Incidence of ventilator associated pneumonia in the intensive care unit of the Saint George Hospital University Medical Center and comparison of qualitative and semi-quantitative culture techniques

Abstract

Background: Ventilator-associated pneumonia (VAP) is one of the most common complications that occur in the Intensive Care Unit (ICU). It is defined as pneumonia happening for more than 48 hours following patients intubation and mechanical ventilation (MV). The current diagnosis of VAP relies on a combination of clinical and microbiological criteria including bedside examination, radiographic examination, and microbiological analysis of respiratory secretions. The purpose of the study was first to determine the incidence of VAP in the ICU of the Saint Georges Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut. Methods: The study was conducted over a period of 6 months with all intubated and mechanically ventilated patients who were screened on admission to ICU. Patients were monitored from date of admission to the date of discharge from ICU or death. A diagnosis of VAP was made on a Clinical Pulmonary Infection Score (CPIS) of >6. Endotracheal aspirates were collected every other day and underwent phenotypic and genotypic microbiological analysis. Results: Of 135 patients admitted in the ICU, 73 were diagnosed with VAP. Significant association was found between the intubation days and the development of bacterial infection. The most common organisms isolated were Acinetobacter baumannii (isolated from 70 patients) and Pseudomonas aeruginosa (isolated from 65 patients). Both infections were associated with early intubation period. Conclusion: VAP is one of the most common complications that occur in the ICU among patients undergoing MV and it is associated with poor outcome. There was significant association between duration of ventilation and development of VAP, which highlights the essential need for preventives measures.