Comparison of microbiological profile of pathogens isolated from early-onset and late-onset ventilator-associated pneumonia in a tertiary care center

Background and Objectives: Ventilator- Associated Pneumonia (VAP), an important form of Hospital Acquired Pneumonia, specifically refers to pneumonia developing in a patient on Mechanical Ventilator for more than 48 hours after intubation or tracheostomy. The time of onset of pneumonia is an important risk factor for specific pathogens & outcome in patients with VAP. Early onset VAP (EO- VAP), defined as occurring within first 4 days of hospitalization, usually caused by antibiotic sensitive bacteria i.e., community acquired, whereas the late onset (LO-VAP) i.e., more than 5 days are associated with increased mortality in patient. The emergence of Multi-Drug Resistant (MDR) pathogens is becoming a therapeutic challenge as the treatment alternatives are unavailable, toxic and with poor outcome. VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, to prevent mortality and morbidity. Early detection of pathogens causing VAP helps to control their spread by administration of suitable antibiotics and proper infection control measures. The study was conducted to compare the bacteriological profile of pathogens causing EO-VAP and LO VAP in Fr. Muller Medical College Hospital. Materials and Methods: A total of 100 patients, on mechanical ventilation for more than 48 hours who were diagnosed to have VAP were included in the study between May 2009 to April 2010. Their Endotracheal Aspirate were collected and processed. From 100 pathogens of count >10 5 CFU/mL were characterized and antibiogram was determined using standard antibiotics regime. Results: Among 100 patients studied, fifty five patients were of LO-VAP and remaining forty five were EO-VAP. Acinetobacter species, Klebsiella pneumoniae, Pseudomonas aeruginosa were the most common pathogens causing VAP. Majority of the pathogens causing EO- and LO-VAP had similar sensitivity pattern, i.e., sensitive to high end antibacterials like Levofloxacin, Amikacin, Carbapenemes. Conclusion: In the patients studied, there was no difference in the antibiogram of the pathogens causing EO- and LO-VAP.