Search Results (474)

Background: Skin and soft tissue infections (SSTIs) are a major cause of emergency room (ER) visits and hospitalizations. Long-acting lipoglycopeptides (LALs), such as dalbavancin and oritavancin, offer potential for early discharge and outpatient management, especially in patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) or with comorbidities. Methods: We conducted a retrospective observational cohort study from March to December 2024 in an Italian tertiary-care hospital. Adult patients treated in the ER with a single dose of dalbavancin (1500 mg) or oritavancin (1200 mg) for SSTIs were included. Demographic, clinical, and laboratory data were collected. Follow-up evaluations were performed at 14 and 30 days post-treatment to assess outcomes. Results: Nineteen patients were enrolled (median age 59 years; 53% female). Most had lower limb involvement and elevated inflammatory markers. Three patients (16%) were septic. Fourteen patients (74%) were discharged without hospital admission; hospitalization in the remaining cases was due to comorbidities rather than SSTI severity. No adverse drug reactions were observed. At 14 days, 84% of patients had clinical resolution; only 10% had recurrence by day 30, with no mortality nor readmission reported. Conclusions: LALs appear effective and well-tolerated in the ER setting, supporting early discharge and reducing healthcare burden. Broader use may require structured care pathways and multidisciplinary coordination. Full article

Background: Nutrition is of paramount importance during early development, since suboptimal growth in this period of life is linked to adverse long- and mid-term outcomes. This is particularly relevant for preterm infants, who fail to thrive during the first weeks of life and develop extrauterine growth restriction (EUGR). This group of premature babies represents an interesting population to investigate using a metabolomic approach to optimize nutritional intake. Aims: To analyse and compare the urinary metabolomic pattern at birth of preterm infants with and without growth restriction at 36 weeks of postmenstrual age or at discharge, searching for putative markers of growth failure. Methods: We enrolled preterm infants between 23 and 32 weeks of gestational age (GA) and/or with a birth weight <1500 g, admitted to the Neonatal Intensive Care Unit (NICU) at the Department of Women’s and Children’s Health of Padova University Hospital. We collected urinary samples within 48 h of life and performed untargeted metabolomic analysis using mass spectrometry. Results: Sixteen EUGR infants were matched with sixteen non-EUGR controls. The EUGR group showed lower levels of L-cystathionine, kynurenic acid, L-carnosine, N-acetylglutamine, xanthurenic acid, aspartylglucosamine, DL5-hydroxylysine-hydrocloride, homocitrulline, and L-aminoadipic acid, suggesting a lower anti-inflammatory and antioxidant status with respect to the non-EUGR group. Conclusions: Metabolomic analysis suggests a basal predisposition to growth restriction, the identification of which could be useful for tailoring nutritional approaches. Full article

Background: Preterm infants and their families face a challenging experience during their stay in the neonatal intensive care unit (NICU). Family-centered care emphasizes the importance of welcoming parents, involving them in their baby’s daily care, and supporting the development of parenting skills. NICU staff should support parents in understanding their baby’s needs and in strengthening the parent–infant bond. Although many tools outline what parents should learn, there is a limited structured framework to monitor their involvement in the infant’s care. Tracking parental participation in daily caregiving activities could support professionals in effectively guiding families, ensuring a smoother transition to discharge. Aims: The aim of this study was to evaluate the adherence to and effectiveness of a structured tool for parental involvement in the NICU. This tool serves several key purposes: to track the progression and timing of parents’ autonomy in caring for their baby, to support parents in building caregiving competencies before discharge, and to standardize the approach of NICU professionals in promoting both infant care and family engagement. Methods: A structured template form for documenting parental involvement (“together TO-CARE template”, TTCT) was integrated into the computerized chart adopted in the NICU of Modena. Nurses were asked to complete the TTCT at each shift. The template included the following assessment items: parental presence; type of contact with the baby (touch; voice; skin-to-skin); parental involvement in care activities (diaper changing; gavage feeding; bottle feeding; breast feeding); and level of autonomy in care (observer; supported by nurse; autonomous). We evaluated TTCT uploaded data for very low birth weight (VLBW) preterm infants admitted in the Modena NICU between 1 January 2023 and 31 December 2024. Staff compliance in filling out the TTCT was assessed. The timing at which parents achieved autonomy in different care tasks was also measured. Results: The TTCT was completed with an average of one entry per day, during the NICU stay. Parents reached full autonomy in diaper changing at a mean of 21.1 ± 15.3 days and in bottle feeding at a mean of 48.0 ± 22.4 days after admission. The mean length of hospitalization was 53 ± 38 days. Conclusions: The adoption of the TTCT in the NICU is feasible and should become a central component of care for preterm infants. It promotes family-centered care by addressing the needs of both the baby and the family. Encouraging early and progressive parental involvement enhances parenting skills, builds confidence, and may help reduce post-discharge complications and readmissions. Furthermore, the use of a standardized template aims to foster consistency among NICU staff, reduce disparities in care delivery, and strengthen the support provided to families of preterm infants. Full article

