Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study (original) (raw)
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Neurology India
Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in patients receiving mechanical ventilation (MV) and contributes to a longer intensive care unit (ICU) stay, duration of MV, and a high morbidity and mortality. The purpose of study was to determine the incidence of VAP in neurosurgery ICU patients and to assess the probable contributing neurosurgical risk factors like the site and nature of the lesion in the brain, the duration of surgery, blood loss during surgery, and infection elsewhere in the body, in the development of VAP. The prospective clinical study included patients with a Glasgow Coma Scale (GCS) score>8 undergoing a neurosurgical procedure and postoperatively receiving MV for> 48 hours, who were followed for the development of VAP. The diagnosis of VAP was in accordance with the Centers for Disease control (CDC) guidelines and was confirmed with a positive quantitative culture in the endotracheal tube aspirate samples. The incidence ...
Infection Control & Hospital Epidemiology
Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were...
Early onset pneumonia in neurosurgical intensive care unit patients
Journal of Hospital …, 1998
To investigate early onset pneumonia in a neurosurgical intensive care unit, we studied a cohort of patients over a 13-month period and compared neurotrauma (T) with non-neurotrauma (NT) patients. Data were abstracted from the infection surveillance database. Five hundred and sixty-five adults were hospitalized in the neurosurgical intensive care unit. 57.9% had trauma and 129 patients developed 152 episodes of pneumonia. Incidence rates, restricted to the 129 first episodes of pneumonia, were 20.1 versus 15.7/1000 patient days and 34.2 versus 27.9/1000 ventilation days, in the T and NT groups respectively. In both groups, the distribution of risk stratified by hospital days was bimodal, being highest during the first three days. However, the risk was higher for T patients (at day 3, 20/1000 ventilation days versus 10.2/1000 ventilation days). The daily risk peaked again at days 5 and 6, and thereafter remained low. Pneumonia occurring within the first three days, or early onset pneumonia (EOP), was associated with trauma (P=O.O36) and, in the NT group only, with a Glasgow coma scale score lower than 9 (P=O.O62). EOP was caused by Staphylococcus UUY~US (33%), Haemophilus spp. (23%), other Gram-positive cocci (22%), and other Gram-negative bacilli (GNB) (19%); w h ereas after the third day GNB other than Huemophilus spp. accounted for 45.4% of isolates (P=O.ll). This large series confirms the high incidence of EOP in neurosurgical intensive care units, particularly among trauma patients, in relation to risk factors different from those seen in other intensive care patients. Further studies are needed to elaborate specific preventive measures during early care.
IP innovative publication pvt. ltd, 2019
Ventilator associated events (VAE) by Centers for Disease Control and Prevention (CDC) was created to overcome the difficulty in surveillance of ventilator associated pneumonia (VAP). Pathogens causing VAP vary from hospitals to hospitals thus necessitat ing the need for local surveillance. The object ive was to calculate the incidence of VAE in our hospital, to assess various organisms responsible for PVAP and to analyse their sensitivity to different antibiotics. The study retro prospectively analysed 53 patients by consecutive sampling who were intub ated from January 2018 to November 2018 in Neuro surgery ICU of our hospital. We used CDC’s guidelines to report VAE. Patient ’s case files were traced using their MRD numbers and data regarding causative organism and their culture and sensitivity report s w ere obtained. Out of 53 intubated patients, we had eight VAE. All of them were reported as possible ventilator associated pneumonia (PVAP). Prolonged ventilator days (> 5 days) were associated with increased risk of VAE in our study. The incidence and VAE rate per 1000 ventilation days were 15.1 % and was 29.6 respectively. Six patients (75%) had monomicrobial aetiology in which two patients died. Remaining t wo patients (25%) had polymicrobial aetiology. Klebsiella pneumoniae was seen in majority (n=6) of t he patients. Colistin had the highest sensitivity to the isolates while Ampicillin was resistant to all four organisms. All of the organisms isolated were MDR pathogen which was resistant to most of the regular anti biotics. Therefore, it is important to f rame local antibiotic policies and precautions to prevent VAE in the future.
Neurosurgery Intensive Care Unit Infections; Single Center Retrospective Study
Aim: Nasocomial infections are the most important cause of mortality and morbidity of the intensive care units. In this study, we evaluated that developed infections in neurosurgery care unit. Patients and methods: 277 cases with the diagnosis of nosocomial infection out of 2381 patients followed up in the neurosurgical intensive care units of our center between 2008 and 2013 were retrospectively evaluated. Results: In our clinic, infection rate was 11.6%, its incidence density was detected as 22.2/1000 patient-days. Pneumonia was the most frequently seen type of infection. Most frequently Staphylococcus aureus (20.15%) and Pseudomonas aeruginosa (14.83%) were detected. Overall mortality rate of the patients who became infected was 12.7 percent. However mortality rate of the patients without infection was 2.6 percent. In 28 patients more than one episode of infection developed which resulted in death of 21 (75%) cases. Conclusion: During monitorization in the intensive care unit, one of the important factors which effect morbidity and mortality is nosocomial infections. In order to be able to prevent infections, routine surveillance studies should be performed and infection control measures should be evolved.
