Incidence, Etiology and Outcome of Ventilator-Associated Pneumonia in Patients with Percutaneous Tracheotomy

Abstract

SUMMARY -Although the incidence of ventilator-associated pneumonia (VAP) is very high, there are still many uncertainties about clinical course of VAP among tracheotomized patients. Th e goal of the present study was to determine the impact of tracheotomy on VAP incidence and etiology, as well as outcome of VAP patients with tracheotomy. Th e study was conducted in a 15-bed Surgical and Neurosurgical Intensive Care Unit (ICU), Sestre milosrdnice University Hospital Center in Zagreb, Croatia. Th e study included all patients undergoing only percutaneous tracheotomy during the study period. According to our data, the incidence of VAP among percutaneous tracheotomized patients was 42%, not considering the time between tracheotomy and VAP onset. However, when only patients developing VAP after tracheotomy were taken into account, the incidence of VAP among tracheotomized patients dropped to 8% only. Th e most commonly isolated bacterium was Staphylococcus aureus, accounting for 17 (37%) isolates, followed by Haemophilus infl uenzae, accounting for another 10 (22%) isolates. Th e development of VAP among percutaneously tracheotomized patients was associated with longer total ICU stay (regardless of whether VAP developed before or after tracheotomy), while total duration of mechanical ventilation and mortality rate remained unaff ected.

Analysis of the Current Situation and Risk Factors of Lower Respiratory Tract Infection among ICU Patients in Guizhou, China During 2019–2022

“…The relevance of a patient's smoking history is aligned with international research [18] . The duration and type of antibiotic used also concurred with existing literature [19] .…”

Ventilator-associated pneumonia in patients on prolonged mechanical ventilation: description, risk factors for mortality, and performance of the SOFA score

“…Em relação aos isolados microbiológicos, todos os episódios de PAVM em nosso estudo foram causados por bacilos gram-negativos, sendo que quase metade deles era P. aeruginosa, corroborando achados de um estudo envolvendo indivíduos com PAVM em um HCILD, (24) relatos feitos ao National Healthcare System Network (25) e achados de um estudo sobre PAVM em pacientes traqueostomizados. (26) P. aeruginosa é uma das principais causas de PAVM em todo o mundo. (27,28) Dias de ventilação mecânica A colonização prévia das vias aéreas por P. aeruginosa é um fator crucial para o desenvolvimento de PAVM.…”

“…Poucos estudos abordaram a PAVM em pacientes em VMP. Em um pequeno estudo sobre PAVM em pacientes traqueostomizados, 3 de 12 faleceram, (26) mas são necessários estudos em maior escala para estabelecer a taxa de mortalidade nessa população. Além disso, a mortalidade de pacientes com DCC é consideravelmente alta: as taxas de mortalidade hospitalar variam de 17% a 31%, enquanto as taxas de mortalidade em 6 e 12 meses são de 49% e 68%, respectivamente.…”

“…Regarding microbiological isolates, all of the episodes of VAP in our study were caused by gram-negative bacilli, almost half of them being P. aeruginosa , corroborating one study involving subjects with VAP in an LTACH, 24 reports of the U.S. National Healthcare System Network, 25 and a study on VAP in tracheostomized patients. 26 P. aeruginosa is one of the leading causes of VAP worldwide. 27 , 28 Prior P. aeruginosa colonization of the airway is a crucial factor for developing VAP.…”

“…Few studies have addressed VAP in patients on PMV. In a small study about VAP in tracheostomized patients, 3 of 12 died, 26 but larger scale studies are needed to establish the mortality rate in this population. Furthermore, the mortality of patients with CCI is considerably high: in-hospital mortality rates range from 17% to 31%, whereas 6-month and 12-month mortality rates are 49% and 68%, respectively.…”