Background/Objective: In-hospital cardiac arrest has high incidence and poor survival rates, posing a significant healthcare challenge. It is important to intervene in the hours before the cardiac arrest to prevent poor outcomes. The modified early warning score (MEWS) is a validated tool for identifying a deteriorating patient. It is an aggregate of vital signs and level of consciousness. We retrospectively evaluated MEWS for trends that might predict patient outcomes. Methods: We performed a single-center, one-year, retrospective study. A comprehensive review was conducted for patients aged 18 years and above who experienced a cardiac arrest. Cases that occurred within an intensive care unit, emergency department, during a procedure, or outside the hospital were excluded. A total of 87 cases met our predefined inclusion criteria. We collected data at 12 h, 6 h and 1 h time periods prior to the cardiac arrest. A trend analysis using a linear model with analysis of variance with Bonferroni correction was performed. Results: Out of 87 patients included in the study, 59 (67.8%) had an immediate return of spontaneous circulation (ROSC). Among those who achieved ROSC, 41 (69.5%) died during the admission. Only 20.7% of the patients that sustained a cardiac arrest survived to discharge. A significant increase in the average MEWS was noted from the 12 h period (MEWS = 3.95 ± 2.4) to the 1 h period (MEWS = 5.98 ± 3.5) (p ≤ 0.001) and the 6 h period (4.65 ± 2.6) to the 1 h period (5.98 ± 3.5) (p = 0.023) prior to cardiac arrest. Conclusions: An increase in the MEWS may be a valuable tool in identifying at-risk patients and provides an opportunity to intervene at least 6 h before a cardiac arrest event. Further research is needed to validate the results of our study. Full article

Background/Objectives: Breastmilk offers numerous benefits for the health and development of preterm infants, while prolonged hospitalization may impair neurodevelopment. At our institution, the implementation of enhanced family-centered care (FCC) has enabled earlier discharge of preterm infants. This study aimed to assess the impact of early discharge on breastfeeding and breastmilk provision. Methods: This analysis is based on data from a prospective single-center longitudinal cohort study conducted from October 2020 to November 2023, involving six consecutive cohorts (one baseline and five intervention cohorts; n = 184). FCC was progressively enhanced across cohorts. The primary outcome of the main study was postmenstrual age (PMA) at discharge. In this secondary analysis, breastfeeding and breastmilk provision were assessed at four time points: 4 weeks postnatal age, at discharge, 4 weeks post-discharge, and at 3 months PMA. Results: From baseline to intervention cohort 5, the PMA at discharge declined significantly from 37.8 ± 2.1 to 35.7 ± 0.91 weeks (p = 0.03), while the percentage of infants necessitating home nasogastric tube feeding increased from 6.3% to 66.7% (p < 0.01). The proportion of breastmilk of daily feeding volume remained unchanged at 4 weeks postnatal age (0.66 ± 0.42 vs. 0.9 ± 0.28) and at discharge (0.6 ± 0.45 vs. 0.79 ± 0.36). At 4 weeks post-discharge, 65.8% vs. 62.5% of the infants were on partial or exclusive breastmilk (p = 0.91) feeding. Similarly, the percentage of exclusively breastfed infants at 4 weeks post-discharge (23.7% vs. 19.8%) and at 3 months PMA (20% vs. 28.6%) did not differ significantly between baseline and intervention cohort 5. Conclusions: Early discharge did not reduce breastmilk supply or exclusive breastfeeding. However, the persistently low rate of exclusive breastfeeding post-discharge highlights the need for additional support strategies during and after hospitalization. Full article

