The Effect of Late-Onset Ventilator-Associated Pneumonia in Determining Patient Mortality

Kollef, Marin H.; Silver, Patricia; Murphy, Denise; Trovillion, Ellen

doi:10.1378/chest.108.6.1655

Cited by 376 publications

(205 citation statements)

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“…The organisms associated with ventilator-associated pneumonia that we identified are similar to those reported in the literature. 12,13,15,16,18 The most common causes overall are P. aeruginosa and Staphylococcus aureus. Early cases of ventilator-associated pneumonia are more commonly associated with methicillin-sensitive Staphylococcus aureus and late cases with methicillin-resistant Staphylococcus aureus.…”

Section: Discussionmentioning

confidence: 99%

“…Cases of ventilator-associated pneumonia were categorized as early, occurring within the first 4 days on the ventilator, and late, occurring after 5 or more days on the ventilator. [18][19][20][21] Data were summarized for all three hospitals combined and then compared between adult and pediatric hospitals, between teaching and community adult hospitals, and between types of ICUs at all three hospitals.…”

Section: Study Methodsmentioning

confidence: 99%

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Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

Babcock

Zack

Garrison

et al. 2003

Infect. Control Hosp. Epidemiol.

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Objective:To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings.Design:Observational retrospective cohort study of microbiologic etiologies of ventilator-associated pneumonia from 1998 to 2001 in a multi-hospital system. Microbiologic results were compared between hospitals and between different intensive care units (ICUs) within hospitals.Setting:Three hospitals—one pediatric teaching hospital, one adult teaching hospital, and one community hospital— in one healthcare system in the midwestern United States.Patients:Patients at the target hospitals who developed ventilator-associated pneumonia and for whom microbiologic data were available.Results:Seven hundred fifty-three episodes of ventilator-associated pneumonia had culture data available for review. The most common organisms at all hospitals were Staphylococcus aureus (28.4%) and Pseudomonas aeruginosa (25.2%). The pediatric hospital had higher proportions of Escherichia coli (9.5% vs 2.3%; P < .001) and Klebsiella pneumoniae (13% vs 3.1%; P < .001) than did the adult hospitals. In the pediatric hospital, the pediatric ICU had higher P. aeruginosa rates than did the neonatal ICU (33.3% vs 17%; P = .01). In the adult hospitals, the surgical ICU had higher Acinetobacter baumannii rates (10.2% vs. 1.7%; P < .001) than did the other ICUs.Conclusions:Microbiologic etiologies of ventilator-associated pneumonia vary between and within hospitals. Knowledge of these differences can improve selection of initial antimicrobial regimens, which may decrease mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Study Methodsmentioning

confidence: 99%

Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

Babcock

Zack

Garrison

et al. 2003

Infect. Control Hosp. Epidemiol.

Self Cite

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“…Studies have provided different results when determining attributable mortality, in part because of very different populations (less-acute trauma patients, acute respiratory distress syndrome [ARDS] patients, and medical and surgical ICU patients) and in part as a result of variances in appropriate empirical medical therapy during the initial 2 days. Furthermore, the organisms recovered have an impact on outcome, with higher mortality rates seen in VAP caused by Pseudomonas aeruginosa, Acinetobacter spp., and Stenotrophomonas maltophilia (109). Beyond mortality, the economics of VAP include increased ICU lengths of stays (LOS) (from 4 to 13 days), and incremental costs associated with VAP have been estimated at between $5,000 and $20,000 per diagnosis (20,206,211).…”

Section: Introductionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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SUMMARY While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.

