Ventilator-Associated Pneumonia in Critically Ill Patients Admitted at National Kidney and Transplant Institute

Aim: To determine the incidence of Ventilator- Associated Pneumonia (VAP) in a tertiary specialty hospital, including the outcome, risk factors, microbiology and cost of hospitalization. Methods: This is a prospective cohort study. All adult patients admitted in the intensive care unit (ICU) intubated for more than 48 hours were included and satisfied the criteria for VAP based on the American Thoracic Society 2005 Guidelines were followed up. Results: During a total of 12-month, two-year study period, a total of 73 patients were followed-up. Fourteen patients (19%) developed VAP. Acute renal failure (RR 2.8, 95% CI 1.2, 6.6), history of smoking and alcoholic intake increased the risk for developing VAP (RR 1.9, 95% CI 1.2, 2.8 and RR 2.3, 95% CI 1.6, 3.4). Sedation (RR 8.4, 95% CI 2.4, 29.6) and surgery (RR 2.0, 95% CI 1.2, 3.2) during intubation were also noted as risk factors to develop VAP. The mortality rate was 71 percent. Multidrug resistant gram negative bacilli were the most common isolates (93%). Patients with VAP have a significantly longer duration of intubation (p=0.003), ICU stay (p=0.001) and hospital stay (p=0.006). Conclusion: In our institution, the incidence rate of VAP is 19 percent and mortality rate is 71 percent. Risk factors associated with VAP are acute renal failure, history of smoking, alcoholic intake, sedation and surgery. Patients with VAP are not more likely to die than those without. Multidrug resistant gram negative bacilli is the most common isolate. Patients with VAP had a longer duration of hospitalization and greater cost of care. Keywords: isolate, hospital cost, outcome, risk factors, ventilator-associated pneumonia