Retrospective evaluation of patients diagnosed with ventilator associated pneumonia in Aydın Adnan Menderes University Hospital

Healthcare-associated infections (HAI) are the most common infections in hospitalised patients. Ventilator-associated pneumonia (VAP) ranks 4th among these infections. Ventilator-associated pneumonia is pneumonia diagnosed with symptoms of a lower respiratory tract infection 48 hours or more after mechanical ventilation has been started in patients without a previous lung infection. Ventilator-associated pneumonia is an important condition to diagnose and treat early because it prolongs the duration of mechanical ventilation and significantly increases morbidity and mortality. It can be diagnosed by clinical, laboratory, imaging and microbiological agent detection. The aim of this study was to retrospectively evaluate the demographic and clinical characteristics, laboratory and imaging findings of patients followed up with a diagnosis of VAP. A total of 60 patients, ranging in age from neonatal period to 18 years, who were admitted to the neonatal intensive care unit (NICU) and paediatric intensive care unit (PICU) of Aydın Adnan Menderes University were included in our study. Patients with recurrent episodes of VAP were only included in the study if they had a single episode of VAP. Of the patients included in the study, 88.3% (n=53) were hospitalised in the NICU and 11.7% (n=7) in the PICU. It was observed that 33 (55.0%) of the patients were female and 27 (45.0%) were male. The mean age of the patients followed up in the neonatal intensive care unit was 45.7±39.4 days and the median age of the patients in the NICU was 54.8 (2.3-182.5) months. Chronic diseases were present in 95.0% (n=57) of the patients; among these, chronic lung disease was the most common (n=44, 38.6%). Patients were hospitalised for a mean of 46.2±38.1 days and received mechanical ventilator (MV) support for a mean of 45.4±37.7 days when diagnosed with VAP. It was observed that the mode of delivery was C/S in 85% (n=51) of the patients. The rate of gestational age <28 weeks was 53.3% (n=32). Birth weight was <1000 g in 61.7% (n=37). Endotracheal tube (ETT) was present in 95% of the patients and tracheostomy was present in 5%. Orogastric catheter (OG) was present in 88.3%, nasogastric catheter (NG) in 10%, foley catheter in 1.7%, umbilical venous catheter (UVC) in 6.7%. It was determined that 83.3% of the patients had a peripheral vascular access and 10% had a central venous catheter (CVC). Culture growth was detected in 63.3% (n=38) of the patients in the study. Pseudomonas species were found in 62.5% (n=25), Stenotrophomonas maltophilia in 10% (n=4) and Acinetobacter spp in 7.5% (n=3) of these growths. Peripheral blood culture growth was found in 10% (n=6) of the patients included in the study and no catheter growth was found in any patient. All patients had chest X-ray findings and 90% of the patients had infiltration on chest X-ray. The mean leukocyte count was 15169±8188, the mean neutrophil count was 8873±6528 and the mean lymphocyte count was 4081±1845 and CRP was positive in 36 (60%) patients. The median value of CRP was 7.3 (2-311). In our study, dual combination antibiotic treatment was frequently initiated at the time of diagnosis and the most commonly used antibiotics were piperacillin-tazobactam, cefoperazone-sulbactam, meropenem, vancomycin, amikacin and gentamicin. The mean duration of hospitalisation in the intensive care unit was 133.9±77.3 days and the mean duration of hospitalisation in MV support was 112.9±111.8 days. It was observed that 68.3% (n=41) of the patients recovered completely, 16.7% (n=10) recovered and had another episode of VP within one month, and 10% (n=6) died during this period.