A clinical study on the pattern of antimicrobial drug use and drug resistance in patients with ventilator-associated pneumonia in a tertiary care hospital.

Context: Ventilator-associated pneumonia (VAP) develops nearly in about one-third of the patients, 48 h after receiving mechanical ventilation. Common pathogens are Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter spp., Klebsiella spp., Escherichia coli, Proteus spp., Enterobacter spp. and Enterococcus spp. including multidrug-resistant pathogens.

Aim: The study aims to assess the pattern of antimicrobial drug use in VAP and to assess the etiological organisms and their drug sensitivity and resistance pattern.

Settings and design: Study participants admitted to Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bengaluru, and who developed VAP were included in this prospective observational study.

Subjects and methods: Bronchial secretions were subjected to microbiological analysis. The etiological organisms, their drug sensitivity and resistance pattern, and the outcome of drug therapy were recorded. The clinical course of the study participants was monitored till either the resolution of pneumonia or the demise of the participant.

Statistical analysis used: Qualitative data were analyzed using the Chi-square test or Fischer's exact test and quantitative data using the independent t-test.

Results: Early VAP was seen in 91.7% and late VAP in 8.3% of the participants. The organisms isolated were S. aureus, Enterococcus spp., Acinetobacter spp., Klebsiella pneumoniae and P. aeruginosa. Majority of the study participants with early VAP (75%, n = 41) completely recovered from pneumonia and 80%, n = 4 participants with late VAP recovered completely.

Conclusion: The organisms had a varied sensitivity and resistance pattern. The clinical outcome was multifactorial and its association with specific antimicrobial agents cannot be drawn.