Infection-Related Ventilator-Associated Complication and Possible Ventilator-Associated Pneumonia among Mechanically Ventilated Patients of Adult Medical and Surgical Intensive Care Units

Abstract

Objective An observational study was conducted to evaluate (1) the incidence rates of infection-related ventilator-associated complication (IVAC) and possible ventilator-associated pneumonia (PVAP) among mechanically ventilated patients of adult medical and surgical intensive care units (ICUs) and (2) the pathogen distribution in patients with PVAP.

Materials and Methods The IVAC and PVAP rates of medical and surgical ICUs, between July 1, 2017, and June 30, 2021, per 1,000 mechanical ventilator (MV) days were calculated. The significance of difference in IVAC and PVAP rates between medical and surgical ICUs was calculated. The level of significance was set at less than 0.05.

Results MV utilization ratios of adult medical and surgical ICUs were 0.32 and 0.26, respectively (p < 0.001). About 8 and 7 episodes of IVAC and 14 and 6 episodes of PVAP were reported from adult medical and surgical ICUs, accounting for IVAC rates of 3.17 and 1.8 per 1,000 MV (p > 0.05) and PVAP rates of 2.46 and 1.59 per 1,000 MV days in medical and surgical ICUs, respectively (p > 0.05). Acinetobacter baumannii complex either singly or in combination was isolated in 11/20 PVAP cases.

Conclusion IVAC and PVAP were more in medical compared with surgical ICUs. The most common pathogen in patients with PVAP was A. baumannii complex. More studies are warranted to monitor the significance of ventilator-associated event on patient outcomes.

Keywords

ventilator-associated events - infection -related ventilator-associated complication - possible ventilator-associated pneumonia - Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) - adult medical and surgical intensive care units

Note

The work was presented as chaired poster in the XVII Annual Conference of Hospital Infection Society of India. HISICON 2021. The study was approved by the Institute Ethics Committee, Number T-EM-F/Micro/16/27.

Authors' Contributions

B.B. contributed to the conceptualization, methodology, formal analysis, resources, data curation, writing - original draft, writing - review and editing, supervision, and project administration. A.M. contributed to the data curation, writing - review and editing, supervision, and project administration. J.S.K. contributed to resources, supervision, and project administration. J.J. contributed to methodology and project administration. J.R., J.B., C.S., R.P., and M.K. contributed to formal analysis, data curation, and writing - review and editing.

Publikationsverlauf

Artikel online veröffentlicht:
26. Juli 2022

• References

• 1 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-332
• 2 Magill SS, Klompas M, Balk R. et al. Developing a new, national approach to surveillance for ventilator-associated events. Crit Care Med 2013; 41: 2467-2475
• 3 Sharma A, Das M, Mishra B. et al. Ventilator-associated events: Incidence and mortality in intensive care unit of a super specialty hospital of north India. Int J Health Allied Sci 2020; 9: 62-66
• 4 Apisarnthanarak A, Pinitchai U, Thongphubeth K. et al. Effectiveness of an educational program to reduce ventilator-associated pneumonia in a tertiary care center in Thailand: a 4-year study. Clin Infect Dis 2007; 45: 704-711
• 5 Klompas M, Kleinman K, Murphy MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol 2014; 35: 502-510
• 6 Nakahashi S, Imai H, Imanaka H. et al. Ventilator-associated events: prevalence and mortality in Japan. J Thorac Dis 2018; 10: 6942-6949
• 7 Dallas J, Skrupky L, Abebe N. et al. Ventilator-associated tracheobronchitis in a mixed surgical and medical ICU population. Chest 2011; 139: 513-518
• 8 He Q, Wang W, Zhu S. et al. The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study. Crit Care 2021; 25: 44 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851639/