Original article

Risk factors and microbiological profile of ventilator-associated pneumonia in a tertiary-care intensive care unit in Tuzla: a prospective observational study

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Abstract

Aim: To determine the prevalence and microbiological profile of ventilator-associated pneumonia (VAP) in mechanically ventilated patients and to assess clinical and laboratory parameters associated with its development, with emphasis on C-reactive protein (CRP) levels and duration of mechanical ventilation.

Methods: This single-centre prospective observational cohort study included 118 adult patients who required invasive mechanical ventilation for more than 48 hours in the intensive care unit of the University Clinical Centre Tuzla. Patients were classified into VAP and non-VAP groups. Demographic, clinical, laboratory, and microbiological data were collected, and in-hospital outcomes were recorded. Statistical analysis included between-group comparisons, univariate logistic regression, and receiver operating characteristic (ROC) curve analysis.

Results: VAP was diagnosed in 41 patients (34.7%). Gram-negative pathogens predominated (≈85%), with Acinetobacter baumannii identified most frequently (43.9%), followed by Pseudomonas aeruginosa and Klebsiella pneumoniae. Patients with VAP had significantly longer durations of mechanical ventilation (12.5 vs. 7.3 days, p<0.001) and hospitalisation (19.6 vs. 12.2 days, p<0.001), as well as higher CRP levels (178.2 vs. 126.4 mg/L, p<0.001). Reintubation, elevated CRP, leukocytosis, hypercapnia, and prolonged mechanical ventilation were associated with VAP. CRP demonstrated good-to-moderate discriminative ability for VAP (AUC=0.83).

Conclusion: VAP remains a common and clinically significant complication in mechanically ventilated patients. Elevated CRP levels and prolonged mechanical ventilation may support early clinical suspicion using routinely available parameters.

Keywords: Acinetobacter baumannii, C-reactive protein, intensive care unit, mechanical ventilation, ventilator-associated pneumonia