Impact of clinical severity index, infective pathogens, and initial empiric antibiotic use on hospital mortality in patients with ventilator-associated pneumonia

Tseng, Chia‐Cheng; Liu, Shih-Feng; Wang, Chin‐Chou; Tu, Mei-Lien; Chung, Yoon Kyu; Lin, Meng-Chih; Fang, Wen‐Feng

doi:10.1016/j.ajic.2011.08.017

Cited by 32 publications

(41 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Young et al found that patients infected with MDR-AB had a mean of US $60,913 additional charges and 13 extra days of hospital stay [12]. It has been reported that VAP caused by A. baumannii or infection by another MDR pathogen was significantly associated with hospital mortality [2]. Prior studies have examined the predictors of mortality in patients with MDR-AB infections [11,15].…”

Section: Introductionmentioning

confidence: 99%

“…Ventilator-associated pneumonia (VAP) is considered one of the most common infections in these units [2]. The estimated incidence of VAP varies among different countries, ranging from 3% to 47% [3,4], with a mortality of 16% to 70% [3,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…The estimated incidence of VAP varies among different countries, ranging from 3% to 47% [3,4], with a mortality of 16% to 70% [3,5,6]. Acinetobacter baumannii, a Gram-negative coccobacillus, is increasingly becoming one of the most common pathogens causing VAP [2,5]. It is responsible for about 5% to 10% of VAP cases occurring in the ICU [7] and is associated with high ICU mortality (61%) [5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Almomani

McCullough

Gharaibeh

et al. 2015

J Infect Dev Ctries

View full text Add to dashboard Cite

Introduction: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is common in hospitals and impacts patient survival. We determined the incidence of MDR-AB VAP in critical care units and examined the predictors of 14-day mortality in these patients. Methodology: A retrospective case series study was conducted at a tertiary referral teaching hospital in north Jordan. A list of patients with a positive culture of A. baumannii between January 2007 and June 2013 was retrieved using computerized hospital databases. Medical records of all these patients were reviewed, and cases of VAP infected with MDR-AB were identified. Predictors of 14-day mortality were determined using multivariable logistic regression adjusted for possible confounders. Results: Out of 121 A. baumannii-VAP cases, 119 (98.3%) were caused by MDR-AB. The incidence rate of MDR-AB VAP was 1.59 cases per 100 critical care unit admissions. The mortality of A. baumannii-VAP cases in critical care units was 42% (50/119). Being prescribed two or more definitive antibiotics (prescribed based on susceptibility data) (OR = 0.075, 95% CI = 0.017-0.340, p = 0.001) and ipratropium/salbutamol during mechanical ventilation (OR = 0.140, 95% CI = 0.028-0.705, p = 0.017) were independently associated with lower hospital mortality. Conclusions: Our results suggest incidence of MDR-AB VAP in critical care units is high and that prescription of antibiotics based on antibiotic susceptibility and use of bronchodilators is associated with lower mortality in this population. Larger prospective studies are needed to explore whether these findings can be replicated in different clinical settings.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Almomani

McCullough

Gharaibeh

et al. 2015

J Infect Dev Ctries

View full text Add to dashboard Cite

show abstract

“…1 Scores to predict 30-day mortality in hospitalized patients, such as the APACHE II score, have been noted to be early and independent indicators of mortality and clinical failure in VAP patients. 1,6,7,15 In our study, patients with higher APACHE II scores were more likely to experience MRSA VAP clinical failure.…”

Section: Discussionmentioning

confidence: 63%

Sepsis in patients with ventilator associated pneumonia due to methicillin-resistant Staphylococcus aureus: incidence and impact on clinical outcomes.

Raghuram¹,

Gnoni²,

Wiemken³

et al. 2017

JRI

View full text Add to dashboard Cite

Background: Sepsis is a clinical syndrome associated with organ dysfunction due to a dysregulated host response to infection. Methicillin-resistant Staphylococcus aureus (MRSA) ventilatorassociated pneumonia (VAP) is a serious infection frequently associated with sepsis. The objectives of this study were to define the incidence of sepsis and clinical failure in patients with MRSA VAP. Methods: This was a secondary analysis of the Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. We used the 3rd International Consensus Definitions for sepsis. The presence of clinical failure was evaluated at the 14 day follow-up and defined as: 1) progression of baseline signs and symptoms of pneumonia, or 2) death. The ChiSquare Trend Test was utilized to determine the association between the level of organ dysfunction and clinical failure. Results: MRSA VAP was diagnosed in 205 patients with 138 (67%) presenting with sepsis. Clinical failure occurred in 14% (8/57) of patients without sepsis. Clinical failure occurred in 18% (13/73) of patients with sepsis and 1 organ dysfunction, in 28% (12/43) of patients with sepsis and 2 organ dysfunction, in 28% (5/18) of patients with sepsis and 3 organ dysfunction, and in 100% (4/4) of patients with sepsis and 4 organ dysfunction (p= 0.01). Conclusions: Sepsis is a frequent complication of MRSA VAP and the number of organ dysfunction correlates with clinical failure in these patients. Effective prevention and treatment of sepsis and associated organ dysfunction is essential to avoid cumulative burden of disease in MRSA VAP.

show abstract

“…Patients with ventilator-associated pneumonia (VAP) caused by carbapenem-resistant CRAB, the incidence of which has been rising substantially, may be predisposed to poor outcome because of limited therapeutic options and the likelihood of inappropriate empirical antibiotic therapy (4,5).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of nebulized colistin-based therapy without concurrent intravenous colistin for ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii

Kim

Lee

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Although there have been studies regarding the role of nebulized colistin as adjunctive therapy of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB), a paucity of information on the efficacy of nebulized colistin as monotherapy is available. Methods:We retrospectively reviewed 219 patients with VAP caused by CRAB treated with either intravenous (n=93) or nebulized colistin (n=126), from March 2010 to November 2015. Factors related to clinical failure was assessed using propensity-score-matched analysis.Results: Of 219 patients, 39 patients from each group (n=78) were matched after covariate adjustment using propensity score. There were no significant differences in baseline characteristics as well as the rates of clinical failure between the propensity-score-matched groups [Odds ratio (OR), 0.48; 95% confidence interval (CI), 0.19-1.19; P=0.11], while a significantly lower rate of acute kidney injury (AKI) during colistin therapy (18% vs. 49%, P=0.004) was observed in nebulized colistin group. In addition, multivariable analysis revealed that nebulized colistin did not significantly alter the rate of clinical failure [adjusted odds ratio (aOR), 0.36; 95% CI, 0.12-1.09; P=0.070]. Instead, medical intensive care unit (ICU) admission (aOR, 7.14; 95% CI, 1.60-32.00; P=0.010), and septic shock (aOR, 3.93; 95% CI,; P=0.018) were independent risk factors for clinical failure.Conclusions: Our findings suggest that nebulized colistin-based therapy, even without concurrent administration of intravenous colistin, may be an effective and safe treatment option for VAP caused by CRAB.

show abstract

Impact of clinical severity index, infective pathogens, and initial empiric antibiotic use on hospital mortality in patients with ventilator-associated pneumonia

Cited by 32 publications

References 30 publications

Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Sepsis in patients with ventilator associated pneumonia due to methicillin-resistant Staphylococcus aureus: incidence and impact on clinical outcomes.

Efficacy of nebulized colistin-based therapy without concurrent intravenous colistin for ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii

Contact Info

Product

Resources

About