A study of incidence, risk factors, pathogen profile and ventilator associated pneumonia in NICU at SMGS hospital Jammu

Background: VAP (Ventilator associated pneumonia) is one of the most common healthcare associated infections among ventilated neonates. Aim: of the study was to study the incidence, risk factors, pathogen profile and outcome associated with development of Ventilator Associated Pneumonia (VAP) in neonates who require mechanical ventilation for more than 48 hours. Study design: Hospital based prospective observational study for 1 year, conducted between Dec 2015 to Nov 2016. Materials & Methods: This prospective observational study was conducted in NICU (Neonatal intensive care unit) of SMGS Hospital Jammu. All intubated neonates of age less than 28 days, admitted in NICU who required mechanical ventilation for more than 48 hours, were studied for development of VAP. Neonates who had overt signs and symptoms of pneumonia at the initiation of mechanical ventilation, those with major congenital anomaly, or those with birth weight less than 1000 were excluded from the study. Socio-demographic data, maternal data, Natal and Perinatal data, History of presenting complaints, Anthropometry, General physical examination and systemic examination in detail was recorded. The diagnosis of VAP was made on the basis of criteria given by National Nosocomial Infection Surveillance System (2004) pediatric modification of the original guidelines given by CDC (Center for disease control and Prevention).Statistical Analysis: The data was analyzed by “Statistical package For Social Sciences (SPSS) software Version 20.0 and represented as Mean±SD and percentages. Results: total neonates included were 105. Out of which 35 developed VAP. Incidence of VAP in our study was 37.9 per 1000 days of mechanical ventilation. Prematurity, birth weight, number of reintubation attempts, duration of mechanical ventilation days and hospital stay in days were significant predictors of VAP on Bivariate analysis. Duration of mechanical ventilation, prematurity and very low birth weight were 3 single independent and statistically significant risk factor for development of VAP on multiple logistic regression analysis. Gram negative organisms predominate as the cause of VAP in our study with klebsiella and E.Coli being the most common. Mortality  rates  among  the neonates developing VAP was 9/35 (25.7%). Conclusion: VAP is a potentially lethal and common problem among ventilated patients in NICU. The endotracheal aspirate of intubated patients should be sent routinely. By using aseptic precautions while handling ventilated patients and empirical antibiotics as per the endotracheal aspirate culture sensitivity pattern of NICU in the patients who develop VAP, we may be able to improve the outcome rate of the patients on mechanical ventilation.