Clinical and Etiological Exploration of Ventilator-Associated Pneumonia in the Intensive Care Unit of a Developing Country

Omar Nisar; Samaha Nisar; Shahbaz Khattak Haroon Ur Rashid; Syed Muhammad Ibne Ali Jaffari; Zaki Haider; Fiza Fatima; Shan E Zahra; Ali Hassan Ijaz; Mehwish Kaneez; Gulfam Khan Shairwani

doi:10.7759/cureus.47515

Clinical and Etiological Exploration of Ventilator-Associated Pneumonia in the Intensive Care Unit of a Developing Country

Cureus. 2023 Oct 23;15(10):e47515. doi: 10.7759/cureus.47515. eCollection 2023 Oct.

Affiliations

¹ Internal Medicine, Shalamar Medical and Dental College, Lahore, PAK.
² Internal Medicine, Shifa International Hospital Islamabad, Islamabad, PAK.
³ Internal Medicine, Rashid Latif Medical College, Lahore, PAK.
⁴ Internal Medicine, Faisalabad Medical University, Faisalabad, PAK.
⁵ Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.
⁶ Pediatrics, Rawalpindi Medical University, Rawalpindi, PAK.
⁷ Critical Care Medicine, District Headquarter Hospital, Rawalpindi, PAK.

Abstract

Background Ventilator-associated pneumonia (VAP) is a critical concern in the intensive care unit (ICU), with significant implications for patient outcomes. This retrospective cross-sectional study aimed to determine the prevalence of VAP in an ICU of a developing country, identify the predominant etiological factors, assess patient outcomes, and underscore the need for tailored interventions in high-risk patient groups. Methods This retrospective cross-sectional study included 589 ICU patients who underwent ventilator-assisted breathing for over 48 hours. Among them, 151 developed VAP. The diagnosis was made on clinical, laboratory, and radiological findings, and tracheal aspirate cultures. Exclusions included pediatric patients, less than 48 hours of ventilation, and pre-existing lung infections. Patient data encompassed gender, age, comorbidities, outcomes, admission reasons, isolated microorganisms, and clinical findings. Results 151 patients out of the 589 developed VAP. The age of the patients ranged between 31 to 69 years and the mean age was 45.43 ± 8.92 years. Clinical diagnoses upon ICU admission varied, including sepsis, trauma, stroke, and metabolic disorders. Chest X-rays commonly revealed atelectasis (19.2%), consolidation (21.9%), pleural effusion (11.9%), and lobar pneumonia (45.7%). Tracheal aspirate cultures predominantly isolated multidrug-resistant gram-negative rods, with methicillin-resistant gram-positive cocci and fungal pneumonia prevalent in neutropenic sepsis cases. Notably, only 54 (35.8%) of patients survived, with significantly poorer outcomes observed in sepsis, neutropenic sepsis, and stroke cases compared to trauma and post-operative admissions. Conclusion Multidrug-resistant organisms and the spread of nosocomial infections are the predominant causes of VAP in the ICU. This emphasizes the urgent need for multifaceted interventions to prevent and manage VAP effectively. Developing and implementing targeted strategies, considering the unique challenges faced in resource-constrained healthcare settings can aid in decreasing the mortality associated with it.

Keywords: developing country; etiological factors; intensive care unit; nosocomial infections; ventilator-associated pneumonia.