scholarly journals Ventilator-associated pneumonia in a tertiary care hospital in India: incidence and risk factors

2009 ◽  
Vol 3 (10) ◽  
pp. 771-777 ◽  
Author(s):  
Noyal Mariya Joseph ◽  
Sujatha Sistla ◽  
Tarun Kumar Dutta ◽  
Ashok Shankar Badhe ◽  
Subhash Chandra Parija
Keyword(s):  
Risk Factors ◽  
Early Onset ◽  
Preventive Measures ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Emergency Intubation

Background: Knowledge of the incidence of ventilator-associated pneumonia (VAP) and its associated risk factors is imperative for the development and use of more effective preventive measures. Methodology: We performed a prospective study over a period of 15 months to determine the incidence and the risk factors for development of VAP in critically ill adult patients admitted in different intensive care units (ICUs) of Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), a tertiary care hospital in Pondicherry, India. Results: The incidence of VAP was 30.67 and 15.87 per 1,000 ventilator days in the two different ICUs. In our study 58.3% of the cases were late-onset VAP, while 41.7% were early-onset VAP. Univariate analysis indicated that the following were significantly associated with VAP: impaired consciousness, tracheostomy, re-intubation, emergency intubation, and nasogastric tube. Emergency intubation and intravenous sedatives were found to be the specific risk factors for early onset VAP, while tracheostomy and re-intubation were the independent predictors of late-onset VAP by multivariate logistic regression analysis. Conclusions: Knowledge of these risk factors may be useful in implementing simple and effective preventive measures including non-invasive ventilation, precaution during emergency intubation, minimizing the occurrence of reintubation, avoidance of tracheostomy as far as possible, and minimization of sedation.

scholarly journals Spectrum of Early Onset and Late Onset Ventilator Associated Pneumonia (VAP) in a Tertiary Care Hospital of Bangladesh: A Prospective Cohort Study

2015 ◽  
Vol 3 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Uzzwal Kumar Mallick ◽  
Mohammad Omar Faruq ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Onset ◽  
Prospective Cohort ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital

Objective : To compare the outcome of critically ill patients developing early onset Ventilator-associated pneumonia (VAP) occurring within 96 h of ICU admission and late onset VAP occurring after 96 h of ICU admission in critically ill patients admitted in the ICU of BIRDEM General Hospital of Bangladesh.Study Design: Prospective cohort study.Material and Methods: Study data obtained over a period of 24 months (July 2012 - June 2014) in the ICU of a tertiary care hospital was prospectively analyzed. Subjects were classified by ventilator status: early onset VAP (< 96 hrs of mechanical ventilation) or late-onset VAP (?96 hrs of mechanical ventilation). Baseline demographics and bacterial etiology were analyzed according to the spectrum of status of VAP.Results: The incidence of VAP was 35.73 per 1,000 ventilator days. In our study 52% of the cases were early-onset VAP, while 48% were late-onset VAP. Acinetobacter was the commonest organism isolated from late-onset VAP (p = 0.029) while Pseudomonas was the commonest isolates obtained from early-onset VAP (p = 0.046). Klebsiella, MRSA and E. coli were almost identically distributed between groups (p > 0.05). There is significant difference of sensitivity pattern of Acinetobacter baumannii and pseudomonas aeruginosa in both early and late-onset VAP (p=0.01). The overall mortality rate in our study was 44%. The mortality was significantly higher in the late-onset VAP (62.5%) than that in the early-onset VAP (26.9%) (p=0.011).Conclusion: From this study we conclude that late-onset VAP had poor prognosis in terms of mortality as compared to the early-onset type. The higher mortality in the late-onset VAP could be attributed to older age, higher co-morbidities like diabetes mellitus, COPD and CKD. The findings are similar to findings of other international studiesBangladesh Crit Care J March 2015; 3 (1): 9-13

Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India

2020 ◽  
pp. 004947552098245
Author(s):  
Pooja Kumari ◽  
Priya Datta ◽  
Satinder Gombar ◽  
Deepak Sharma ◽  
Jagdish Chander
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Control Measures ◽  
North India ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Utilisation Rate

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

scholarly journals Prevalence of Ventilator Associated Pneumonia in Neonates in A Tertiary Care Hospital in Western Nepal

2019 ◽  
Vol 57 (216) ◽  
Author(s):  
Anita Lamichhane ◽  
Aparna Mishra
Keyword(s):  
Sample Size ◽  
Neonatal Intensive Care ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Point Estimate ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Cross Sectional

