Risk factors for ventilator associated pneumonia in patients with trauma and head injury in a tertiary care teaching hospital of rural Gujarat

Abstract

Ventilator associated pneumonia (VAP) is one of the major complications occurring in patients with mechanical ventilation, particularly in patients with trauma and head injury. The present study was conducted to determine the rate of VAP in patients with trauma and head injury, risk factors associated with them and their microbial profile as well as antimicrobial susceptibility patterns. A prospective observational study was conducted at Surgical Intensive Care Unit at tertiary care teaching hospital between 1st December 2016 and 31st May 2018. All patients with traumatic injury with or without head injury and who have been intubated and put on mechanical ventilation for more than 48 hours, were included in the study. Patients developing VAP were considered as cases whereas those who did not develop VAP served as controls. Out of 174 patients included in the study, 39 patients developed VAP with an incidence rate of 22.4% and incidence density of 21.7 per 1000 ventilator-days. Risk factors such as GCS < 9 on admission, history of vomiting, craniotomy and tracheostomy were found to be statistically significant (p< 0.05) for development of VAP. Duration of ICU stay (30±16 vs 8±4.9 days) and duration of intubation (25.85±16 vs 5.83±4 days) were statistically significant findings. Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae were the most common organisms isolated. Most of these organisms were multi drug resistant but were susceptible to colistin. Tracheostomy maintenance and infection control practices for patients undergoing surgical interventions such as craniotomy should be reviewed to bring down VAP rates.