Background: Ventilator-associated pneumonia is the most common type of nosocomial infection in ICUs. Hence, this study shall focus on the morbidity, mortality, and costs associated with this infection among ICU patients.Materials and Methods: The current research is a prospective descriptive-analytical study. The study population included patients admitted to the Tertiary Referral Hospital of Kerman University of Medical Sciences who were enrolled in the study according to inclusion criteria and demographic characteristics data, length of stay in ICU and general wards, and direct and indirect medical expenses such as unemployment and rehabilitation cost, etc.Results: Nine of the 144 patients studied died. (4 in the Ventilator-Associated Pneumonia (VAP) group and 5 in the non-VAP group). Among them, the prevalence of Acinetobacter Baumannii was significantly higher than other bacteria (P-Value=0.001). The duration of hospitalization in the ICU (18±9 vs. 9.5±6 days) and recovery time (21.6±9 9.6 vs. 13.2±7 days) were higher in the VAP group (P-Value<0.05). Moreover, the duration of hospitalization in the general ward was 15.4±8 days in the VAP group and 10.6±6 days in the non-VAP group (P-Value<0.05). The cost of treatment in the VAP group ($7952.28) was significantly higher than in the non-infected group ($4400.98). The average rehabilitation cost in the VAP group was $2571.42 and in the non-affected group was $1530.88. The financial loss due to the delay in work starting was $482 in the non-VAP group which was significantly less than the VAP group ($792).Conclusion: Having VAP can significantly increase mortality, length of stay in the ICU as well as increase direct and indirect costs for patients.

Ventilator-Associated pneumonia (VAP) is one of the prevalent nosocomial infections and the most severe Acquired infection in intensive care units (ICUs) [1]. VAP usually occurs forty-eight hours after the starting of mechanical ventilation. This infection has several complications, including hospital long stay, high medical costs, high antibiotic use, and high mortality rates [2, 3]. The prevalence of VAP in developing countries is more than that in developed countries [2]. Despite recent advances in diagnostic and therapeutic methods, VAP has remained a common infection and a major cause of mortality in the ICUs [2, 3]. VAP affects approximately 27% of critically ill patients in ICU wards [2, 3]. Prevention of VAP is a significant challenge for workers in intensive care units and should be considered as a priority. There are some strategies to prevent VAP, such as appropriate sedation and early weaning, semi-seating position, oral hygiene, applying noninvasive positive pressure ventilation (NPPV), tracheal secretion management, nurses hand hygiene, selective decontamination of the digestive tract, appropriate antibiotic therapy, and subglottic secretion suctioning [2, 4, 5]. Another under attention approach to preventing VAP is to ensure adequate pressure of endotracheal cuff. Tracheal cuff pressure should be maintained in the accurate range (20– 30 cm H2O), and under inflation and over inflation can be associated with the risk of aspiration and tracheal injury [6, 7]. Micro aspiration of subglottic secretions due to cuff under Inflation is one of the most critical risk factors for the VAP [4], Therefore, ensuring adequate pressure of cuff to prevent micro aspiration is a low-cost, easy, and practical approach in VAP prevention. However, the importance of this technique in guidelines and studies is under attention. Various methods are used to assess the accuracy of tracheal cuff pressure, including manual (Minimal leak and Finger Palpation) and automatic (Direct Manometer and Continuous Monitoring) methods. Two common methods for checking the accuracy of cuff pressure are the manual method (Minimal leak) and the use of direct manometer [6]. Studies showed that continuous monitoring of cuff pressure could also be more efficient in VAP prevention [1, 4]. Given the importance of this issue, the design and implementation of the guillotines to assess and ensure adequate cuff pressure along with other measures is necessary and can help to prevent VAP...

Introduction: Ventilator-Associated Pneumonia (VAP), as defined by the Centers for Disease Control and prevention (CDC), is a pneumonia that occurs in a patient receiving mechanical ventilation that develops 48 hours or more after initiation of ventilation. Re-intubation which occur within 72 hours of planned extubation may be effective in VAP incidence. The aim of this study was to determine VAP incidence in re-intubated patients in comparison to patients underwent intubation without re-intubation to highlight re-intubation as a risk factor for VAP.Methods and Materials: A total of 1230 intubated patients, admitted to Pediatric Intensive Care Unit (PICU) department were enrolled in this cohort observational study consecutively from May 2010 to May 2014. VAP was clinically suggested and confirmed by chest X-ray. Patients demographic data, underlying disease, duration of mechanical ventilation length of PICU stay and re-intubations were recorded prospectively.Results: In this study 336 intubated patients out of 1230 patients admitted to PICU department developed VAP (27%) with higher incidence in re-intubated patients (30% vs. 12%).Conclusion: VAP developed in nearly one third of intubated patients in our study. Re-intubation was significant risk factor for development of VAP.

Introduction: Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oral hygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients. This study aimed to evaluate recent OHC strategies to decrease VAP. Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase, Cochrane Library, and Web of Science databases from inception to September 10, 2020 were reviewed to compare the effects of selective oropharyngeal decontamination (SOD) on the incidence of VAP in adult patients requiring mechanical ventilation. Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for final analysis. The results showed that the use of chlorhexidine for oropharyngeal decontamination reduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria. Also, it was observed that the combined use of colistin and chlorhexidine was more effective than chlorhexidine alone in preventing VAP. The results of studies on the use of toothbrushes to reduce the incidence of pneumonia are unclear since they used chlorhexidine at the same time. However, tooth brushing is one of the best ways to maintain oral hygiene. Using povidoneiodine, Nanosil, and non-absorbable topical antibiotics reduced the incidence of VAP, while Iseganan did not show a significant effect in this regard. Conclusion: The prophylactic use of topical bactericidal agents in critically-ill patients is effective in reducing the incidence of VAP. However, the use of non-absorbable topical antibiotics is more effective than other methods in oropharyngeal decontamination.

Introduction & Objective: Vacuolar proteinase is an aspartic enzyme in Candida albicans (C. albicans) that is expressed by VAP gene and plays an important role in the development of systemic candidiasis. The aim of this study was to evaluate VAP gene expression in C. albicans strains isolated from patients with systemic candidiasis.Materials & Methods: The evaluation of VAP gene expression was performed using reverse transcriptase- polymerase chain reaction (RT- PCR) method and samples were electrophoresed in 1.5% agarose gels. In addition, a total of 48 female Balb/c mice (six-weeks old and weight of 25 g) were experimentally infected by various C. albicans strains and the level of VAP gene expression was assessed in yeasts obtained from the blood of infected mice.Results: The level of VAP gene expression in non-Iranian strains was significantly higher than those of Iranian strains (P<0.05). Our results showed that VAP gene expression of C. albicans strains isolated from mice blood increased compared to human patients. A significant difference in the ratio of VAP to 18S rRNA genes was observed in both clinical and control strains of C. albicans isolated from non-Iranian patients compared to Iranian patients (P<0.05). The VAP and 18S rRNA bands were appeared after electrophoresis of the clinical strains of C. albicans obtained from human patients and mice blood that were about 220 and 302 bp, respectively.Conclusion: VAP gene as producer proteinase can act as an important gene in the development of systemic candidiasis caused by C. albicans.