Clinical Pattern of Hospital Acquired Pneumonia at Tertiary Care Teaching Hospital
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant contributors to morbidity and mortality, with mortality rates nearing 62%. These infections are the second most prevalent cause of nosocomial infections overall, but they are the most common in intensive care units (ICUs). Additionally, HAP and VAP are linked to the highest mortality rates among nosocomial infections. Methods: To investigate the clinical, radiological, and bacteriological profile of hospital-acquired pneumonia (HAP) and factors influencing its outcomes, we conducted an 24-month prospective study at a governmental hospital's general ICUs. Diagnosis of HAP was based on the ATS/IDSA 2016 guidelines, requiring both radiological criteria (new or progressive infiltrates in chest x-ray) and clinical criteria (at least two of the following: fever > 38°C, leucocytosis or leucopenia with purulent secretions, decreased oxygenation). Results: The majority (53%) of study population had chronic respiratory illness followed by diabetes (31%) and other systemic illnesses. 50 (19%) of HAP patients didn’t have any co-morbidities According to chest x ray and HRCT thorax reports of HAP patients, 108 (40%) had infiltrates in single lobe, 90(33%) cases had infiltrates in 2 lobes and 88(33%) cases had infiltrates in 3 or more lobes. Bilateral infiltrates seen in 52% of patients. Out of 2054 patients, 626 (30%) cases were on mechanical ventilation out of which 145(7%) developed HAP. 70 (7%) cases developed HAP among 1428(70%) cases who were not on mechanical ventilation. Out of 270 HAP cases, 145(54%) had ventilator associated pneumonia and 125(46.29%) cases had HAP among non-ventilated patients. Conclusion: High incidence rate of HAP was linked with P. aeruginosa, K. pneumoniae, tracheostomy, and APACHE II ≥17. Furthermore, high mortality rate was strongly correlated with reintubation, duration in ICU ≥5 days, HAP outcome, DM, APACHE II ≥17, and neurological diseases. More research should be conducted to reassess the impact of HAP in nongovernmental ICU settings.