneumonia in neonates in a tertiary care hospital in western Nepal.Methods: A descriptive cross-sectional study was carried out in a tertiary care hospital in the western region of Nepal from March 2016 to February 2019 after approval from the Institutional review committee. Sample size was calculated and convenience sampling was done to reach the sample size. Data were collected from hospital records and entered in Statistical Package for the Social Sciences, point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.Results: Out of 95 patients ventilated in neonatal intensive care unit in the last 3 years, 23 (24.01%) developed ventilator-associated pneumonia. Prevalence of ventilator-associated pneumonia is 23 (24.01%) at 95% (14%-34%). Late onset ventilator associated pneumonia was seen in 15 (15.78%) while early onset ventilator associated pneumonia was seen in 8 (8.42%). Conclusions: Prevalence of ventilator associated pneumonia in neonates in tertiary care hospital is high compared to other studies conducted in neonates.

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Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens

The Journal of Infection in Developing Countries ◽

10.3855/jidc.634 ◽

2010 ◽

Vol 4 (04) ◽

pp. 218-225 ◽

Cited By ~ 22

Author(s):

Noyal Mariya Joseph ◽

Sujatha Sistla ◽

Tarun Kumar Dutta ◽

Ashok Shankar Badhe ◽

Desdemona Rasitha ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Late Onset ◽

Tertiary Care ◽

Multidrug Resistant ◽

Multi Drug Resistance ◽

P Value ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Candida Spp ◽

Beta Lactamases

Background: Ventilator-Associated Pneumonia (VAP) is the most frequent intensive-care-unit (ICU)-acquired infection. The aetiology of VAP varies with different patient populations and types of ICUs. Methodology: A prospective study was performed over a period of 15 months in a tertiary care hospital to determine the various aetiological agents causing VAP and the prevalence of multidrug resistant (MDR) pathogens. Combination disk method, Modified Hodge test, EDTA disk synergy (EDS) test and AmpC disk test were performed for the detection of extended spectrum beta-lactamases (ESBL), carbapenemases, metallo-beta-lactamases (MBL) and AmpC β-lactamases respectively. Results: Enterobacteriaceae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Candida spp. were more common in early-onset VAP, while non-fermenters (Pseudomonas spp. and Acinetobacter spp.) were significantly associated with late-onset VAP (P value 0.0267, Chi-square value 4.91). Thirty-seven (78.7%) of the 47 VAP pathogens were multidrug resistant. ESBL was produced by 50% and 67% of Escherichia coli and Klebsiella pneumoniae respectively. MBL was produced by 20% of P. aeruginosa. AmpC beta-lactamases were produced by 33.3% and 60.7% of the Enterobacteriaceae and non-fermenters respectively. Of the S. aureus isolates, 43% were methicillin resistant. Prior antibiotic therapy and hospitalization of five days or more were independent risk factors for VAP by MDR pathogens. Conclusions: VAP is increasingly associated with MDR pathogens. Production of ESBL, AmpC beta-lactamases and metallo beta-lactamases were responsible for the multi-drug resistance of these pathogens. Increasing prevalence of MDR pathogens in patients with late-onset VAP indicate that appropriate broad-spectrum antibiotics should be used to treat them.

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Spectrum of Early Onset and Late Onset Ventilator Associated Pneumonia (VAP) in a Tertiary Care Hospital of Bangladesh: A Prospective Cohort Study

Bangladesh Critical Care Journal ◽

10.3329/bccj.v3i1.24095 ◽

2015 ◽

Vol 3 (1) ◽

pp. 9-13 ◽

Cited By ~ 3

Author(s):

