Ventilator associated pneumonia in a respiratory intensive care unit: What has changed during three years period?

In this study,we aimed to evaluate Ventilator Associated Pneumonia(VAP) between the years 2011-2013 in the respiratory intensive care unit(ICU) of a university hospital in terms of aetiological agents,antibiotical resistances and prognosis.121(87 male,median age 72 yrs,mean APACHE II 24±8.5)cases who met the clinical and bacteriological VAP criteria is included in the study.Mechanical ventilation rates were minimum 0.34,maximum 0.88 dates while VAP rates were minimum 8,maximum 75 days per 1000 ventilator days.ARDS and blood transfusion rates were higher in late onset VAP(65.3%)cases while parenteral nutrition rates were higher in early onset VAP(34.7%)cases (p values;0.029, 0.005 and 0.001 respectively).The most common agent isolated from endotracheal samples was A. baumannii (53.7%)having tendency to have increased Imipenem,Meropenem,Ceftazidim,Cefepime,Gentamicin,Levofloxasin resistances in years.Being previously intubated or intubation in our ICU were detected as independent risk factors for having resistance to extended spectrum beta-lactam/beta-lactamase inhibitors in multivariate analyses(p=0.044 and OR=2.44, p=0.036 and OR= 2.67 respectively).Noninvasive positive pressure ventilation before intubation was detected as an independent risk factor for having resistance to antipseudomonal cephalosporins in multivariate analyses(p=0.037 and OR=2.64).Nosocomial infections were seen in 70(%57.9) cases 36(%29.8) of which were VAP.Median durations of ICU and hospital stay were 21.5 and 26 days respectively.73.6% of cases were dead.Clinical irresponsiveness was increasing the mortality 6.8 fold while procalcitonin levels being 1 µg/L ≥ on first day of VAP 10.4 fold.