Clinical Outcomes of Ventilator-Associated Pneumonia and its Associated Factors Among Critically Ill Patients at Muhimbili National Hospital, 2024-2025

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilators. It significantly
contributes to mortality and prolonged ICU stay which shows the need to re-evaluate the outcomes and its contributing factors in critically ill patients.

Objectives: To determine clinical outcomes of ventilator-associated pneumonia (VAP) and its associated factors among critically ill patients at Muhimbili National Hospital, from January 2024 to November 2025.

Methods: A facility based retrospective cross-sectional study was conducted at Muhimbili National Hospital (MNH) from January 2024 to November 2025. It included all adult patients who developed VAP after at least 48 hours of MV and stayed in the Medical Intensive Care Unit (MICU) for at least 5 days. Data on demographics, co-morbidities, ventilation factors, clinical signs, complications and outcomes were extracted from the patient medical files on Microsoft Excel and managed on SPSS software to make descriptive statistics to summarize patient characteristics, while Chi-square tests assessed the associations between the factors and outcomes.

Results: A total of 117 patients developed VAP during the study period and among the 560 mechanically ventilated patients, the proportion of VAP was found to be 20.9%. The mean age was 53.1 years (SD ± 21.2), and the gender distribution was nearly equal. Most cases were late-onset VAP (70.9%). Hypertension (54.7%) and diabetes (23.1%) were the most common comorbidities found. Almost all patients (99.1%) required invasive ventilation, and one-third remained ventilated for more than 20 days. The most frequently documented clinical features were leukocytosis (75.2%), fever (64.1%), and purulent secretions (58.1%). Overall mortality was high at 68.4%, while only 23.9% of patients were discharged from the ICU. Poor outcomes were significantly associated with hypertension, diabetes, chronic respiratory disease, older age, and prolonged ventilation duration (all p < 0.05).

Conclusion: VAP is still a public health concern as the proportion of cases in MNH during the study period was 20.9%. There was a higher case-fatality rate than most studies, of 68.4% among the study population. Early identification of these factors will help in reducing the problem through early intervention
and therefore improve outcome.