• Early tracheostomy
• Late tracheostomy
• Mechanical ventilation
• Percutaneous dilatation tracheostomy
• Surgical tracheostomy
• Survival
• Tracheostomy
• Weaning

• Intensive care unit
• Invasive mechanical ventilation
• MIMIC-IV database
• Predictive model
• Timing of tracheotomy
• Tracheotomy

• Humans
• Tracheotomy/methods
• Critical Illness
• Male
• Female
• Middle Aged
• Prognosis
• Retrospective Studies
• Aged
• Respiration, Artificial/methods
• Time Factors
• Intensive Care Units
• Glasgow Coma Scale
• Predictive Value of Tests
• ROC Curve

Endotracheal tube (ETT) is an important risk factor for the development of Ventilator-associated pneumonia (VAP), as it acts as a reservoir for infectious microorganisms and bypasses the host’s defenses. One of the preventive measures for VAP is endotracheal tube composition. It has been reported that biofilm formation is reduced by using ETTs coated with pure silver or silver compounds. However, noble metal-alloy ETTs have not been adequately studied.

To evaluate the efficacy of noble metal alloy ETT (coated Bactiguard Infection Protection ETTs) in preventing VAP compared to standard non-coated ETTs in patients requiring ≥ 48 hours of mechanical ventilation and presenting for coma due to drug intoxication.

Randomized controlled study.

Participants were randomized using sealed envelopes with a concealed 1:1 allocation to either the intervention group or the control group. The intervention group used a noble metal–alloy ETT, while the control group received standard ETT. The primary outcomes were the incidence of VAP (per ventilated patients) and the duration of mechanical ventilation.

Initially, a total of 188 patients were assessed for eligibility, and the final allocation group consisted of 180 patients, who were subsequently randomized into the intervention group (n = 97) and control group (n = 83). The incidence of VAP in the intervention and control groups was 27.83% and 43.16% (P = 0.03), and the VAP ratio per 1000 ventilation days was 51.26/1000 and 83.38/1000 (P = 0.01), respectively. The mean durations of mechanical ventilation were 3.2 ± 0.78 in the intervention group and 5.03 ± 1.88 in the control group (P = 0.22). There was no statistically significant difference between groups in terms of mortality and duration of hospital stay.

Noble metal-alloy ETT reduces the incidence of VAP, ventilation days, and ICU stay for patients in mechanical ventilation.

• Antibiotics
• Delphi method
• India
• MRSA
• Methicillin-resistant Staphylococcus aureus

Ventilator-associated pneumonia (VAP) is an important cause of healthcare-associated infections, resulting in prolonged hospitalization with increased morbidity and mortality. Knowledge of predominant local pathogens and their antimicrobial susceptibility patterns helps in selection of appropriate initial antibiotic therapy in these critical cases.

The aim and objective of this study is to characterize the microbiology and antimicrobial susceptibility patterns of VAP isolates in a tertiary cancer center.

This is a 4-year qualitative observational study carried out at a tertiary care cancer hospital in Mumbai. All nondirect bronchoalveolar lavage specimens from patients with a clinical suspicion of VAP sent from the critical care unit to the department of microbiology were processed as per standard laboratory procedures. All isolates were identified to species level and an antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method and/or the VITEK 2 automated identification and susceptibility system, according to Clinical and Laboratory Standards Institute guidelines.

The study comprised 1,074 patients: 710 (66.10%) men and 364 (33.90%) women. A total of 827 bacterial isolates were obtained with 780 (94.32%) gram-negative organisms and 47 (5.68%) gram-positive organisms; of which Acinetobacter baumannii (38.7%), Pseudomonas aeruginosa (17.5%), and Klebsiella pneumoniae (16.6%) were the commonest. Of gram-negative bacilli, multidrug-resistant organisms constituted 87.50% and were susceptible to colistin.

VAP is associated with pathogens, such as A. baumannii, P. aeruginosa, and K. pneumoniae in our setting. High rates of resistance to aminoglycosides, β-lactam-β-lactamase inhibitor combinations, and carbapenems were noted.

Sangale A, Bhat V, Kelkar R, Biswas S. Microbiology of Ventilator-associated Pneumonia in a Tertiary Care Cancer Hospital. Indian J Crit Care Med 2021;25(4):421–428.