Introduction: Ventilator-associated pneumonia is a serious problem which needs to be addressed for a better outcome of the ventilated babies. The present study is undertaken to find out the prevalence of ventilator-associated pneumonia in neonates in a tertiary care hospital in western Nepal.Methods: A descriptive cross-sectional study was carried out in a tertiary care hospital in the western region of Nepal from March 2016 to February 2019 after approval from the Institutional review committee. Sample size was calculated and convenience sampling was done to reach the sample size. Data were collected from hospital records and entered in Statistical Package for the Social Sciences, point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.Results: Out of 95 patients ventilated in neonatal intensive care unit in the last 3 years, 23 (24.01%) developed ventilator-associated pneumonia. Prevalence of ventilator-associated pneumonia is 23 (24.01%) at 95% (14%-34%). Late onset ventilator associated pneumonia was seen in 15 (15.78%) while early onset ventilator associated pneumonia was seen in 8 (8.42%). Conclusions: Prevalence of ventilator associated pneumonia in neonates in tertiary care hospital is high compared to other studies conducted in neonates.

scholarly journals Identification of Risk Factors for Typhoid Fever in Children Admitted in a Tertiary Care Hospital

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Soma Halder ◽  
◽  
Md. Ekhlasur Rahman ◽  
Mst Mukta Sarker ◽  
Fabia Hannan Mone ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Enteric Fever ◽  
Tertiary Care Hospital ◽  
Systemic Disease ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Control Group ◽  
Major Public Health Problem ◽  
Care Hospital

Enteric fever remains a major public health problem in developing countries like Bangladesh. Improvement in the health facility, vaccination, and health-related awareness program the incidence of enteric fever among children is not decreased. The study aimed to find out the risk factors for enteric fever in hospitalized children in a tertiary care hospital. Methodology: We conducted a hospital-based case-control study to identify the risk factors in children residing in Dhaka city. We enrolled 50 enteric fever cases as a case group and 50 age-matched febrile patients as a control group. Result: Out of 50 cases, 2 patients were below one year and most of them were pre-school aged 26(52%). Univariate analysis showed that enteric fever is more who take food with the help of the mother and caregiver (OR=7.1); 95% CI= 26.7 -61.3) and never or rarely wash hands before preparing food and before feeding (OR= 5.7; 95% CI= 23.2 -52.8). Cases were eating outdoors at the mobile food vendors and consuming ice-cream regularly (OR=2.28; 95% CI=1- 39) whereas the control group also took street food but less frequently. Conclusion: Enteric fever is an exclusive food and water-borne systemic disease and one of the major public health problems in Bangladesh. Not only overcrowding, unsafe drinking water are the common risk factors but also hand washing both children and caregiver, poor food habit is the important risk factors. So, health education to children and food handlers may reduce the incidence of enteric fever in children.

scholarly journals Risk Factors of Poorly Controlled Childhood Epilepsy - A Study in A Tertiary Care Hospital

2012 ◽  
Vol 34 (2) ◽  
pp. 44-50 ◽  
Author(s):  
AKM Moinuddin ◽  
Md Mizanur Rahman ◽  
Shaheen Akhter ◽  
Syeda Tabassum Alam ◽  
CA Kawser
Keyword(s):  
Risk Factors ◽  
Early Onset ◽  
Odds Ratio ◽  
Tertiary Care Hospital ◽  
Focal Epilepsy ◽  
Tertiary Care ◽  
Idiopathic Epilepsy ◽  
Care Hospital ◽  
Hospital Design ◽  
One Year

Objective: Identifying the risk factors of poor seizure control in children in a setting of tertiary care hospital. Design: Retrospective study. Setting: Child Development and Neurology Unit in the department of Paediatrics of Bangabandhu Sheikh Mujib Medical University (BSMMU). Study period: January 2004 through December 2005. Subjects: One hundred and twenty epileptic children were studied. They were grouped into controlled group (seizure free for more than six months) and poorly controlled group (having one or more seizure per month over a period of six months or more and who had experienced trials of at least two different antiepileptic drugs at optimum doses alone or in combination with adequate compliance) at the end of intervention and compared. Results: In this study 76 (63.3%) children were male and 44 (36.7%) children were female. Out of 120 cases 79 (65.8%) were in controlled group and 41 (34.2%) cases had poorly controlled epilepsy. Mean age of the controlled group and poorly controlled group of children were 79 months and 40.3 months respectively. Focal epilepsy was found in 30 (68%) cases in controlled and in 14 (31.8%) cases of poorly controlled group and generalized epilepsy was found in 42 (72%) cases in controlled and in 19 (28.8%) cases in poorly controlled group. Idiopathic epilepsy was more common which was 37 (46%) in controlled group against 14 (34%) in poorly controlled group. But symptomatic and cryptogenic cases were more prevalent with poorly controlled group 57.5% than controlled group 53%. In poorly controlled group 48.8% had cerebral palsy in comparison to 22.8% of controlled group. Early onset of seizure before one year was 25.3% in controlled and 78% in poorly controlled group (odds ratio=.2322, p =.0082) and one or more seizure per week 43% in controlled and 92.7% in poorly controlled group (odds ratio=.1218, p=.0032) were found as risk factors of poorly controlled epilepsy. Conclusion: Early onset of seizure before one year, symptomatic epilepsy and one or more seizure per week at diagnosis were found as risk factors of poorly controlled epilepsy in children attending a tertiary care hospital. DOI: http://dx.doi.org/10.3329/bjch.v34i2.10216 BJCH2010; 34(2): 44-50

