Incidence, causative agents and outcomes of ventilator associated tracheobronchitis

Background
Ventilator-associated tracheo-bronchitis (VAT) is a widespread infection in both surgical and medical intensive care units (ICU). VAT patients have high rates of morbidity and mortality as well as higher medical expenses.


Objective
To study incidence, causative organisms and outcomes of VAT in mechanically ventilated patients.


Methods
This study was conducted on 70 patients whose age was greater than 18 years and have been mechanichally ventilated greater than 48 h. According to the diagnostic criteria of VAT, patients were divided into two groups: group I included 30 patients without VAT, while group II included 40 VAT patients. Outcomes of the patients were followed-up regarding time span of ICU stay, duration of mechanical ventilation, development of ventilator associated pneumonia (VAP), and mortality in the ICU.


Results
Incidence of VAT was 40/95 (42.1%), Klibseala pneumonie was the most frequent isolated causative agent in 14 (35.0%) of group II. As compared with group I, VAT was substantially related with longer ICU stays and longer duration of mechanical ventilation, seven patients with VAT developed VAP. No discernible statistical difference was found in mortality between the two groups.(13.3% vs. 30%), univariate and multivariate analysis showed that significant predictors of higher risk factors were HCO3, Colony forming unit greater than 105 and isolated organism Acinetobacter.


Conclusion
VAT is a transitional stage between colonization of the lower respiratory tract and VAP. The greater incidence of VAT requires additional studies to establish protocols in critical care units.