Background/Objectives: Hip fractures are highly prevalent worldwide, primarily affecting frail elderly patients. Frailty increases the risk of complications like postoperative delirium, which negatively impacts outcomes, including morbidity and mortality. Current recommendations favor a multidisciplinary approach and effective pain control, often using preoperative peripheral nerve blocks. We aimed to evaluate a multimodal approach’s efficacy in reducing postoperative delirium and complications in geriatric hip fracture patients. Methods: This study was conducted between March 2020 and June 2022. A total of 144 patients evaluated prior to the implementation of an optimized clinical pathway protocol (OCPP) were compared to 117 patients evaluated following its implementation. The protocol included early preoperative evaluation, streamlined medication adjustments, prompt surgical intervention and fascia iliaca compartment block (FICB) for analgesia. In addition, early patient mobilization and resumption of oral intake were promoted. The primary outcome was the incidence of delirium during hospitalization. Secondary outcomes were a composite of 30-day mortality or major complications, duration of stay, hospital readmission after discharge and 1-year mortality. Results: The OCPP intervention significantly reduced the incidence of postoperative delirium from 44% to 29% (a 33% relative reduction; p = 0.017), the rate of major complications or death was 14.5% in OCPP group and 25.7% in the control group (p = 0.02). Significantly more patients in the OCPP group were mobilized within 24 h (74.4% vs. 41.3% in the control group, p < 0.001). The median time to ambulation was also shorter in the OCPP group: 65 h (IQR: 39–115) compared to 72 h (IQR: 48–119.75) in the control group (p = 0.028). No differences were observed on hospital stay and 1-year mortality. Conclusions: Among patients undergoing hip fracture repair the implementation of a OCPP significantly reduced the incidence of postoperative delirium and the rate of major complications or death. This improvement was associated with significantly earlier patient mobilization and ambulation. The OCPP was not associated with a lower hospital stay and lower rate of one-year mortality. Full article

Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine wards. Materials and Methods: This prospective cohort study included 134 acutely ill patients aged ≥50 years who were hospitalized in an internal medicine department and evaluated within the first 48 h of admission. Nutritional status was evaluated using the Mini nutritional assessment–short form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty was evaluated using the FRAIL scale and Clinical Frailty Scale (CFS). The primary outcomes were prolonged hospitalization (>10 days), mortality, and rehospitalization at 3 and 6 months post-discharge. Results: According to MNA-SF, 33.6% of patients were malnourished; 44% had nutritional risk per NRS-2002, and 44.8% were malnourished per GLIM. Frailty prevalence was 53.7% (FRAIL) and 59% (CFS). Malnutrition defined by all three scales (MNA-SF, NRS-2002, GLIM) was significantly associated with prolonged hospitalization (p = 0.043, 0.014, and 0.023, respectively), increased rehospitalization at both 3 months (p < 0.001) and 6 months (p < 0.001). Mortality was also significantly higher among malnourished patients. Higher CFS scores and low handgrip strength were additional predictors of adverse outcomes (p < 0.05). In multivariable analysis, GLIM-defined malnutrition and CFS remained independent predictors of rehospitalization and mortality. Conclusions: Frailty and malnutrition are highly prevalent and independently associated with prolonged hospital stay, short-term rehospitalization and mortality. Routine screening at admission may facilitate early identification and guide timely interventions to improve patient outcomes. These findings might guide hospital protocols in aging health systems and support the development of standardized geriatric care pathways. Full article

Objective: This study aimed to evaluate the relationship between the Prognostic Nutritional Index (PNI) and demographic characteristics, presenting complaints, clinical diagnoses, and patient outcomes in patients admitted to the emergency department for gastrointestinal (GI) emergencies. The predictive value of PNI for the clinical course of patients with GI emergencies was investigated. Method: This retrospective cross-sectional study included 583 patients with a diagnosis of GI emergencies in the emergency department of a tertiary university hospital between January 2021 and December 2024. Data such as age, sex, presenting complaints, final diagnosis, and emergency department outcomes (discharge, ward admission, and transfer to intensive care unit) were collected. The PNI value was calculated using serum albumin (g/dL) and total lymphocyte count (/mm³) with the formula PNI = 10 × albumin + 0.005 × lymphocyte. The PNI was calculated based on serum albumin levels and peripheral lymphocyte counts. Results: The mean age of the study group was 63.4 ± 17.4 years, and 52.1% of the patients were female. The number of patients with a PNI value < 38 was significantly higher in the intensive care unit (p < 0.001). PNI values were considerably lower, especially in patients diagnosed with malignancy, cirrhosis, and GI hemorrhage (X² = 71.387; p < 0.001). The PNI was an independent predictor of outcomes in patients with GI emergencies. The mean PNI was significantly higher in discharged patients but significantly lower in patients admitted to the intensive care unit (p < 0.002). The cut-off score for PNI was calculated using the median value, and the cut-off score for PNI was <38. Conclusion: PNI is a powerful biomarker for predicting the clinical severity and prognosis of patients with GI emergencies. Since it can be easily calculated from routine biochemical tests, it can be used as a practical and effective risk stratification tool. The evaluation of PNI, especially for the early detection of critically ill patients at high risk of malnutrition, may contribute to the reduction of morbidity and mortality through the timely initiation of appropriate supportive therapies. Full article

