Spectrum of Early Onset and Late Onset Ventilator Associated Pneumonia (VAP) in a Tertiary Care Hospital of Bangladesh: A Prospective Cohort Study

Authors

  • Uzzwal Kumar Mallick Registrar, Dept. of Critical Care Medicine, National Institute of Neurosciences and Hospital, Dhaka
  • Mohammad Omar Faruq Dept. of CCM, BIRDEM General Hospital, Dhaka
  • ASM Areef Ahsan Associate Prof. & Head of Dept. of CCM, BIRDEM General Hospital, Dhaka
  • Kaniz Fatema Asst. prof. Dept. of CCM, BIRDEM General Hospital, Dhaka
  • Fatema Ahmed Jr. consultant, Dept. of CCM, BIRDEM General Hospital, Dhaka
  • Mohammad Asaduzzaman Dept. of CCM, BIRDEM General Hospital, Dhaka
  • Motiul Islam MD Student, Dept. of CCM, BIRDEM General Hospital, Dhaka
  • Amina Sultana MD Student, Dept. of CCM, BIRDEM General Hospital, Dhaka

DOI:

https://doi.org/10.3329/bccj.v3i1.24095

Keywords:

Ventilator associated pneumonia, Mechanical Ventilation, Endotracheal tube

Abstract

Objective : To compare the outcome of critically ill patients developing early onset Ventilator-associated pneumonia (VAP) occurring within 96 h of ICU admission and late onset VAP occurring after 96 h of ICU admission in critically ill patients admitted in the ICU of BIRDEM General Hospital of Bangladesh.

Study Design: Prospective cohort study.

Material and Methods: Study data obtained over a period of 24 months (July 2012 - June 2014) in the ICU of a tertiary care hospital was prospectively analyzed. Subjects were classified by ventilator status: early onset VAP (< 96 hrs of mechanical ventilation) or late-onset VAP (?96 hrs of mechanical ventilation). Baseline demographics and bacterial etiology were analyzed according to the spectrum of status of VAP.

Results: The incidence of VAP was 35.73 per 1,000 ventilator days. In our study 52% of the cases were early-onset VAP, while 48% were late-onset VAP. Acinetobacter was the commonest organism isolated from late-onset VAP (p = 0.029) while Pseudomonas was the commonest isolates obtained from early-onset VAP (p = 0.046). Klebsiella, MRSA and E. coli were almost identically distributed between groups (p > 0.05). There is significant difference of sensitivity pattern of Acinetobacter baumannii and pseudomonas aeruginosa in both early and late-onset VAP (p=0.01). The overall mortality rate in our study was 44%. The mortality was significantly higher in the late-onset VAP (62.5%) than that in the early-onset VAP (26.9%) (p=0.011).

Conclusion: From this study we conclude that late-onset VAP had poor prognosis in terms of mortality as compared to the early-onset type. The higher mortality in the late-onset VAP could be attributed to older age, higher co-morbidities like diabetes mellitus, COPD and CKD. The findings are similar to findings of other international studies

Bangladesh Crit Care J March 2015; 3 (1): 9-13

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Published

2015-07-10

How to Cite

Mallick, U. K., Faruq, M. O., Ahsan, A. A., Fatema, K., Ahmed, F., Asaduzzaman, M., Islam, M., & Sultana, A. (2015). Spectrum of Early Onset and Late Onset Ventilator Associated Pneumonia (VAP) in a Tertiary Care Hospital of Bangladesh: A Prospective Cohort Study. Bangladesh Critical Care Journal, 3(1), 9–13. https://doi.org/10.3329/bccj.v3i1.24095

Issue

Vol. 3 No. 1 (2015)

Section

Original Articles

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