Ventilator-associated pneumonia rates in a level I trauma intensive care unit in KwaZulu-Natal Province, South Africa, compared with international benchmarks

Main Article Content

B Ngxabi
T C Hardcastle

Abstract





Background. Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critically ill patients in intensive care units (ICUs) worldwide. Despite the huge healthcare economic burden and the significant negative morbidity and mortality impact of VAP, its incidence and outcomes in the trauma ICU (TICU) population were poorly documented in South Africa (SA).


Objectives. To determine the incidence of VAP in a level I trauma centre at Inkosi Albert Luthuli Central Hospital in Durban, SA, compared with international benchmarks. Determining mortality rates, the average length and cost of ICU stay, ventilator days and antibiotic consumption was a secondary objective.


Methods. This retrospective chart review of the trauma registry at the centre examined the incidence of VAP and secondary outcomes over the period January 2017 - December 2019. A data pro forma was used with VAP diagnoses as per the 2015 Centers for Disease Control and Prevention definitions. The comparator was international literature-based benchmark VAP rates in TICUs.


Results. The study included 395 patients, of whom 143 (36.2%) were diagnosed with VAP. The VAP rate was calculated to be 35.6 per 1 000 ventilator days. Thirty-one patients with VAP (21.7%) died in the ICU, a similar figure to that for the non-VAP group (22.6%). There were no statistically significant differences in age, sex, mechanism of injury or Injury Severity Score between the VAP and non-VAP groups (p>0.05). There were statistically significant differences between the two groups in number of days on mechanical ventilation, ICU length of stay and ICU cost. The VAP group had a median of 12 ventilation days v. 5 days for the non-VAP group (p<0.001), and spent a median of 7 days longer in the ICU (p<0.001). The median cost of ICU stay for VAP patients was almost double that for non-VAP patients (p<0.001).


Conclusion. VAP rates in this local TICU were similar to international rates. Trauma patients, especially those with traumatic brain injury, are at higher risk of VAP than general ICU patients, so strict adherence to evidence-based VAP prevention bundles is necessary among TICU staff.





Article Details

How to Cite
Ventilator-associated pneumonia rates in a level I trauma intensive care unit in KwaZulu-Natal Province, South Africa, compared with international benchmarks. (2024). Southern African Journal of Critical Care, 40(3), e1967. https://doi.org/10.7196/SAJCC.2024.v40i3.1967
Section
Research Articles
Author Biographies

B Ngxabi, Department of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Department of Anaesthesia and critical care, UKZN, Consultant

T C Hardcastle, Department of Surgical Sciences, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Trauma and Burns Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa

Associate Professor of Surgery

Dept of Surgical Sciences, University of Kwazulu-Natal, Durban, South Africa

How to Cite

Ventilator-associated pneumonia rates in a level I trauma intensive care unit in KwaZulu-Natal Province, South Africa, compared with international benchmarks. (2024). Southern African Journal of Critical Care, 40(3), e1967. https://doi.org/10.7196/SAJCC.2024.v40i3.1967

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