Background/Objectives: Total knee arthroplasty (TKA) is commonly associated with postoperative muscle atrophy and weakness, while traditional rehabilitation is often limited by pain and patient compliance. Passive blood flow restriction (pBFR) training may offer a safe, low-threshold method to attenuate muscle loss in this early phase. This pilot study examined the feasibility, safety, and early effects of pBFR initiated during hospitalization on muscle mass, swelling, and functional recovery after TKA. Methods: In a prospective, single-blinded trial, 26 patients undergoing primary or aseptic revision TKA were randomized to either a control group (CON: sham BFR at 20 mmHg) or intervention group (INT: pBFR at 80% limb occlusion pressure). Both groups received 50 min daily in-hospital rehabilitation sessions for five consecutive days. Outcomes, including lean muscle mass (DXA), thigh/knee circumference, 6 min walk test (6 MWT), handgrip strength, and patient-reported outcomes, were assessed preoperatively and at discharge, six weeks, and three months postoperatively. Linear mixed models with Bonferroni correction were applied. Results: The INT group showed significant preservation of thigh circumference (p = 0.002), reduced knee swelling (p < 0.001), and maintenance of lean muscle mass (p < 0.01), compared with CON, which exhibited significant declines. Functional performance improved faster in INT (e.g., 6 MWT increase at T3: +23.7%, p < 0.001; CON: −7.2%, n.s.). Quality of life improved in both groups, with greater gains in INT (p < 0.05). No adverse events were reported. Conclusions: Initiating pBFR training on the first postoperative day is feasible, safe, and effective in preserving muscle mass and reducing swelling after TKA. These findings extend prior BFR research by demonstrating its applicability in older, surgical populations. Further research is warranted to evaluate its integration with standard rehabilitation programs and long-term functional benefits. Full article

Background/Objectives: Despite advancements in surgery, esophagectomy remains one of the most challenging and complex gastrointestinal surgical procedures, burdened by significant perioperative morbidity and mortality rates, as well as high financial costs. Recognizing the need for standardized care provided by a multidisciplinary healthcare team, the EUropean PErioperative MEdical Networking (EUPEMEN) initiative developed a dedicated protocol for perioperative care of patients undergoing esophagectomy, aiming to enhance recovery, reduce morbidity, and homogenize care delivery across European healthcare systems. Methods: Developed through a multidisciplinary European collaboration of five partners, the protocol incorporates expert consensus and the latest scientific evidence. It addresses the entire perioperative pathway, from preoperative preparation to hospital discharge and postoperative recovery, emphasizing patient-centered care, risk mitigation, and early functional restoration. Results: The implementation of the EUPEMEN esophagectomy protocol is expected to improve patient outcomes through a day-by-day structured prehabilitation plan, meticulous intraoperative management, and proactive postoperative rehabilitation. The approach promotes reduced postoperative complications, earlier return to oral intake, and shorter hospital stays, while supporting multidisciplinary coordination. Conclusions: The EUPEMEN protocol for esophagectomy provides a comprehensive guideline framework for optimizing perioperative care in esophageal surgery. In addition, it serves as a practical guide for healthcare professionals committed to advancing surgical recovery and standardizing clinical practice across diverse care environments across Europe. Full article

Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3) Abbott left ventricular assist device (LVAD), it is unknown how the role of the LVAD outpatient clinic may affect the long-term survival after hospital discharge. Our objective is to share our standardized protocol for outpatient care, to describe the role of the LVAD outpatient clinic in postoperative long-term care after LVAD implantation, and to report survival. Methods: We retrospectively reviewed all patients implanted with HM3 LVAD in our institute between September 2015 and January 2025. Patients who received HeartWare Ventricular Assist Device (HVAD) and HeartMate 2 LVAD devices were excluded from our study, to ensure a homogenous cohort focusing on the latest and the only currently used LVAD device generation. We included a total of 48 patients. After LVAD patients are discharged from our center, they are followed in our outpatient clinic in 3-month intervals. During visits, bloodwork, EKG, wound inspection, and echocardiography are performed in addition to LVAD analysis. The role of the outpatient clinic is to detect early signs of deterioration or problems and act accordingly to prevent serious complications. Results: Thirty-three patients (68.7%) are still alive in 2025; two patients (4.2%) had a successful heart transplantation; and thirty-one patients (64.5%) are still on LVAD support. There were 210 total patient years of support. The mean time on device is 4.4 years. During the follow-up period we noticed 15 deaths (31.3%). Notably, there was no technical device-related death. Kaplan–Meier analysis estimated an overall survival rate of 97.9%, 92.8%, 83.7%, and 51.1% at 1, 2, 4, and 8 years, respectively. Conclusion: Strict control of patients after discharge in an outpatient clinic is essential for the long-term survival of these patients. A well-structured outpatient program is of utter importance to avoid LVAD-related complications and should be a cornerstone for the treatment, especially in non-transplant centers. Full article

Background: The Da Silva Cone procedure for Ebstein anomaly has dramatically improved tricuspid valve competence and clinical outcomes. However, preoperative left ventricular (LV) dysfunction and immediate postoperative right ventricular (RV) systolic dysfunction are frequently observed. While excellent valve outcomes are well established, recovery of biventricular function following the Cone remains less defined. This study aimed to evaluate longitudinal changes in RV and LV function postoperatively and over a minimum of six months post-Cone operation. Methods: A single center retrospective review of 134 patients who underwent Cone repair for Ebstein’s anomaly from 2016 to 2024 was performed. Echocardiograms were analyzed at three time points: preoperative (Time 1), hospital discharge (Time 2), and ≥6 months postoperative (Time 3). RV parameters included fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and tricuspid S′. LV parameters included left ventricular ejection fraction (LVEF), end-diastolic volume indexed to body surface area (LVEDVi), left ventricular stroke volume (LVSVi), and mitral E/E′. Subgroup analyses examined outcomes by prior Glenn, Starnes procedure, and degree of RV dilation. Paired two sample t-tests were used to compare serial measures. Results: Median age at surgery was 7.8 years (IQR: 2.3–17.7). All patients had discharge echocardiograms; 70 had follow-up studies at ≥6 months. RV function declined postoperatively with reductions in FAC (35% to 21%), TAPSE (2.0 to 0.8 cm), and S′ (13 to 5 cm/s), all p < 0.001. By Time 3, these measures improved (FAC to 29%, TAPSE to 1.3 cm, S′ to 7 cm/s) but did not fully return to baseline. LVEDVi and LVSVi increased significantly by Time 3 (LVEDVi: 47 to 54 mL/m²; LVSVi: 30 to 34 mL/m²; p < 0.001), while LVEF remained unchanged. Patients with prior Glenn or Starnes had greater Time 1 LV volumes and lower RV function, but by Time 3, most differences resolved. Moderate–severe preoperative RV dilation was associated with worse RV function at Time 2 and normalized by Time 3. Conclusions: The Da Silva Cone procedure leads to early postoperative RV dysfunction with partial recovery over the mid-term follow-up. Concurrently, LV filling and stroke volume improve, reflecting favorable interventricular interaction. These findings support echocardiographic surveillance to guide functional recovery post-Cone and inform patient counseling. Full article