scholarly journals Clinical profile and outcomes among neonatal pneumonia patients admitted in a tertiary care hospital, Gujarat, India

2021 ◽  
Vol 8 (5) ◽  
pp. 914
Author(s):  
Jigisha R. Patadia ◽  
Ankit Parmar ◽  
Vijay B. Shah ◽  
Praful R. Bambharoliya
Keyword(s):  
Early Onset ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Antibiotic Sensitivity ◽  
Clinical Profile ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
X Ray

Background: Neonates are highly vulnerable to infection due to factors like immaturity, immunologic deficiencies at time of birth and in-utero maternal infection. Neonatal pneumonia continues to remain important cause of mortality and morbidity in developing countries like India. The aim of this study was to study the clinical profile and outcome of neonatal pneumonia.Methods: This descriptive observational study was carried out at NICU of tertiary care hospital with level III nursery during August-October 2012. A total of 200 neonates admitted in NICU during the study period were included as per inclusion criteria. All neonates were observed on day of admission, on day of deterioration and day of discharge. Clinical parameters, investigation profile, probable aetiology, intervention required and outcome was noted.Results: Out of 200 neonates admitted during study period, 64 neonates were having neonatal pneumonia, making incidence of 32%. All symptomatic patients having respiratory distress were evaluated by taking blood samples for blood culture with antibiotic sensitivity, C-reactive protein, sepsis screen and X-ray chest. Onset of pneumonia was decided on basis of appearance of symptoms like early onset (<72hours) or late onset (>72 hours). Half of the patients had shown improvement after intervention but 16% deteriorated which required ventilatory support. Mortality was 32.81% and it was more in early onset (40%) than late onset (28.2%).Conclusions: There was no single parameter which can be used for diagnosis of neonatal pneumonia. Clinical features with chest X-ray with sepsis markers have to be considered in diagnosing pneumonia.

scholarly journals Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens

2010 ◽  
Vol 4 (04) ◽  
pp. 218-225 ◽  
Author(s):  
Noyal Mariya Joseph ◽  
Sujatha Sistla ◽  
Tarun Kumar Dutta ◽  
Ashok Shankar Badhe ◽  
Desdemona Rasitha ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Multi Drug Resistance ◽  
P Value ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Candida Spp ◽  
Beta Lactamases

Background: Ventilator-Associated Pneumonia (VAP) is the most frequent intensive-care-unit (ICU)-acquired infection. The aetiology of VAP varies with different patient populations and types of ICUs. Methodology: A prospective study was performed over a period of 15 months in a tertiary care hospital to determine the various aetiological agents causing VAP and the prevalence of multidrug resistant (MDR) pathogens. Combination disk method, Modified Hodge test, EDTA disk synergy (EDS) test and AmpC disk test were performed for the detection of extended spectrum beta-lactamases (ESBL), carbapenemases, metallo-beta-lactamases (MBL) and AmpC β-lactamases respectively. Results: Enterobacteriaceae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Candida spp. were more common in early-onset VAP, while non-fermenters (Pseudomonas spp. and Acinetobacter spp.) were significantly associated with late-onset VAP (P value 0.0267, Chi-square value 4.91). Thirty-seven (78.7%) of the 47 VAP pathogens were multidrug resistant. ESBL was produced by 50% and 67% of Escherichia coli and Klebsiella pneumoniae respectively. MBL was produced by 20% of P. aeruginosa. AmpC beta-lactamases were produced by 33.3% and 60.7% of the Enterobacteriaceae and non-fermenters respectively. Of the S. aureus isolates, 43% were methicillin resistant. Prior antibiotic therapy and hospitalization of five days or more were independent risk factors for VAP by MDR pathogens. Conclusions: VAP is increasingly associated with MDR pathogens. Production of ESBL, AmpC beta-lactamases and metallo beta-lactamases were responsible for the multi-drug resistance of these pathogens.  Increasing prevalence of MDR pathogens in patients with late-onset VAP indicate that appropriate broad-spectrum antibiotics should be used to treat them.

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