VENTILATOR-ASSOCIATED PNEUMONIA IN ADULT ICU PATIENTS: INCIDENCE AND RISK FACTORS

Background: Ventilator-associated pneumonia (VAP) poses a significant healthcare-associated infection threat to adult intensive care units (ICUs). It leads to prolongation of ventilation duration, longer ICU stay, increased use of antimicrobials, and more deaths. Objective: To evaluate how often VAP occurs in adult ICU patients on mechanical ventilation and to explore patient- and care-related factors that increase the risk of developing VAP. Methods: A prospective observational affiliate study was planned and conducted in the Department of Intensive Care Unit at Hameed Latif Hospital, Lahore, during the period from August 2024 to February 2025. Adult patients (≥18 years) who were on invasive mechanical ventilation for ≥48 hours were included in the study on a consecutive basis. VAP was identified clinically and radiologically, and microbiologically, when evidence was available, after 48 hours of ventilation. A variety of variables were recorded, such as demographics, comorbidities, prior antibiotic exposure, delirium, reintubation, oral care frequency, ventilation duration, and outcomes. Incidence was determined based on the number of cases per 100 ventilated patients and per 1000 ventilator-days. Independent predictors were determined by multivariable logistic regression. Results: Among 240 mechanically ventilated patients, 54 cases of VAP were identified (22.5%), with an incidence density of 23.5 for every 1000 ventilator-days. Most of the VAP cases were late-onset (66.7%). Patients who developed VAP had significantly longer duration of mechanical ventilation and ICU stay. ICU mortality was 33.3% in the VAP patients, compared to 18.3% in non-VAP patients. In the multivariate analysis, the factors that independently increased the risk of VAP were ventilation duration >7 days, reintubation, delirium, inadequate oral care, and prior antibiotic exposure. Conclusion: Ventilator-associated pneumonia was frequent and led to poor clinical outcomes. Measures aiming at prompt weaning, prevention of reintubation, delirium control, antimicrobial stewardship, and standardized oral hygiene may be helpful in lowering the VAP burden.