Incidence, risk factors, and clinical outcomes of ventilator-associated pneumonia in a South Indian oncology intensive care unit: A retrospective observational study
Abstract
Ventilator-associated pneumonia (VAP) remains one of the most important healthcare-associated infections among critically ill patients receiving invasive mechanical ventilation. Patients with malignancy are particularly vulnerable because of disease- and treatment-related immunosuppression. The primary objective of this study was to determine the incidence of VAP in a tertiary oncology intensive care unit (ICU). Secondary objectives included evaluation of associated risk factors, microbiological characteristics, and patient outcomes. A retrospective observational study was performed in adult patients (>18 years) who required invasive mechanical ventilation for more than 48 hours between January 2020 and December 2022. Patients with pre-existing pneumonia or those extubated within 48 hours were excluded. Demographic characteristics, oncological history, ICU interventions, ventilator bundle compliance, microbiological data, and clinical outcomes were obtained from medical records. Independent predictors of VAP were explored using multivariate logistic regression analysis. Among 102 eligible patients, 10 (9.8%) developed VAP (1.96 episodes per 1,000 ventilator days). Multivariable logistic regression demonstrated that corticosteroid exposure (adjusted OR: 14.19, 95% CI: 1.16–173.37; P , 0.038) and duration of mechanical ventilation (adjusted OR: 1.26 per additional day, 95% CI: 1.09–1.46; P , 0.002) were independently associated with VAP. Patients with VAP had longer durations of ventilation and higher in-hospital mortality. Although the incidence of VAP in this oncology ICU was relatively low, the infection was associated with considerable mortality and prolonged ICU support. Strategies focusing on minimizing ventilation duration, optimizing corticosteroid use, and strengthening infection prevention practices may help improve outcomes in this vulnerable population.