European Journal of Clinical Microbiology & Infectious Diseases, 2016
The purpose of this study was to assess the main clinical predictors and microbiological features of ventilatorassociated pneumonia (VAP) in the Intensive Care Unit (ICU) environment. This work is a retrospective analysis over one year from September 2010 to September 2011. Patients' risk factors, causes of admission, comorbidities and respiratory specimens collected in six Italian ICUs were reviewed. Incidence and case fatality rate of VAP were evaluated. After stratification for VAP development, univariate and multivariate analyses were performed to assess the impact of patients' conditions on the onset of this infection. A total of 1, 647 ICU patients (pts) were considered. Overall, 115 patients (6.9 %) experienced at least one episode of VAP. The incidence rate for VAP was 5.82/1,000 pts-days, with a case fatality rate of 44.3 %. Multivariate analysis showed that admission for neurological disorders (aIRR 4.12, CI 1.24-13.68, p = 0.02) and emergency referral to ICU from other hospitals (aIRR 2.11, CI 1.03-4.31, p = 0.04) were associated with higher risk of VAP, whereas a tendency to a higher risk of infection was detected for admission due to respiratory disease, cardiac disease, trauma and for having obesity or renal failure. A total of 372 microbiological isolates from respiratory specimens were collected in VAP patients. The most common species were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, showing high resistance rates to carbapenems. Neurological disorders and emergency referral at the admission into the ICU are significantly associated with the onset of VAP. A high incidence of multi-drug resistant Gram-species was detected in the respiratory specimens.
Neurocritical Care, 2009
Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among medical intensive care unit (ICU) patients and is associated with increased mortality and length of stay (LOS). Neurologic disease is a risk factor for VAP development, but the relationship between VAP and outcomes in patients admitted to the ICU for neurologic reasons remains largely unknown. Methods All mechanically ventilated patients over a 2-year period with neurovascular disease were included in a retrospective study. Data collected included patient demographics, dates of admission and discharge, LOS, and ventilator hours. Comparisons between neurologic patients who did and did not develop VAP were made using univariate and multivariate analysis. Results Of 585 intubated neurovascular patients, 24 (4.1%) developed VAP. Compared with those who did not develop VAP, those with VAP were younger (51.8 ± 13.9 years vs. 58.8 ± 15.9 years, P = 0.03), had increased LOS (32.6 ± 29.2 days vs. 14.5 ± 7.8 days, P < 0.001), and more ventilator hours (272 ± 257 h vs. 85.9 ± 140 h, P < 0.001). There was no difference in mortality between patients with and without VAP (25.0% vs. 28.3%, P = 0.72). VAP was not an independent predictor of mortality in a multivariate model (OR 1.11, 95% CI 0.37-3.30, P = 0.855). Conclusions VAP in neurocritical care patients is associated with increased LOS and ventilator hours, but is not associated with increased mortality, contrary to prior studies in medical ICU patients.
Empiric antimicrobial therapy for ventilator-associated pneumonia after brain injury
European Respiratory Journal, 2016
Issues regarding recommendations on empiric antimicrobial therapy for ventilator-associated pneumonia (VAP) have emerged in specific populations.To develop and validate a score to guide empiric therapy in brain-injured patients with VAP, we prospectively followed a cohort of 379 brain-injured patients in five intensive care units. The score was externally validated in an independent cohort of 252 brain-injured patients and its extrapolation was tested in 221 burn patients.The multivariate analysis for predicting resistance (incidence 16.4%) showed two independent factors: preceding antimicrobial therapy ≥48 h (p<0.001) and VAP onset ≥10 days (p<0.001); the area under the receiver operating characteristic curve (AUC) was 0.822 (95% CI 0.770–0.883) in the learning cohort and 0.805 (95% CI 0.732–0.877) in the validation cohort. The score built from the factors selected in multivariate analysis predicted resistance with a sensitivity of 83%, a specificity of 71%, a positive predic...
Journal of natural science, biology, and medicine
Ventilator-associated pneumonia (VAP) is the most frequent Intensive Care Unit acquired infection. The aim is to determine the incidence, bacteriology and factors affecting VAP and to determine the multi-drug resistant (MDR) pathogens. This was a prospective observational study conducted over a period of 1 year from April 1, 2011, to March 31, 2012. The patients fulfilling criteria of VAP were included in this study. This was performed using SPSS trial version 11.0 software (SPSS Inc., Chicago, Illinois, USA) and the values of P < 0.05 were considered statistically significant. Totally 74 (27.71%) patients were developed VAP. Of total 74 patients with VAP 53 (71.62%) were females and 21 (28.37%) were females (P < 0.0001). Total 13 (17.56%) patients had early-onset VAP and 61 (82.43%) had late-onset VAP (P < 0.0001). The overall incidence of VAP rate per 1000 ventilator days was 39.59. Total 126 bacterial isolates found in 74 patients with VAP. Predominant isolates were Gram...
National Journal of Medical Research, 2020
Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection diagnosed in the intensive care unit (ICU). The aim is to determine the incidence, bacteriology and resistant pattern and 28 days mortality in intensive care unit. Methods: This prospective study was conducted in intensive care unitfrom July 2017 through June 2018. All the patients who were on mechanical ventilation for >48 h in the ICU during the study period were enrolled. VAP was diagnosed according to the Centre for Disease Control (CDC) criteria. Fisher's exact test was applied to compare two or more set of variables.P-value less than 0.05 was considered to be statistically significant. Results: A total of 117 patients were included in the study and VAP developed in 49 patients with an incidence of VAP 0.42% episodes of infection/1000 mechanical ventilation days(95% Confidence Interval: 0.32 to 0.514).These were predominantly caused by Gram-negative organisms and the most common organism isolated was Acinetobacter baumanii(12 isolates,40%). Acinetobacter baumanii infection was associated with prolonged ICU stay(P value 0.009).Colistin was the most effective drug in our study and found to be effective in >90% of the patients. The overall mortality of VAP patients in our study was 36.7%. Patients with underlying diabetes mellitus and hypertension had adverse outcome in comparison to the patients without underlying comorbidity (P value=0.017). Conclusions: VAP continues to be a major threat to patients who are admitted for mechanical ventilation into the critical care unit, emphasizing the urgent need for infection control measures.