RISK FACTORS, MICROBIOLOGICAL SPECTRUM, ANTIBIOTIC SENSITIVITY AND OUTCOMES OF VENITILATOR ASSOCIATED PNEUMONIA IN NEONATES: A STUDY FROM A TERTIARY CARE HOSPITAL IN SOUTHERN ASSAM
DOI:
https://doi.org/10.22159/ijcpr.2026v18i1.8008%20Keywords:
Neonatal VAP, Antimicrobial resistance, Multi-drug resistant (MDR), NICU, Gram-negative bacteriaAbstract
Objective: To determine the incidence, microbiological profile, antibiotic sensitivity, risk factors, and outcomes of VAP in neonates.
Methods: This prospective observational study, conducted for one year in a tertiary care NICU in Southern Assam, included 101 neonates ventilated for over 48 h. VAP was defined using CDC criteria, integrating clinical, Laboratory, radiological, and microbiological findings. Data on patient characteristics, VAP occurrence, microbiology, and antibiotic susceptibility were collected and analysed.
Results: Thirty-seven (36.7%) neonates developed VAP, resulting in an incidence of 41.11 per 1,000 ventilator days. Key risk factors significantly associated with VAP included prematurity, low birth weight, bronchopulmonary dysplasia, and asphyxia. Common clinical signs were new onset tachypnoea and increased respiratory secretions. VAP led to significantly longer hospital stays (38.1±17.82 vs. 21.4±14.3 d, p=0.0001) and mechanical ventilation durations (13.42±8.74 vs. 5.89±3.56 d, p=0.0001), alongside increased antibiotic use. Gram-negative organisms predominated (68.9% of 45 isolates), notably multi-drug resistant (MDR) Acinetobacter spp. and ESBL-producing Klebsiella pneumoniae/oxytoca. Pseudomonas isolates showed high resistance to Amikacin, Meropenem, and Piperacillin+Tazobactam. MRSA exhibited good Linezolid susceptibility. VAP is associated with increased morbidity and mortality.
Conclusion: Neonatal VAP imposes a substantial burden, driven by prematurity, severe underlying conditions, and a high prevalence of MDR Gram-negative pathogens. Our findings highlight the urgent need for robust infection control, vigilant surveillance, and culture-guided antibiotic therapy to optimize outcomes and combat antimicrobial resistance. Larger, multi-center studies are essential.
Downloads
References
1. Shane AL, Sanchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017 Nov 18;390(10104):1770-80. doi: 10.1016/S0140-6736(17)31002-4, PMID 28434651.
2. Azab SF, El-Sayed ZM, El-Sayed ZM, Abdelrahman AM, Sherief LM, Osman NH. Impact of a ventilator-associated pneumonia prevention bundle on neonatal intensive care unit patients. J Infect Public Health. 2015 May-Jun;8(3):268-74. doi: 10.1016/j.jiph.2014.09.001.
3. Rosenthal VD, Al-Abdely HM, El-Kholy AA, AlKhawaja SA, Leblebicioglu H, Mehta Y. International nosocomial infection control consortium report data summary of 50 countries for 2010-2015: device-associated module. Am J Infect Control. 2016;44(12):1495-504. doi: 10.1016/j.ajic.2016.08.007, PMID 27742143.
4. Zhou Q, Lee SK, Jiang SY, Chen C, Kamaluddeen M, Hu XJ. Efficacy of an infection control program in reducing ventilator-associated pneumonia in a Chinese neonatal intensive care unit. Am J Infect Control. 2013;41(11):1059-64. doi: 10.1016/j.ajic.2013.06.007, PMID 24041863.
5. Tripathi S, Malik GK. Neonatal ventilator-associated pneumonia: an emerging problem. Indian Pediatr. 2010 Oct;47(10):867-71. doi: 10.1007/s12098-014-1561-x.
6. Sharma R, Goyal A, Ghosh S, Kapil A, Ray P, Taneja N. Microbiological spectrum and antibiotic sensitivity pattern in neonatal intensive care unit. Indian J Pediatr. 2012 Apr;79(4):490-3. doi: 10.1007/s12098-011-0594-6.
7. Erichsen Andersson A, Petzold M, Bergh I, Karlsson J, Eriksson BI, Nilsson K. Comparison between mixed and laminar airflow systems in operating rooms and the influence of human factors: experiences from a Swedish orthopedic center. Am J Infect Control. 2014;42(6):665-9. doi: 10.1016/j.ajic.2014.02.001, PMID 24713595.
8. Dudeck MA, Horan TC, Peterson KD, Allen Bridson K, Morrell GC, Pollock DA. National Healthcare Safety Network (NHSN) report data summary for 2009, device-associated module. Am J Infect Control. 2011;39(5):349-67. doi: 10.1016/j.ajic.2011.04.011, PMID 21774120.
9. Hogue AN, Temple Cooper ME, Lagzdins M, Worley S, Scwersenski J, Floyd R. Effects of in-utero exposure to selective serotonin reuptake inhibitors and venlafaxine on term and preterm infants. J Neonatal Perinat Med. 2017;10(4):371-80. doi: 10.3233/NPM-16133, PMID 29286926.
10. Centers for Disease Control and Prevention. Ventilator-associated event (VAE) surveillance protocol. In: CDC NHSN Patient Safety Manual, Chapter 10. Atlanta (GA): CDC; 2025 Jan. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf.
11. Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18(2):208. doi: 10.1186/cc13775, PMID 25029020.
12. German National Nosocomial Infection Surveillance System (KISS). NEO-KISS module for very low birth weight infants. National Reference Center for Surveillance of Nosocomial Infections (NRZ) Website; 2020. Available from: https://www.nrz-hygiene.de/en/KISS-Modul/KISS/NEO.
