Study on ventilator associated pneumonia

Not yet recruiting

• Conditions: Factors influencing health status and contact with health services,

• Registration Number: CTRI/2022/09/045768
• Lead Sponsor: AIIMS Rishikesh

Brief Summary

Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in any Intensive Care Unit (ICU) despite recent advances in diagnosis and accuracy of management. VAP is also the most frequent ICU acquired infection. In 2015 CDC conducted a point-prevalence survey in a sample of acute care hospitals in U.S. and determined that of the 427 health care–associated infections identified, pneumonia was the most common infection with 32% of those being ventilator associated. Early-onset VAP is usually less severe, associated with a better prognosis, and is more likely to be caused by antibiotic-sensitive bacteria. Late-onset VAP, is usually caused by multi-drug resistant (MDR) pathogens and is associated with increased morbidity and mortality. Many studies from India have investigated the causative organisms of VAP. Pseudomonas spp., Acinetobacter spp., E.coli , Klebsiella pneumoniae, and Staphylococcus aureus were identified as the common VAP pathogens, with varying prevalence. Up to 40% of these infections can be polymicrobial. Pseudomonas spp., Acinetobacter spp.and,even Enterobacteriaceae are quite often MDR. Therefore, the local microbial flora causing VAP needs to be studied in each setting to guide more effective and rational utilization of antimicrobial agents.

For the last few decades, hospitals have taken the hospital-acquired infections seriously. Several hospitals have established infection tracking and surveillance systems in place, along with robust prevention strategies to reduce the rate of hospital-acquired infections. The impact of hospital-acquired infections is seen not just at an individual patient level, but also at the community level as they have been linked to multidrug-resistant infections. Identifying patients with risk factors for hospital-acquired infections and multidrug-resistant infections is very important in the prevention and minimization of these infections.



So for there is scanty literature about prevalence, bacteriology, and antibiotic susceptibility pattern about VAP in India. Although mechanical ventilation (MV) is a life-saving intervention, it has its own potential complications. Newer antibiotics in the past decade have not brought down the mortality in the critical care facilities across the world, associated with VAP. The increasing incidence, mortality, MDR pathogens of VAP in Critical Care Units are the main challenges prompting for this study. The main concerns are to determine the prevalence, bacteriology, local antibiotic susceptibility, and resistance pattern including MDR isolates, risk factors, and outcome of VAP at a tertiary care institute.



As per CDC/NHSN guidelines ,



Pneumonia (PNEU) is identified by using a combination of imaging, clinical and laboratory criteria.



Ventilator: Any device used to support, assist, or control respiration (inclusive of the weaning period) through the application of positive pressure to the airway when delivered via an artificial airway, specifically an oral/nasal endotracheal or tracheostomy tube.



Ventilator-associated pneumonia (VAP): A pneumonia where the patient is on mechanical ventilation for > 2 consecutive calendar days on the date of event, with day of ventilator placement being Day 1,\*



AND



the ventilator was in place on the date of event or the day before.



\*If the ventilator was in place prior to inpatient admission, the ventilator day count begins with the admission date to the first inpatient location.



If a break in mechanical ventilation occurs for at least one full calendar day, ventilator day count for ventilator association starts anew upon reintubation and/or re-initiation of mechanical ventilation.

Detailed Description

Not available

Study Timeline

• Last Update Posted: 2022-09-20
• Study Start: 2022-09-24

Recruitment & Eligibility

• Status: Not Yet Recruiting
• Sex: All
• Target Recruitment: 101

Inclusion Criteria

Admitted to ICU and intubated for ≥ 48 hrs.

Exclusion Criteria

• Community Acquired Pneumonia 2.
• Pre-existing pneumonia 3.
• Pregnancy 4.
• Immunocompromised patients 5.
• Patient / attendant refusing to give consent for participating in study.

Study & Design

• Study Type: Observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Total number of VAP cases	One year

Secondary Outcome Measures

Name	Time	Method
Organism isolated along with frequency	Antibiotic sensitivity/resistance pattern

Trial Locations

Locations (1)

AIIMS Rishikesh; 🇮🇳 Dehradun, UTTARANCHAL, India

AIIMS Rishikesh

🇮🇳Dehradun, UTTARANCHAL, India

Ravi Chaudhary

Principal investigator

8853419492

Ravichaudhary8080@gmail.com