Epidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database

Rello, Jordi; Ollendorf, Daniel A.; Oster, Gerry; Vera-Llonch, Montserrat; Bellm, Lisa A.; Redman, Rebecca; Kollef, Marin H.

doi:10.1378/chest.122.6.2115

Cited by 1,105 publications

(747 citation statements)

References 28 publications

(26 reference statements)

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“…Sepsis and pneumonia were second culprit of HAIs and leads to death in developing countries also reported Tanriover et al, (2006) in contrast a study showed, sepsis is a significant cause of increased rate of mortality in developed countries (Angus et al, 2001;De Coppi et al, 2007;Frikha et al, 2005) in contrast to this Degoricija et al, (2006) reported sepsis can be treated with intensive medical care and antibiotics use. Whereas pneumonia which may be ventilator associated or ICU associated contributed equally to promote HAIs as it is found in other related studies (Chastre and Fagon, 2002;Rello et al, 2002). Most of the patients were catheterised but UTI incidence were significantly lower this may be due to early removal of catheter.…”

Section: Discussionsupporting

confidence: 57%

Mortality rate associated with hospital acquired infections among burn patients

et al. 2016

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Abstract-Introduction:Hospital acquired infections (HAIs) are the major contributors of mortality associated with burn injuries. The aim of this research was to document the antecedents affiliated with major burn injuries, hospitalization and mortality in burn patients. Methods: We performed a single center prospective study of patients admitted during 3 months period (April-June 2014) in burn wards of government hospital. There were 100 patients in this investigation which were observed weekly. The inclusion criterion was based on the shifting of patients from emergency to the wards after initial treatment of more than 24 h. Variables included were age and gender of the patient, the percent total body surface area (%TBSA) burn, the cause of the burn. Results: Mean age of patients was 30.29 years. More females (55.67%) were admitted than males (44.32%). The total body surface area (%TBSA) burnt were from 15%-95% respectively moreover children were more sensitive to hospital acquired infections (HAIs) and mortality rate was 34% in children with mean age of 5 years and disability of body parts were 42% among 75% were females. Whereas the most common (HAIs) were primary bloodstream (PBS) with mean value of 30.50, wound infections (WIS) were at second prevalence with mean value of 27.50, followed by sepsis (S) and pneumonia (P) 10.33, eye infections (EIs) 4.833 and urinary tract infections (UTIs) 2.667. Factors significantly (p-value= 0.000) associated with increased duration of hospitalization caught HAIs mortality include the age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt. Conclusion: It concluded that the mortality was very much dependent on age and gender of the patient, burn causes, affected area as well as % TBSA burnt are considerable factors in determining the relationship of HAIs and whether the patients will survive or knuckle to injuries. Better compliance techniques, stricter control over disinfection and sterilization practices and usage of broad spectrum antibiotics, and reduction of the environmental contamination are required to reduce the HAIs rates among burn patients.

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Section: Discussionsupporting

confidence: 57%

Mortality rate associated with hospital acquired infections among burn patients

et al. 2016

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“…However, in an unselected ICU population, it has been suggested that late-onset pneumonia and not early-onset pneumonia can be associated with excessive mortality. 27,31,32 The SAPS II score, serum lactatemia, and vasopressor requirements on ICU admission were significantly higher in patients who developed E-HAP. They also required immediate postoperative mechanical ventilation exceeding 2 days more frequently.…”

Section: Discussionmentioning

confidence: 98%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum b-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed. Orthotopic liver transplantation (LT) is a widely accepted treatment for patients with end-stage liver disease. Despite global improvements in survival over the last few decades, sepsis remains the leading cause of early postoperative mortality. 1,2 Lower respiratory tract infections are a major concern in this context.

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“…1,2 VAP is associated with delayed extubation, prolonged stays in the ICU and hospital, increased mortality and morbidity, and increased use of health care resources. 3,4 As such, prevention of VAP is an essential objective of health care delivery in ICUs. Many strategies and guidelines have been developed and proposed for the prevention of VAP.…”

mentioning

confidence: 99%

Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

El-Khatib

Zeineldine

Ayoub

et al. 2010

American Journal of Critical Care

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Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended. Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia. Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia. Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience. Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia. (American Journal of Critical Care. 2010;19:272-277) by AACN on April 4, 2019 http://ajcc.aacnjournals.org/ Downloaded from Although knowledge of the guidelines does not guarantee implementation and adherence, lack of knowledge may be a barrier to adherence to and implementation of VAP prevention guidelines. Many studies have focused on assessing the knowledge of ICU nurses regarding measures for the prevention of VAP. [9][10][11][12][13] Other ICU health care providers-particularly respiratory therapists, who are involved in controlling endotracheal cuff pressure, avoiding microaspiration of subglottic secretions, and controlling contamination of mechanical ventilator equipment-can have a significant effect on the prevention of VAP in patients receiving mechanical ventilation in the ICU. 14 The aim of this study was to assess the knowledge of ICU health care providers (ie, physicians, nurses, and respiratory therapists) related to evidence-based guidelines for prevention of VAP. MethodsA multiple-choice questionnaire consisting of 9 items (Table 1) that had been developed, validated, and tested by Blot et al 12 and Labeau et al 13 was distributed to all physicians, nurses, and respiratory therapists working in the ICU of a 420-bed university hospital. The ICU had 20 beds with an approximate daily average of 12 patients receiving mechanical ventilation. Any staff member who was aware of the previous 2 studies by Blot et al 12 and Labeau et al 13 was not allowed to participate in the study; such exclusion was intended to eliminate any po...

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Epidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database

Cited by 1,105 publications

References 28 publications

Mortality rate associated with hospital acquired infections among burn patients

Mortality rate associated with hospital acquired infections among burn patients

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

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