Bacterial Flora as Determinants of Ventilator Associated Pneumonia in Intubated Patients in An Intensive Care Unit

Nkoroi, Beatrice Nkirote (2014) Bacterial Flora as Determinants of Ventilator Associated Pneumonia in Intubated Patients in An Intensive Care Unit. Masters thesis, Kenyatta University.

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Abstract

Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. Of these, ventilator associated pneumonia (VAP), a common complication of endotracheal intubation and subsequent mechanical ventilatory support in critically ill ICU patients is a major concern for intensivists and other health care players. The issue of concern is whether the microbial agent present in the respiratory tract of patients at the time of intubation is likely to cause VAP in the intubated and mechanically ventilated patient. Studies done internationally have established a profile of some of the common bacterial agents responsible for VAP, however no studies have been done in Kenya to profile the common pathogens responsible for VAP and therefore, relatively little information is available about the Kenyan epidemiology of such infections. The purpose of this study was to provide an up-to-date picture of the demographic characteristics of patients who develop VAP, the prevalence of VAP and the common bacterial causative agents and the antimicrobial sensitivity patterns in a mixed medical – surgical ICU of the Aga Khan University Hospital, Nairobi Kenya. One hundred patients admitted into the ICU who were intubated during the study period were enrolled. Endotracheal aspirates were taken at the time of intubation and repeated when a clinical suspicion of VAP was made. Data was collected using preprinted case report forms and analyzed using chi-square and Pearson’s correlation as appropriate using the statistical software for social sciences (SPSS) version 17. Data was presented in tables, histograms, and other pictorial presentations as appropriate. The mean age of the patients was 55.86 years (95 % CI: 52.15, 59.67). Males were 57(57 %) and females were 43 (43 %).Most of the patients were admitted to ICU via A and E (35 %). Patients with medical conditions were (57) 57 %, those with surgical conditions were 25 (25 %) while 18 (18 %) had both a medical and surgical condition. A total of 78 (78 %) patients had chronic comorbidities while twenty two (22) patients did not have any comorbidity. Among the 78 who had comorbidities only 9 (12 %) had respiratory related comorbidities. A total of 21 (21 %) patients had a history of respiratory infection at the time of admission into ICU. Sixteen patients developed VAP, giving the prevalence of VAP at the AKUH, N ICU of 16 % (95 % CI: 14.0-23.6 %).The most common bacterial pathogens isolated from the patients with VAP were Acinetobacter baumanii (37.5 %), Pseudomonas aeruginosa (12.5 %), Klebsiella pneumoniae (6.3 %). Candida albicans was isolated in 12.5 % of patients with VAP. Thirty two percent (32 %) of the pathogens isolated demonstrated high resistance and MDR patterns to the antibiotics commonly prescribed in this ICU. Meronem (26 %), Tazopipril and Rocephine each at 12 % were the most commonly prescribed antimicrobial agents. Further studies are recommended to establish the susceptibility patterns of the individual antimicrobial agents and evaluate the clinical outcomes of patients with VAP

Item Type:	Thesis (Masters)
Subjects:	R Medicine > RT Nursing
Divisions:	Africana
Depositing User:	Tim Khabala
Date Deposited:	13 Jun 2017 10:33
Last Modified:	13 Jun 2017 10:33
URI:	http://thesisbank.jhia.ac.ke/id/eprint/1804

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