Comparison of early- and late-onset ventilator-associated pneumonia among stroke patients of neurosurgery intensive care unit: A prospective study

Background: Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops in patients after 48 h of mechanical ventilation. Most common complications among stroke patients in Neurosurgery ICU are Ventilator associated pneumonia, Urinary tract infections, Venous thromboembolism, Pressure ulcers. This study aims to estimate the prevalence of VAP and to identify the bacterial pathogens causing early-onset and late-onset VAP and their antibiotic susceptibility profile. Materials and Methods: This was a prospective and longitudinal study carried out at Kalinga Institute of Medical Sciences, Bhubaneswar, India, from September 1, 2022 to May 31, 2024. This study included stroke patients admitted to the neurosurgery ICU who developed VAP. The demographic, clinical, and microbiological data were collected in the case report pro forma. VAP was diagnosed based on the clinical pulmonary infection score system. Microbiological processing of samples was done as per the India Council of Medical Research standard operating procedures. Results: In our study, the prevalence of VAP was 5.75% (47/817). Early-onset VAP was developed in 24 patients (51%) and late-onset VAP was seen in 23 patients (49%). The common pathogens isolated from the early-onset and late-onset VAP were Acinetobacter baumannii and Klebsiella pneumo niae. K. pneumoniae was most susceptible to tigecycline (100%), A. baumannii was most susceptible to minocycline (80%), both in early- and late-onset VAP. The mortality rate was higher in late-onset VAP 10 (43.47%). Conclusion: The prevalence of VAP is 5.75%. The pathogens isolated are Klebsiella pneumoniae and A. baumannii complex , and in late onset VAP, maximum were resistant to most of the commonly used antibiotics.