13. Gupta A, Nayak A, Gopinath KG, Rathod DA, Krishnan R, Kumar A. Clinical outcomes of ventilator-associated pneumonia in mechanically ventilated neonates. Indian Pediatr. 2013 Oct;50(10):899-903. doi: 10.1007/s12098-013-1147-x.
14. Sulek K, Mc Donald LC, Balchunas L, Jarvis WR, Kurmasheva RT, Khudyakova ND. Incidence risk factors and outcomes of ventilator-associated pneumonia in neonates. J Perinatol. 2005 Aug;25(8):533-9.
15. Al-Kadri H, Al-Anazi A, Al-Burayh N, Al-Kadi M. The association between neonatal mortality and ventilator-associated pneumonia. Alexandria Journal of Medicine; 2024. Available from: https://doaj.org/article/6e0193e2ae4f46a09b2cc08cd979d89a.
16. Mir Z, Ali I, Qureshi O, Wani G. Risk factors pathogen profile and outcome of ventilator-associated pneumonia in a neonatal intensive care unit. Int J Contemp Pediatr. 2015;2(1):17. doi: 10.5455/2349-3291.ijcp20150204.
17. Rangelova VR, Raycheva RD, Kevorkyan AK, Krasteva MB, Kalchev YI. Ventilator-associated pneumonia in neonates admitted to a tertiary care NICU in Bulgaria. Front Pediatr. 2022;10:909217. doi: 10.3389/fped.2022.909217, PMID 35837238.
18. Tuteja A, Pournami F, Nandakumar A, Prabhakar J, Jain N. Endotracheal aspirate and ventilator-associated pneumonia in neonates: revisiting an age-old debate. Indian J Pediatr. 2022 Dec;89(12):1202-8. doi: 10.1007/s12098-022-04142-y, PMID 35503590.
19. Ghobrial EE, Farag YM, Abdul-Aziz DM, Omar MA. Assessment of epicardial adipose tissue thickness in children with familial mediterranean fever. J Trop Pediatr. 2020;66(2):121-8. doi: 10.1093/tropej/fmz040, PMID 31257436.
20. Kulkarni S, Gilbert C, Zuurmond M, Agashe S, Deshpande M. Blinding retinopathy of prematurity in Western India: characteristics of children reasons for late presentation and impact on families. Indian Pediatr. 2018;55(8):665-70. doi: 10.1007/s13312-018-1355-8, PMID 30218512.
21. Singh DP, Yadav DK, Sharma M, Singh S. Risk factors and outcome of ventilator-associated pneumonia in a tertiary care neonatal intensive care unit. J Clin Neonatol. 2015;4(4):214-8. doi: 10.4103/2249-4847.170991.
22. Vu EL, Rusin CG, Penny DJ, Kibler KK, Easley RB, Smith B. A novel electrocardiogram algorithm utilizing ST-segment instability for detection of cardiopulmonary arrest in single ventricle physiology: a retrospective study. Pediatr Crit Care Med. 2017;18(1):44-53. doi: 10.1097/PCC.0000000000000980, PMID 27755397.
23. Modi KB, Patel SM, Patel KM, Patel J, Patel K. Risk factors for ventilator-associated pneumonia in neonates: a prospective observational study. J Med Sci Clin Res. 2017;5(8):27885-91.
24. Moreno CS, Rogero SO, Ikeda TI, Cruz AS, Rogero JR. Resveratrol and radiation biological effects. Int J Nutrology. 2020;5(1):28-33. doi: 10.1055/s-0040-1701425.
25. Samayam P, Ranganathan PK, Balasundaram R. Study of weight patterns in exclusively breast fed neonates does the route of delivery have an impact? J Clin Diagn Res. 2016;10(1):SC01-3. doi: 10.7860/JCDR/2016/17889.7025, PMID 26894138.
26. Jiang P, Wei J. The application of pulmonary ultrasound in neonatal ventilator-associated pneumonia. Front Pediatr. 2022;10:882056. doi: 10.3389/fped.2022.882056, PMID 35844761.
27. Dey S, Sharma D, Kohli M, Mishra A. Utility of quantitative tracheal aspirate cultures in predicting ventilator-associated pneumonia in neonates. Indian J Pediatr. 2021;88(3):250-4. doi: 10.1007/s12098-020-03441-4.
28. Morales Lopez J, Ortiz Cartagena C, Alonso Bello CD, Gonzalez Serrano D, Serna Gallego A, Cortes Lopez HJ. Antibiotic-Resistant Pseudomonas aeruginosa: Current Challenges and emerging alternative therapies. Antibiotics (Basel). 2024;13(4):913. doi: 10.3390/antibiotics13040913.
29. Rallis D, Giapros V, Serbis A, Kosmeri C, Baltogianni M. Fighting antimicrobial resistance in neonatal intensive care units: rational use of antibiotics in neonatal sepsis. Antibiotics (Basel). 2023;12(3):508. doi: 10.3390/antibiotics12030508, PMID 36978375.
30. S Karger Gmb H, Freiburg. PharmaNews. Kompass Pneumol. 2022;10(6):322-4. doi: 10.1159/000528268.
31. Biswas N, Roy D, Borah M, Chanda DD, Das P, Datta K. Antibiotic resistance pattern in isolated pathogens of urinary tract infections in pediatric patients at a Tertiary Care Hospital. Int J Curr Pharm Sci. 2025 Mar 15;17(2):79-85. doi: 10.22159/ijcpr.2025v17i2.6083.
Published
How to Cite
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.