Ventilator Associated Pneumonia in Geriatric Intensive Care Unit

Thesis 2014 Ventilator Associated Pneumonia in Geriatric Intensive Care Unit/ El-said,Mai Samy , 616 الأمراض

تصنيف ديوى

616.075.241

المؤلف

El-said,Mai Samy , العنوان: Ventilator Associated Pneumonia in Geriatric Intensive Care Unit/ بيان المسئولية : Mai Samy El-said;Supervisor:Eman Mohammed Kamel ,Rania Ali Ammar,

عنوان موازي

الألتهاب الرئوى المصاحب لجهازالتنفس الصناعى فى وحدة الرعاية المركزة للمسنين.

تاريخ النشر

2014

الحجم: 141.p: ابعاد الوعاء: 30.cm.

درجة الرسالة

Thesis(m.s)Ain-Shams University-Faculty of Medicine-Clinical and Chemical Pathology

ملخص

Hospital-acquired pneumonia is the most common life-threatening hospital-acquired infection, and the majority of cases are associated with mechanical ventilation.

Ventilator associated pneumonia (VAP) occurs 48 hours after intubation and mechanical ventilation. It is a common infectious disease that is found in intensive care unit (ICU), which occurs in 8-38% of patients who underwent mechanical ventilation. The incidence of pneumonia has been known to be higher in ICU patients than in general ward patients and even 3 ~ 10-fold higher in patients who underwent mechanical ventilation .

Time of onset of pneumonia is an important epidemiologic variable and risk factor for specific pathogens and outcomes in patients with HAP and VAP.

1) Early-onset VAP (occurring within the first 4 days of hospitalization) usually carry a better prognosis and are more likely to be caused by antibiotic sensitive bacteria.

2) Late-onset VAP (occurring greater than 4 days after hospital admission) are more likely to be caused by multiple-drug resistant pathogens associated with increased hospital mortality and morbidity .

VAP is the leading cause of nosocomial mortality for patients with respiratory failure. Approximately 60% of all deaths in patients with nosocomial infections are associated with HAP and the mortality rate is higher in critically ill patients and those patients developing VAP.

Risk factors associated with VAP development were grouped into intrinsic factors (individual variable of age, co-morbidity, disease severity, etc.) and extrinsic factors (potential hospital environment risks, prior use of antibiotics, tracheal intubations .

The detection of the causative organism in VAP is imperative for guiding an appropriate therapy as there is strong evidence of the adverse effect of inadequate empirical treatment on outcome.

A number of strategies have been proposed for VAP prevention; Among others, modifications to the endotracheal tube (ETT), ETT secretion removal, patient positioning in the lateral horizontal position, kinetic therapy, and administration of probiotics.

Several studies have shown that appropriate antimicrobial treatment of patients with VAP significantly improves outcome, more rapid identification of infected patients and accurate selection of antimicrobial agents represent important clinical goals.

The aim of this study is to determine the etiological agents, assosciated risk factors and antibiotic susceptibility patterns of ventilator assosciated pneumonia (VAP).

This study was conducted on a total number of 100 broncho-alveolar lavage (BAL) and (ETT) specimens of patients developing VAP like symtoms admitted at Ain Shams University Hospital Geriatric Intensive Care Units. All specimens were subjected to standard bacteriological procedures including-- Gram’s stain, Culture on Blood agar, MacConkey agar and chocolate agar. Biochemical reaction. Antimicrobial susceptibility testing by disc diffusion method on Mueller–Hinton agar plate.

In our study we found that, The age of the patients ranged from 45 – 88 years, the mean age being 63.4 years. The sex distribution of the patients is 60 % males & 40 % females.

The commonest comorbidity was stroke (28%) followed by pulmonary disorders (17%),cardiac disorders (17%).

Out of 100 patients, 39 % show criteria of early onset VAP & 61 % show criteria of late onset VAP. Most common organisms isolated in early onset VAP were Acintobacter (30%) and Staphylococcus aureus (26.7% ). Most common organism isolated in late onset VAP was Acintobacter (42.6%), followed by Klebsiella (27.7). 100% of bacterial isolates in early and late onset Ventilator acquired pneumonia were sensitive to vancomycin and linezolids. Invasive diagnostic testing is not needed routinely to manage suspected VAP and diagnostic bronchoscopy was not used routinely as it was not considered safe in critically ill patients; endotracheal tube also was used with results similar to BAL. The variation and differences in the clinical and bacteriological pattern are related to the ICU case mix and difference in the definition and diagnostic studies used and such differences make direct comparison between studies difficult. This study confirms the magnitude of the problem of VAP. So the best approach to manage this problem seems to be adaptation of preventive strategies.

الموضوع: Ventilator Associated Pneumonia Geriatric Intensive Care Unit

مؤلف فرعي

Kamel,Eman Mohammed, / Supervisor مؤلف فرعي: Ammar,Rania Ali, / Supervisor

الهيئة المشرفة

Ain-Shams University / Faculty of Medicine -department of Clinical and Chemical Pathology