Critical Care and Shock

Ventilator Associated Pneumonia: Incidence, Etiology, and Preventive Strategies

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Objective: To determine the incidence of ventilator associated pneumonia (VAP) in the intensive care unit, and to characterize most common causative pathogens and resistance pattern. To evaluate compliance to VAP prevention strategies and their documentation in order to identify areas for quality improvement.

Design: A retrospective single center study was performed in which medical records were reviewed from all patients on mechanical ventilator admitted to intensive care unit from January to December 2007. The Clinical Pulmonary Infection Score (CPIS) and problem list were used to identify VAP cases. Data on microbial isolates and antimicrobial resistance were collected as well as documentation of measures to prevent VAP.

Setting: A multidisciplinary, eight-bed Intensive Care Unit (ICU) at a metropolitan municipal hospital in Puerto Rico.

Patients and participants: A total of 60 patients that required mechanical ventilation for more than 48 hours.

Measurements and results: The overall estimated VAP rate was 37.15. There was an extremely low compliance to head of bed elevation, daily sedation interruption and oral care. The most common pathogens identified in early and late onset VAP were Klebsiella species, Acinetobacter baumanii, and Pseudomonas aeruginosa, all being multidrug resistant pathogens.

Conclusions: The lack of compliance to VAP preventive measures as part of the routine management of patients in mechanical ventilation may explain the high VAP rate. Multidisciplinary teams are needed to establish standardized protocols as well as periodic quality improvement reviews to prevent this complication.

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