• Shamshad Ali
  • Khalid Waheed
  • Zafar H Iqbal


Background: Ventilator associated pneumonia (VAP) is an important and common complication of mechanically ventilated patients. It is the leading cause of morbidity and mortality in Intensive Care Units (ICU) worldwide. The aim of study was to determine the pattern of bacteria involved in VAP in intensive care unit of Jinnah hospital Lahore. Methods: It was descriptive case series study, conducted over a period of one year on mechanically ventilated 50 patients. American Thoracic Society (ATS) guidelines recommend quantitative/semi-quantitative culture of endotracheal aspirates (ETA) or bronchoscopic aspirates/washing from the infected lung segments for the diagnosis of VAP. Hence this study was conducted to identify the types of bacteria involved in VAP in our ICU. Patients enrolled were clinically and radiologically suspected VAP, admitted in the ICU of Jinnah Hospital/Allama Iqbal Medical College (AIMC) Lahore. Bronchial washings were taken with the help of Fiber optic bronchoscope. Wherever bronchoscopy was not possible, subglottic secretions were collected with the help of sterilized catheter and sucker. Collected samples were sent to the Pathology laboratory of AIMC for aerobic culture and sensitivity. Results: Major pathogenic bacteria isolated were Gram negative (74%). Among this group E. coli, Pseudomonas, Klebsiella and Acinetobacter were the commonest organisms. Gram positive bacteria were 20%, Staphylococcus aureus (MRSA) and β-haemolyticus streptococci were the major isolate. In 4% cases mixed growth and in 2% cases no growth was reported. Conclusion: Major pathogenic organisms of VAP in our ICU are Gram negative bacteria. The Bacteriological culture of endobroncheal aspirates is helpful in the diagnosis and management of VAP. Emperic antibiotic therapy for VAP should cover Gram negative organisms.  Keywords: Ventilator Associated Pneumonia (VAP), Fiber Optical Bronchoscope (FOB), Intensive Care Unit (ICU), Endotracheal Aspirates (ETA), Culture and Sensitivity (C/S)


Chastre J, Fagon JY. Ventilator associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.

Bonten MJ, Bergmans DC, Ambergen AW, de Leeuw PW, van der Geest S, Stobberingh EE, et al. Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients. Am J Respir Crit Care Med 1996;154:1339–46.

Doern GV, Brown SD. Antimicrobial susceptibility among community- acquired respiratory tract pathogens in the USA: Data from PROTEKT US 2000–01. J Infect 2004;48:56–65.

Weinstein RA. Hospital acquired infections. In: Kasper DL, Braunwald E, Fanci AS, et al, editors. Harrison’s principal of internal medicine. 16th ed. New York: McGraw-Hill, 2005:777.

Rajasekhar T, Anuradha K, Suhasini T, Lakshmi V. The role of quantitative cultures of non-bronchoscopic samples in ventilator associated pneumonia. Indian J Med Microbiol 2006;24:107–13.

Ibrahim EH, Ward S, Sherman G, Schaiff R, Fraser VJ, Kollef MH. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 2001;29:1109–15.

Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001;344:817–22.

Paradisi F, Corti G, Cinelli R. Streptococcus pneumoniae as an agent of nosocomial infection: treatment in the era of penicillinresistant strains. Clin Microbiol Infect 2001;7 Suppl 4: 4–42.

Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989;139:877–884.

Sopena N, Sabria M. Multicenter study of hospital-acquired pneumonia in non-ICU patients. Chest 2005;127:213–9.

Babcock HM, Zack JE, Garrison T, Trovillion E, Kollef MH, Fraser VJ. Ventilator-associated pneumonia in a multi-hospital system: Differences in microbiology by location. Infect Control Hosp Epidemiol 2003;24:853–8.

Combes A, Figliolini C, Trouillet JL, Kassis N, Wolff M, Gibert C, et al. Incidence and outcome of polymicrobial ventilator-associated pneumonia. Chest 2002;121:1618–23.

American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.

Fagon JY, Chastre J, Wolff M, Gervais C, Parer-Aubas S, Stephan F, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia: a randomized trial. Ann Intern Med 2000;132:621–30.

Weinstein RA. Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med 1991;91:179S–184S.

Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004;350:2452–60.

Varun Goel, Sumati A Hogade, SG Karadesai Ventilator associated pneumonia in a medical intensive care unit. Microbial and susceptibility pattern of isolated micro organisms and outcome. Indian J Anaesth. 2012;56(6):558–62.