Uzzwal Kumar Mallick ◽

Mohammad Omar Faruq ◽

ASM Areef Ahsan ◽

Kaniz Fatema ◽

Fatema Ahmed ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Early Onset ◽

Prospective Cohort ◽

Tertiary Care Hospital ◽

Late Onset ◽

Tertiary Care ◽

Ventilator Associated Pneumonia ◽

Care Hospital

Objective : To compare the outcome of critically ill patients developing early onset Ventilator-associated pneumonia (VAP) occurring within 96 h of ICU admission and late onset VAP occurring after 96 h of ICU admission in critically ill patients admitted in the ICU of BIRDEM General Hospital of Bangladesh.Study Design: Prospective cohort study.Material and Methods: Study data obtained over a period of 24 months (July 2012 - June 2014) in the ICU of a tertiary care hospital was prospectively analyzed. Subjects were classified by ventilator status: early onset VAP (< 96 hrs of mechanical ventilation) or late-onset VAP (?96 hrs of mechanical ventilation). Baseline demographics and bacterial etiology were analyzed according to the spectrum of status of VAP.Results: The incidence of VAP was 35.73 per 1,000 ventilator days. In our study 52% of the cases were early-onset VAP, while 48% were late-onset VAP. Acinetobacter was the commonest organism isolated from late-onset VAP (p = 0.029) while Pseudomonas was the commonest isolates obtained from early-onset VAP (p = 0.046). Klebsiella, MRSA and E. coli were almost identically distributed between groups (p > 0.05). There is significant difference of sensitivity pattern of Acinetobacter baumannii and pseudomonas aeruginosa in both early and late-onset VAP (p=0.01). The overall mortality rate in our study was 44%. The mortality was significantly higher in the late-onset VAP (62.5%) than that in the early-onset VAP (26.9%) (p=0.011).Conclusion: From this study we conclude that late-onset VAP had poor prognosis in terms of mortality as compared to the early-onset type. The higher mortality in the late-onset VAP could be attributed to older age, higher co-morbidities like diabetes mellitus, COPD and CKD. The findings are similar to findings of other international studiesBangladesh Crit Care J March 2015; 3 (1): 9-13

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Ventilator associated pneumonia: incidence and risk factors in a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190741 ◽

2019 ◽

Vol 6 (2) ◽

pp. 848

Author(s):

Manish Rathor ◽

Neetu Sharma

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Risk Factor ◽

Late Onset ◽

Tertiary Care ◽

Polymorphonuclear Cells ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Altered Sensorium ◽

Associated Risk Factors

Background: The objective of this study is to find the occurrence and contributing risk factor of ventilator associated pneumonia (VAP) in 2 months-5 years age group.Methods: This was a prospective, observational, hospital-based study carried out in a tertiary care setting hospital. All patients between 2 months-5 years age admitted in the ICU who had undergone MV were included in the study. Inclusion criteria includes patients who developed pneumonia after the 48 hours of mechanical ventilation and those patients were excluded who developed pneumonia within 48 hours of mechanical ventilation and having respiratory system findings /involvement prior to the MV. After recruiting patients baseline clinical characteristics (age, sex, diagnosis, duration of MV) were taken, monitored and diagnosed VAP using CDC guidelines until they were discharged or deceased. The parameters such as fever, oxygenation, leucocytosis, other risk factors. chest X-ray and ETA>105CFU/ML or microscopy (grain stain>l bacteria/>10 polymorphonuclear cells) were collected every 48 hours.Results: This study was done in 133 patients while 42 patients (31.58%) developed VAP during their ICU stay. Early onset VAP occurred in 34 (80.9%) while late onset VAP was observed in the remaining 8 (19.1%) patients. In ETA culture CFU>105 Klebsiella (38%) was the predominant isolate followed by Pseudomonas (23%), Acinetobacter (17%), Staphylococcus (13%) and Citrobacter (10%) are offending organism responsible for VAP in MV patient in present study. On analysis (univariate) reintubation, altered sensorium at intubation and use of antacid are found significantly associated risk factors with the development of VAP. Multivariate analysis revealed that reintubation was an important risk factor for the development of the VAP.Conclusions: The various risk factors can be minimized for better outcome of patients undergoing mechanical ventilation. Risk factors such as reintubation, altered sensorium at intubation and use of antacid are associated with VAP and also the physician treating must have knowledge and awareness about prevention of these risk factor to improve the outcome of patients.

