This study was designed to check the effectiveness of current empirical therapy in the

treatment of a nosocomial lower respiratory tract infection in patients on mechanical ventilation

caIled Ventilator associated pneumonia (YAP). To evaluate the empirical therapy, antibiotic

susceptibility testing and pattern of resistance by YAP isolates in patients suspected to be

suffering from YAP was determined.
This was a prospective study involving 58 patients on mechanical ventilation with suspected
VA.P in a tertiary care hospital. The method involved pathogen identification, Antibiotic
Sensitivity testing, hepatic, renal and hematological profiles and monitoring of Arterial blood
gases of the patient. Pathogens from tracheal aspirates of the patients were subjected to
comrnonly used antibiotics for their antibiograms. The prescribed antibiotics were evaluated by
routine culture/sensitivity testing of tracheal aspirates and each patient was followed up to be
assessed for the treatment progress. Effect of Antibiotic was evaluated for seven days by
recording the parameters of patients such as Temperature of the patient, Pa02, effect on
leukocyte count, and from evaluation of LFTs and RFTs of the patient and the disease status of
the patient. Other outcomes were the mortality in these patients and the impact of inadequate
empirical therapy on patient mortality. Also to study the contribution of various risk factors upon
VAP prognosis.
It was inferred from the study that most of the patients remained febrile. Changes were observed
in the level of liver functional enzymes and less in the values of renal functional tests.
Leucocytes count in most of the patients remained either less than 4000 or greater than I 1000 indicating persistence of infection. High mortality was observed in patients suspected for YAP.
Major factor that caused patients mortality was the treatment failure due to inadequate
amttibiotics. Cross contamination, unhygienic practices by health personnel and lack of adequate
guidelines for antibiotic utilization in the ICU were the important contributors for development
ofVAP and other lower respiratory tract nosocomial infections. Methicillin sensitive
Staphylococcus aureus and E.coli were found to be the most common pathogens involved.
Empirical antibiotic therapy was found inappropriate in 53.4% of cases. It was inferred from the
study that significant results were obtained for correlation of patient's age with treatment
progress. With increase in age chances of treatment failure also increased. The risk factor
showing significant result for increased treatment failure was the prior exposure to antibiotics.
High patient mortality was contributed by increased treatment failure. The two most significant
factors that contributed to treatment failure were either inadequate antim.icrobial therapy or use
of already resistant antibiotics.
It was concluded in the study, there was a high incidence of infection with resistant bacteria and
inappropriate initial antibiotic therapy. Treatment failure due to inadequate antibiotics caused
most mortality. Organ deterioration was also found to contribute to overall mortality in
mechanically ventilated patients.