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“…(3)(4)(5) In addition to showing the magnitude of the problem, such studies point out characteristics to be subsequently examined in strategies for diagnosis, prevention and treatment. Despite the advances in the understanding of the epidemiology of VAP, some fundamental aspects, such as its influence on in-ICU mortality and time in ICU, remain a matter of controversy, and conflicting data have been observed in the literature.…”

Section: Introductionmentioning

confidence: 99%

Pneumonia associada à ventilação mecânica: epidemiologia e impacto na evolução clínica de pacientes em uma unidade de terapia intensiva

et al. 2009

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Objective: Although ventilator-associated pneumonia (VAP) is a major cause of nosocomial infection, its role in the prognosis of patients remains undefined. The objective of this study was to evaluate the impact of VAP on the clinical evolution of patients. Methods: This was a prospective cohort study involving 233 patients on mechanical ventilation (VAP group, n = 64; control group, n = 169). Primary outcomes were time on mechanical ventilation (TMV), time in ICU (TICU), overall length of hospital stay (LHS) and in-ICU mortality. Secondary outcomes were in-hospital mortality, microbiological profile, prior use of antibiotics and risk factors for VAP acquisition. Results: Control and VAP group outcomes were, respectively, as follows: median TMV (days), 9 (interquartile range [IQR]: 5-15) and 23 (IQR: 15-37; p < 0.0001); median TICU (days), 12 (IQR: 8-21) and 27 (IQR: 17-42; p < 0.0001); median LHS (days), 33 (IQR: 18-64) and 46 (IQR: 25-90; p = 0.05); and in-ICU mortality, 38% (95% CI: 31-45) and 55% (95% CI: 42-67; p = 0.02). VAP was a predictor of in-ICU mortality (OR = 3.40; 95% CI: 1.54-7.48). TMV (OR = 2.27; 95% CI: 1.05-4.87) and prior use of antibiotics (OR = 1.07; 95% CI: 1.04-1.10) were risk factors for VAP. VAP did not affect in-hospital mortality. Acinetobacter spp. was the most common isolate (28%). Inappropriate empirical antibiotic therapy was administered in 48% of cases. Conclusions: In this study, there was a high incidence of infection with resistant bacteria and inappropriate initial antibiotic therapy. Long TMV and prior use of antibiotics are risk factors for VAP.Keywords: Pneumonia, ventilator-associated; Cross infection; Intensive care units; Hospital mortality; Risk factors. ResumoObjetivo: Apesar de representar uma das principais causas de infecção nosocomial, o papel da pneumonia associada à ventilação mecânica (PAVM) no prognóstico ainda permanece indefinido. O objetivo deste estudo foi avaliar o impacto dessa doença na evolução clínica dos pacientes. Métodos: Estabeleceu-se uma coorte prospectiva de 233 pacientes sob ventilação mecânica (grupo PAV, n = 64; grupo controle, n = 169). Os desfechos primários foram tempo de ventilação mecânica (TVM), tempo de permanência na UTI (TUTI), tempo de permanência hospitalar (TH) e mortalidade na UTI. Os desfechos secundários foram mortalidade hospitalar, perfil microbiológico, uso prévio de antibióticos e fatores de risco para PAVM. Resultados: Os desfechos dos grupos controle e PAVM foram, respectivamente, os seguintes: mediana do TVM (dias), 9 (intervalo interquartílico [II]: 5-15) e 23 (II: 15-37; p < 0,0001); mediana do TUTI (dias), 12 (II: 8-21) e 27 (II: 17-42; p < 0,0001); mediana do TH (dias), 33 (II: 18-64) e 46 (II: 25-90; p = 0,02); e mortalidade na UTI, 38% (IC95%: 31-45) e 55% (IC95%: 42-67; p = 0,02). A PAVM foi um preditor de mortalidade na UTI (OR = 3,40; IC95%: 1,78). O TVM (OR = 2,27; IC95%: 1,05-4,87) e o uso prévio de antibióticos (OR = 1,07; IC95%: 1,04-1,10) foram fatores de risco para PAVM. A PAVM não afetou a morta...

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The Effect of Late-Onset Ventilator-Associated Pneumonia in Determining Patient Mortality

Cited by 376 publications

References 45 publications

Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Pneumonia associada à ventilação mecânica: epidemiologia e impacto na evolução clínica de pacientes em uma unidade de terapia intensiva

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