• Carbapenem-resistant A. baumannii (CRAB)
• Multidrug-resistant organisms
• Nondirect bronchoalveolar lavage
• Ventilator-associated pneumonia

• intensive care unit
• mechanical ventilation
• nosocomial infection
• ventilator associated pneumonia

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bosnia and Herzegovina/epidemiology
• Female
• Follow-Up Studies
• Humans
• Incidence
• Intensive Care Units/statistics & numerical data
• Male
• Middle Aged
• Pneumonia, Ventilator-Associated/epidemiology
• Respiration, Artificial/adverse effects
• Retrospective Studies
• Risk Factors
• Young Adult

• chlorhexidine
• mechanical ventilation
• oral care
• pneumonia

• Antisepsis
• Humans
• Intensive Care Units
• Pneumonia, Ventilator-Associated
• Prevalence
• Toothbrushing

• São Paulo Research Foundation – FAPESP
• University of Taubaté

• Chlorhexidine/administration & dosage
• Humans
• Intensive Care Units
• Intubation, Intratracheal/adverse effects
• Mouthwashes/administration & dosage
• Oral Hygiene/methods
• Pneumonia, Ventilator-Associated/etiology
• Pneumonia, Ventilator-Associated/prevention & control
• Toothbrushing

• Emergency department
• Hospital-acquired infection
• Mechanical ventilation
• Nurses’ knowledge
• Respiratory care
• Ventilator-associated pneumonia

Stress ulcer prophylaxis is associated with bacterial colonization of respiratory tract. The aims of our study were to determine risk factors for trachea colonization (TC), colonization of pharynx (CP) or stomach (CD) and hospital-acquired pneumonia (HAP), and divide the factors into those with high risk and low risk. The study population (ventilated intensive care unit (ICU) patients eligible to receive stress ulcer prophylaxis) was randomized to receive one of three different treatment protocols: ranitidine, sucralfate, and no stress ulcer prophylaxis (control group). Clinical data relative to pre-specified risk factors for TC or HAP were recorded, as follows: APACHE II score (second risk factor), duration of intubation or tracheotomy (third risk factor), duration of mechanical ventilation (fourth risk factor) and duration of hospitalization in the ICU (fifth risk factor). Gastric pH was recorded and microbiological data regarding stomach, pharynx and trachea were collected on the 1^st, 2^nd, 3^rd and 5^th day. Fifty-eight out of 81 patients developed HAP (including ventilator-associated pneumonia), which occurred later in patients with gastric content pH <4 or those that were tracheotomized. Stress ulcer prophylaxis was not associated with HAP; however, it was proved as a risk factor for TC. TC was detected in tracheotomized patients and was caused by gram-negative pathogens. CP was associated with TC, since the majority of patients had CP before TC. A combination of risk factors (APACHE II >18, age >65, mechanical ventilation and sedation) caused a higher incidence of HAP and lower incidence of TC. HAP was more frequent in patients staying in the ICU for >10 days and those with cardiovascular disease as the underlying disorder. Sedation and previous antibiotic therapy correlated with longer latent period (LAT), while higher values of gastric content pH were related to shorter LAT. The longest LAT was found in patients colonized with Acinetobacter spp. Risk factors that accelerated the occurrence of HAP were found to have caused previous colonization. A combination of risk factors increased the likelihood of TC and HAP, and shortened LAT between TC and HAP.

• Bacteria – growth and development
• Healthcare-associated pneumonia
• Intensive care units
• Peptic ulcer
• Risk factors
• Tracheostomy

• Antimicrobial
• infection
• mortality
• resistance

Ventilator-associated pneumonia (VAP) is an important hospital-acquired infection with substantial mortality. Only a few studies are available from India addressing the microbiological aspects of VAP, which have been done with small study populations. This study was carried out in the intensive care units (ICUs) of a tertiary care hospital to assess the profile of pathogens and to determine the pattern of antimicrobial resistance.

This was a retrospective study of clinically suspected cases of VAP. Over a three year period, a total of 247 cases in 2011, 297 in 2012 and 303 in 2013 admitted in ICUs on mechanical ventilation with clinical evidence of VAP were included in our study. The endotracheal aspirate samples from these suspected cases were subjected to quantitative culture technique, and colony count of ≥10⁵ colony forming units/ml was considered significant. Antimicrobial susceptibility test for the isolates was done.

VAP rates of 44.1, 43.8 and 26.3 were seen in 2011, 2012 and 2013, respectively. In all the three years, non-fermentative Gram-negative bacilli were the predominant organisms, followed by Pseudomonas spp. and Klebsiella spp. Staphylococcus aureus exhibited a downwards trend in prevalence from 50.0 per cent in 2011 to 34.9 per cent in 2013. An increase in vancomycin-resistant enterococci was seen from 4.3 per cent in 2012 to 8.3 per cent in 2013, while methicillin resistance amongst the S. aureus crossed the 50 per cent mark in 2013. An increasing trend in resistance was shown by Pseudomonas spp. for piperacillin-tazobactam (PTZ), amikacin and imipenem (IPM). For the non-fermenters, resistance frequency remained very high except for IPM (33.1%) and polymyxin-B (2.4%).

