Risk factors and pathogens involved in early ventilator-acquired pneumonia in patients with severe subarachnoid hemorrhage

Abstract

Ventilator-acquired pneumonia (VAP) is a common burden in intensive care unit (ICU) patients, but, to date, specific data are not available in patients with severe aneurysmal subarachnoid hemorrhage (SAH). A single neuro-ICU retrospective analysis of 193 patients with SAH requiring mechanical ventilation (MV) ≥48 h admitted from January 2005 to May 2010 was undertaken. The diagnosis of early VAP was prospectively upheld during a multidisciplinary staff meeting, according to the American Thoracic Society (ATS) 2005 guidelines with a threshold of 7 days after the onset of MV. Patients had a median age of 53 (44-62) years and 70 (36 %) were male. The median Glasgow coma scale (GCS) score before MV was 9 (5-14). 142 (74 %) patients had a World Federation of Neurosurgeons (WFNS) score ≥III. Aneurysm was secured with an endovascular coiling procedure in 162 (84 %) patients. 81 (48.7 %) patients declared an early VAP. On multivariate analysis, male sex (odds ratio [OR] 2.26, 95 % confidence interval [CI] [1.14-4.46]), use of mannitol before day 7 (OR 3.03, 95 % CI [1.54-5.95]), and achieving enteral nutrition ≥20 kcal kg(-1) day(-1) after day 7 (OR 2.91, 95 % CI [1.27-6.67]) remained independent risk factors of VAP. The main pathogens involved were methicillin-susceptible Staphylococcus aureus (MSSA) (34.9 %), Haemophilus influenzae (28.1 %), Streptococcus pneumoniae (15.5 %), and Enterobacteriaceae (10.7 %). Early VAP was associated with a longer duration of MV and ICU stay, but not with an excess of mortality. Early VAP bears significant morbidity in patients with severe SAH. Pathogens involved in early VAP are susceptible to antibiotics. Among modifiable risk factors of VAP, early enteral nutrition could be an easy and effective target.

Infection prediction for aneurysmal subarachnoid hemorrhage patients at hospital admission: combined panel of serum amyloid A and clinical parameters

“…The WFNS score, for instance, has been previously proposed as the most significant risk factor and predictor of infection in aSAH patients [1,31,33]. In line with these results, we showed that patients with high WFNS scores were more susceptible to developing an infection than patients with good neurological status (p ≤ 0.001).…”

Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

“…EOVAP was defined as pneumonia that occurred during the first 7 days after a trauma, consistent with the literature [6,[18][19][20][21]. The clinical pulmonary infection score (CPIS) was assessed daily for the first 7 days to screen patients for pneumonia [22,23].…”

“…The median ISS scores were 25 (IQR: [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] for those with EOVAP, and 18 (IQR: 14-32) for those without EOVAP (p = 0.009). The gravity of brain injuries was comparable between the groups, in terms of the median head AIS (5, IQR: 4-5 vs. 5, IQR: 4-5; p = 0.09), the median Marshall score (2.5, IQR: 2-5 vs. 2, IQR: 2-5; p = 0.10), and the median minimal GCS score before sedation (6, IQR: 4-7 vs. 6, IQR: 4-8; p = 0.46).…”

Nosocomial Infections after Aneurysmal Subarachnoid Hemorrhage: Time Course and Causative Pathogens

“…Nosocomial infections after aSAH are associated with poor functional outcome and case fatality (2)(3)(4). Risk factors for infections after SAH include higher age, gender, poor clinical condition on admission, intensive care unit (ICU) admission, endotracheal intubation, tracheostomy, urinary cathether, and extraventricular drain (3,5,6). Although infections after aSAH are associated with prolonged length of stay (2,3), it remains unclear if infections result in prolonged length of stay or, vice versa, if prolonged length of stay results in more infections.…”