The Incidence and Etiology of Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Somdetphraphutthaloetla Hospital

Abstract

Objectives: The purpose of this study was to describe the incidence, clinical characteristics, etiology and clinical outcome of patients with HAP and VAP.

Methods: This is a retrospective, descriptive study of HAP and VAP patients who were admitted in Internal Medicine Department, Somdetphraphutthaloetla Hospital during 1 January 2019 to 31 December 2019. Statistic analysis was used to identify patients characteristics, and etiology.

Results: One hundred and thirty-four patients were include. The mean age was 72 years, 59.7% were male. HAP was accounted for 64.9% and VAP 35.1 %. The incidence of HAP was 1.9 per 1,000 patient-days. The incidence of VAP was 6.8 per 1,000 ventilator days. 26.1% of patients were diagnosed to ischemic stroke at admission. The most common comorbidity disease was hypertension (52.2%). Bronchopneumonia was observed in 56.7% and multilobar pneumonia in 78.4%. The most common causative organisms in HAP and VAP were A.baumanii(MDR)(22%), K.pneumoniae(14.4%), A.baumanii(13.6%). The organisms found in VAP greater than HAP were A.baumanii(MDR)(34.1%) and P.aeruginosa(26.8%)(p<0.05). Cephalosporin was the most commonly used initial antibiotic (56%) followed by aminoglycosides (27.6%) and penicillin and derivative (17.9%). The concordance of initial antibiotics was 46.3% and antibiotic were modified 59% of the patients. The modified antibiotics were concordant with isolated bacteria in 96.2%. Carbapenem was the most modified antibiotic. The mortality rate was 35.8%.

Conclusions: HAP and VAP are important hospital-acquired infections. The causative organisms are usually multidrug-resistant especially A.baumanii(MDR), K.pneumoniae(ESBL), P.aeruginosa(MDR).  The local data on incidence and etiology of pneumonia may be helpful choose more appropriate initial antibiotics to improve outcome and reduce mortality rate.