Our findings show VAP as an important problem in the ICU setting. The incidence of multidrug-resistant pathogens was on the rise. The resistance pattern of these pathogens can help an institution to formulate effective antimicrobial policy. To have a comprehensive pan-India picture, multicentric studies are needed.

Acute respiratory distress syndrome (ARDS) and pneumonia have a great impact on the treatment regimen of polytraumatized patients with severe chest trauma. The objective of our study was to determine whether biomarker levels assessed shortly after multiple trauma may predict the occurrence of these conditions.

Our patient population included 71 men and 30 women (mean age, 40.3 ± 15.8 years) with an Injury Severity Score that ranged from 17 to 59 and an Abbreviated Injury Scale Thorax of at least 3. They were admitted to our level I trauma center within one post-traumatic hour and survived for at least 24 hours after the trauma occurred. Thirty-five patients developed ARDS, 30 patients pneumonia and 21 patients both. Five individuals died during hospitalization. The levels of five selected biomarkers, which were identified by a literature search, were assessed at admission (initial levels) and on day 2 after trauma. We performed comparisons of medians, logistic regression analyses and receiver operating characteristic analyses for initial and day-2 levels of each biomarker. With regard to ARDS, initial levels of cytokeratin fragment 21–1, the soluble fragment of cytokeratin 19 (CYFRA21-1) and of the club cell protein 16 (CC16) provided significant results in each statistical analysis. With regard to pneumonia, each statistical analysis supplied significant results for both initial and day-2 levels of CYFRA21-1 and CC16. Consistently, initial CYFRA21-1 levels were identified as the most promising predictor of ARDS, whereas day-2 CC16 levels have to be considered as most appropriate for predicting pneumonia.

CYFRA21-1 levels exceeding cut-off value of 1.85 ng/ml and 2.49 ng/ml in the serum shortly after multiple injury occurred may identify polytraumatized patients at risk for ARDS and pneumonia, respectively. However, CC16 levels exceeding 30.51 ng/ml on day 2 may allow a firmer diagnosis for the development of pneumonia.

Ventilator-associated pneumonia (VAP) is the most frequent Intensive Care Unit acquired infection.

The aim is to determine the incidence, bacteriology and factors affecting VAP and to determine the multi-drug resistant (MDR) pathogens.

This was a prospective observational study conducted over a period of 1 year from April 1, 2011, to March 31, 2012.

The patients fulfilling criteria of VAP were included in this study.

This was performed using SPSS trial version 11.0 software (SPSS Inc., Chicago, Illinois, USA) and the values of P < 0.05 were considered statistically significant.

Totally 74 (27.71%) patients were developed VAP. Of total 74 patients with VAP 53 (71.62%) were females and 21 (28.37%) were females (P < 0.0001). Total 13 (17.56%) patients had early-onset VAP and 61 (82.43%) had late-onset VAP (P < 0.0001). The overall incidence of VAP rate per 1000 ventilator days was 39.59. Total 126 bacterial isolates found in 74 patients with VAP. Predominant isolates were Gram-negative 52 (70.27%). Total 41 (55.40%) patients had polymicrobial VAP, and 33 (44.59%) had single isolate. Total 55 (43.65%) isolates were MDR organisms. Total 22 patients with VAP succumbed during treatment with overall case fatality rate of 29.72%. Of total 55 MDR isolates in VAP, 13 (26.63%) were Klebsiella spp., 11(20%) Pseudomonas aeruginosa, 14 (25.45%) Acinetobacter, 8 (14.54%) Escherichia coli, and 9 (16.36%) coagulase positive Staphylococcus aureus. Total 12 (21.41%) patients succumbed among MDR isolates.

There was a high incidence of MDR pathogens in late-onset VAP. The Gram-negative organisms Klebsiella, PseudomonasE. coli and Acinetobacter were the most commonly isolated organisms with high mortality rates.

• Bacteriology
• Intensive Care Unit
• multi-drug resistant organisms
• poly-microbial
• ventilator-associated pneumonia

• Adult
• Aged
• Aged, 80 and over
• Bacteria/classification
• Bacteria/isolation & purification
• Candida/isolation & purification
• Female
• Hospitals
• Humans
• Incidence
• Intensive Care Units
• Italy/epidemiology
• Male
• Middle Aged
• Mortality
• Pneumonia, Ventilator-Associated/epidemiology
• Pneumonia, Ventilator-Associated/microbiology
• Pneumonia, Ventilator-Associated/pathology
• Retrospective Studies
• Risk Factors

Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality among patients in the Intensive Care Units (ICUs) and results in added healthcare costs. One of the methods of preventing VAP is to use polyurethane (PU)-cuffed endotracheal tube (ETT). This study compares the incidence of VAP and length of ICU stay in patients intubated with conventional polyvinyl chloride (PVC) ETT and PU-cuffed ETT.