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Prognostic factors associated with small for gestational age babies in a tertiary care hospital of Western Nepal: A cross‐sectional study

Health Science Reports ◽

10.1002/hsr2.250 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Nagendra Chaudhary ◽

Shree Narayan Yadav ◽

Suresh Kumar Kalra ◽

Santosh Pathak ◽

Binod Kumar Gupta ◽

...

Keyword(s):

Prognostic Factors ◽

Gestational Age ◽

Small For Gestational Age ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

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Study of the Bacteriological Profile and Their Antimicrobial Susceptibility Pattern in Patients with Skin Infections

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i24a31433 ◽

2021 ◽

pp. 77-84

Author(s):

M. Nandini ◽

S. B. Kiran Madhusudhan

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Skin Infections ◽

Beta Lactamases ◽

Medical College ◽

Antimicrobial Susceptibility Pattern ◽

Extended Spectrum Beta Lactamases ◽

Hospital Acquired ◽

Bacterial Skin Infections

The study group consisted of 150 patients both male and female between 1 – 80 years, with primary and secondary skin infections who attended the out- patient department of Dermatology and surgery at Sree Balaji medical college and hospital a tertiary care hospital in Chennai, Tamilnadu, South India. Patients admitted as in patients in the above two department were also taken for this study. 28 out of 150 cases had primary bacterial and 122 had secondary bacterial skin infections. In this study the prevalence of Methicillin resistant Staphylococcus aureus (MRSA) (40.8%) and Extended spectrum beta-lactamases (ESBL) (40.5%) producers among Enterobacteriaceae was higher. Estimation of MRSA and ESBL has to be done in tertiary care hospital to prevent and curtail further spread of these strains in hospital acquired infections. These isolates pose a serious threat for use of routine groups of antimicrobials.

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A CROSS SECTIONAL STUDY OF BREAST CANCER HISTOMORPHOLOGY AND ITS CORRELATION WITH ER/PR, HER 2NEU AND KI-67 EXPRESSION IN A TERTIARY CARE HOSPITAL AT KANPUR

10.36106/ijar/9500487 ◽

2021 ◽

pp. 9-12

Author(s):

Mahendra Singh ◽

Shobha Dwivedi ◽

Yukteshwar Mishra ◽

Sakshi Tripathi

Keyword(s):

Prognostic Factors ◽

Breast Carcinoma ◽

Tertiary Care ◽

Radical Mastectomy ◽

Cross Sectional Study ◽

Low Grade ◽

Care Hospital ◽

Sectional Study ◽

Ki 67 ◽

Cross Sectional

BACKGROUND Breast carcinoma is the most well-known malignancy in women. Different predictive and prognostic factors, for example, estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor (Her2neu), and Ki67 could inuence breast carcinoma behaviour, yet to date no authoritative connection has been set up among them and breast carcinoma subtypes. In this way present study was done to determine the interrelationships of these predictive and prognostic factors for breast carcinoma. METHODS In this cross sectional study, a total of 50 lumpectomy, modied radical mastectomy specimens of diagnosed carcinoma breast were included in this study. The histopathological grading of the breast carcinoma was performed by Nottingham modication of the Bloom Richardson grading system. All the cases went through immunohistochemistry for ER, PR, Her2neu and Ki67 expression. Association of ER, PR, Her2neu and Ki67 with different histomorphology was established. RESULTS The ER positivity was signicantly lower in tumors >5 cm size whereas Ki67was signicantly increased with increased tumor size. The ER positivity was signicantly lower in high grade tumors as compared to low grade tumors. The positive ER, PR, Her2neu and Ki67 were comparable in between premenopausal and post-menopausal age groups CONCLUSION The present study concludes that ER, PR show inverse while ki67 showed a direct relationship with the tumor grade. Correlation of histomorphology of breast tumor and Her2neu status could not be established.

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