Background: Patients with acute heart failure exhibit high rates of early rehospitalization accompanied by significant mortality. Therefore, identifying high-risk patients who are prone to disease exacerbation may enable early therapeutic interventions for improved disease management. Methods: This single-center, prospective observational study was conducted at a Brazilian hospital. Adult patients hospitalized for acute heart failure were enrolled. On the day of hospital discharge, NT-pro-BNP and body weight data were collected, and bedside lung and inferior vena cava ultrasound examinations were performed. The patients were followed up for up to 30 days after discharge. The primary outcome was rehospitalization for acute heart failure. Results: A total of 100 patients were included in the final analysis, of whom 10% were readmitted within 30 days owing to acute heart failure. The number of patients with total B-line scores >3 in the readmitted and non-readmitted groups was 6 and 19, respectively (60% and 21%, respectively; absolute risk difference: 39%; p = 0.014). The mean inferior vena cava collapsibility index was significantly lower in readmitted compared to that in non-readmitted patients (25.5% vs. 39.8%, standard deviation: 15.4% and 18.4%, respectively; p = 0.020). However, mean body weight and mean NT-pro-BNP levels at discharge did not differ between the groups. In a multivariate logistic regression model adjusted for sex, age, discharge body weight, and left ventricular ejection fraction, a total B-lines score >3 had an odds ratio of 4.72 (95% confidence interval (CI): 1.01–22.13; p = 0.049), while the inferior vena cava collapsibility index had an odds ratio of 0.96 (95% CI: 0.91–1.01; p = 0.091). Conclusions: A total B-line score >3 at discharge in patients hospitalized for acute heart failure was associated with 30-day rehospitalization. In contrast, inferior vena cava ultrasound, discharge body weight, and NT-pro-BNP at discharge were not significant predictors of rehospitalization. Full article

Lower gastrointestinal bleeding (LGIB) is a frequent and potentially life-threatening clinical condition. Over the past two decades, several prognostic scoring systems have been developed to stratify risk and guide the management of patients with LGIB. This comprehensive review aims to summarize and compare the current evidence on the utility, accuracy, and limitations of key LGIB scoring systems, including the Glasgow-Blatchford Score (GBS), AIMS65, ABC score, Oakland score, SALGIB, CHAMPS, and Rockall score. We conducted a structured literature review of studies evaluating these scores in adult patients with LGIB. For each scoring system, we analyzed its origin, components, intended use, and predictive performance regarding clinical outcomes such as severe bleeding, transfusion requirement, in-hospital mortality, rebleeding, and safe discharge. Comparative analyses of diagnostic accuracy were extracted where available. Our findings indicate that while no single score offers comprehensive predictive accuracy across all outcomes, certain tools are particularly effective for specific endpoints. The Oakland and GBS scores are useful for identifying patients at low risk who may be managed safely as outpatients. The ABC and CHAMPS scores demonstrate superior performance in predicting mortality, especially in elderly or comorbid populations. SALGIB, a newer score developed in Vietnam, shows promising performance for early triage but requires further validation. The Rockall score, although historically valuable in upper GI bleeding, offers limited applicability in LGIB due to its reliance on post-endoscopic findings. In conclusion, multiple prognostic tools are now available to support early decision-making in LGIB. Their optimal use requires understanding their strengths, limitations, and appropriate clinical contexts. Integrating these scores into routine practice, along with clinical judgment, can enhance patient outcomes and resource allocation. Full article

Ventilator-associated pneumonia (VAP) develops in patients who stay on mechanical ventilation for more than 48 h. In the presence of causative pathogens, the patient develops clinical signs such as purulent tracheal discharge, fever, and respiratory distress. A prospective observational study was carried out in the Intensive Care Unit (ICU) of Max Healthcare Centre, New Delhi, from 2020 to 2023. The study comprised 70 samples from patients diagnosed with VAP. This study thoroughly examined VAP-associated microorganisms and resistance in the hospital ICU. Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa were the most commonly reported pathogens. Significant drug resistance was seen in P. aeruginosa, K. pneumoniae, A. baumannii and Staphylococcus aureus. The heatmap also supported the antibiotic resistance data patterns obtained from conventional and automated systems of determination. Notably, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Ralstonia insidiosa, and Ralstonia mannitolilytica, showed 60 to 100% of resistance to a number of antibiotics. Among all VAP patients, 31.42% early-onset and 68.57% late-onset VAP cases were detected. Out of 70 patients, 43 patients died (mortality rate 61.4%); majority of them suffered from late-onset VAP. The study goal was to describe the antibiotic resistance patterns and microbial ecology of the pathogens that were isolated from VAP patients. According to the heatmap analysis, a varied VAP microbiome with high prevalences of MDR in A. baumannii, P. aeruginosa, K. pneumoniae, and S. aureus was identified. To address the increasing prevalence of MDR VAP, the study highlights the critical need for improved VAP monitoring, strong infection control, and appropriate antibiotic usage. Full article