Eighty post-laparotomy patients who were mechanically ventilated for >48 h in the ICU were included in this randomised controlled trial. Patients with moderate to severe pre-existing lung conditions were excluded from the study. Patients in group PVC (n = 40) were intubated with conventional PVC-cuffed ETT and those in group PU (n = 40) with PU-cuffed ETT. VAP was defined as a Clinical Pulmonary Infection Score of >6 with a positive quantitative endotracheal culture in patients on ventilator for >48 h.

Overall VAP rates were 23.75%. Thirteen (32.5%) patients in group PVC and six (15%) patients in group PU developed VAP. ICU stay was significantly lesser in patients intubated with PU-cuffed ETT (group PU) (median, 6 days; range: 4–8.5) compared to patients intubated with conventional ETT (group PVC) (median, 8; range: 6–11).

No statistically significant reduction in the incidence of VAP could be found between the groups. The length of ICU stay was significantly lesser with the use of ultra thin PU-cuffed ETTs.

• Polyurethane cuff
• polyvinyl chloride cuff
• ventilator-associated pneumonia

• Healthcare-associated infections (HAI)
• neurosurgery
• ventilator-associated pneumonia (VAP)

• Distilled water
• Oral hygiene
• Tooth brushing
• Ventilator associated pneumonia (VAP)

• Gastropulmonary route
• Genome macrorestriction-pulsed field gel electrophoresis
• Ventilator-associated pneumonia

• Child, Preschool
• Cross Infection/epidemiology
• Cross Infection/microbiology
• Female
• Humans
• Incidence
• India/epidemiology
• Infant
• Intensive Care Units, Pediatric
• Male
• Pneumonia, Ventilator-Associated/epidemiology
• Pneumonia, Ventilator-Associated/microbiology
• Prospective Studies
• Respiration, Artificial
• Risk Factors

Ventilator associated pneumonia (VAP) is a major cause of poor outcome among patients in the intensive care units (ICU) world-wide. We sought to determine the factors associated with development of VAP and its prognosis among patients admitted to different ICUs of a Tertiary Care Hospital in India.

We did a matched case control study during October 2009 to May 2011 among patients, ≥18 years with mechanical ventilation. Patients who developed pneumonia after 48 h of ventilation were selected in the case group and those who did not develop pneumonia constituted the control group. Patients’ history, clinical and laboratory findings were recorded and analyzed.

There were 52 patients included in each group. Among cases, early onset ventilator associated pneumonia (EVAP) occurred in 27 (51.9%) and late onset ventilator associated pneumonia (LVAP) in 25 (48.1%). Drug resistant organisms contributed to 76.9% of VAP. Bacteremia (P = 0.002), prior use of steroid/immunosuppressant (P = 0.004) and re-intubations (P = 0.021) were associated with the occurrence of VAP. The association of Acinetobacter (P = 0.025) and Pseudomonas (P = 0.047) for LVAP was found to be statistically significant. Duration of mechanical ventilation (P = 0.001), ICU stay (P = 0.049) and requirement for tracheostomy (P = 0.043) were significantly higher in VAP. Among each case and control groups, 19 (36.5%) expired.

We found a higher proportion of LVAP compared with EVAP and a higher proportion of drug resistant organisms among LVAP, especially Pseudomonas and Acinetobacter. Drug resistant Pseudomonas was associated with higher mortality.

• Hospital acquired pneumonia
• India
• multidrug resistant organism
• ventilator associated pneumonia

• Hospital-acquired pneumonia
• Intensive care unit
• Multidrug resistant pathogens
• Ventilator associated pneumonia

• Aged
• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use
• Bacteremia/complications
• Bacteremia/diagnosis
• Bacteremia/drug therapy
• Catheter-Related Infections/complications
• Catheter-Related Infections/diagnosis
• Catheter-Related Infections/drug therapy
• Cross Infection/complications
• Cross Infection/diagnosis
• Cross Infection/drug therapy
• Drug Resistance, Bacterial/drug effects
• Drug Resistance, Bacterial/physiology
• Empirical Research
• Female
• Humans
• Intraabdominal Infections/complications
• Intraabdominal Infections/diagnosis
• Intraabdominal Infections/drug therapy
• Male
• Middle Aged
• Pneumonia, Bacterial/complications
• Pneumonia, Bacterial/diagnosis
• Pneumonia, Bacterial/drug therapy
• Time Factors