Incidence and risk factors for ventilator-associated pneumonia in the surgical intensive care unit, Siriraj Hospital

Abstract

Background: Ventilator-associated pneumonia (VAP) is a serious illness with substantial morbidity and mortality resulting in increased costs of hospital care. Even though bundles of care to prevent VAP have been established, the incidence has not been shown to have improved. Objective: To determine the incidence and risk factors of VAP in the general surgical intensive care unit, Siriraj Hospital (SICU). Material and Method: During the period from June 1st, 2010 to June 30th, 2011, 228 adult patients admitted to the general SICU were recruited. All patients required ventilator support for more than 48 hours. Data were collected by reviewing patient medical records and the retrieval of information from the Nosocomial Infection Control, Siriraj Hospital. Results: A total of 21 patients (9.21%) were diagnosed with VAP or an incidence of 8.21 cases/1,000 ventilator days. The onset of VAP was late in the majority of patients. The most common pathogens were A. baumannii (66%) followed by P. aeuruginosa (19%). Multiple logistic regression analyses showed that the numbers of central venous catheter placements, intubations and surgeries and the use of muscle relaxants and steroids were independent risk factors for VAP. Median duration of ventilator and ICU lengths of stay were longer in the VAP group (25 vs. 6 days, 25 vs. 7 days, respectively; all p<0.0001). In addition, the hospital mortality rates were significantly higher in the VAP group (33.33% vs. 12.07%; p = 0.008). Conclusion: The incidence of VAP was high in the SICU. VAP bundles including weaning protocols and airway care should be implemented.