Ventilator-Associated Pneumonia and In-Hospital Mortality: Which Risk Factors may predict In-Hospital Mortality in Such Patients?

Abstract

Background: Ventilator-associated pneumonia (VAP) remains a common case of intensive care unite (İCU) and hospital morbidity and mortality despite advances in diagnostic techniques and manegment. One of most important point for such patients is identification of predictors for mortality in term for futher their modification and reduction of mortality rate.Objective: We aimed to determine the most important risk factors for short-term mortality in patients with VAP in mechanically ventilated patients Methods: This retrospective study was carried out from February 2014 to January 2019. One hundred twenty one adults patients with VAP maintained on mechanical ventilation for more than 48 h in our ICU department were enrolled in the study. VAP was diagnosed as new persistent pulmonary infiltrates on chest radiographs and a least two of following: (1) Fever of ≥38.3C(2) leukocytosis of ≥ 12.000/mm 3 and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples and blood samples of suspected case were collected and processed as per standard protocols. Results:The primary underlying diagnosis and comorbidities were acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in 42 patients, congestive heart failure in 32, neurological disease in 28, and renal disease in 19 patients. Gram-negative agents were the major of finding pathogen (Acinotebacter baumannii accounting for 37.1 %). This infection in 43 case (95.5%) was multi-dying resistant (MDR) pathogen and associated with significantly higher length of ventilation (LOV) and the length of ICU stay (LOS icu ) (p=0.01 respectively). Severe sepsis/septic shock, acute respiratory distress syndrome (ARDS), malnutrition, pulmonary complications such as pleural effusions and bilateral, multi-lobar lung infiltrates were most common findings in VAP patients which were associated with higher mortality (p<0.01) .Acinotebacter baumanii MDR pathogens was associated with higher mortality rate compare with other MDR pathogens (p<0.01) Conclusion:Ventilator-associated pneumonia is a serious ICU complication that is associated with increased in hospital mortality.In patients with VAP malnutrition ,severe sepsis/septic shock, ARDS, MDR Acinotebacter baumannii infection ,bilateral pulmonary infiltrates ,and underlying chronic obstructive pulmonary disease(COPD) are associated with increased risk in-hospital mortality in such patients. Identification of risk factor for in hospital mortality in such patents is important in term on further their modification and reduction of mortality rate

Carbapenem-Resistant Gram-Negative Bacilli Causing Ventilator Associated Pneumonia: Study of MASTDISCS Combi Carba Plus for Detection of Carbapenemase Producing Enterobacterales

“…58 Meanwhile, Sadigov et al reported that the only independent risk factor for increased hospital mortality in VAP patients was A. baumannii infection. 40 However, in previous studies, length of hospital stays more than 9 days preceding the incidence of nosocomial pneumonia was a significant predictor of mortality. 38,59 Prolonged hospitalization was linked to higher risk of infection with antibiotic resistant pathogens, which resulted in higher mortality.…”

“…36,37 Meanwhile, Chen et al, Kumari et al, and Sadigov et al reported that A. baumannii was the most prevalent CR-GNB pathogen, accounting for 78.7%, 37.4%, and 37.1%, respectively. [38][39][40] This variation could be the result of geographical differences between the countries, patient population and clinical setting. 20 Determination of whether the gram-negative isolate is a carbapenemase producer is essential for epidemiological studies and also for selection of the appropriate treatment for infections.…”

Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study

“…11. Aspiration of subglottic secretion-continuous 2 , by suction tubing for evac aspiration 3 , suction force: 100-150 mmHg (Figures 5 and 6).…”

“…Ventilator-associated pneumonia (VAP) in the intensive care unit (ICU) is a complex and multifactorial clinical condition connected with high morbidity (4-61%) and mortality (40-43%) as well as considerable treatment costs [1][2][3][4]. The length of stay of a patient with VAP in the ward usually fluctuates between 10 and 21 days.…”

Factors associated with bronchopulmonary aspiration: a national-based study

“…Mechanically ventilated patients are unable to clear oropharyngeal secretions; therefore, they are at increased risk for bronchopulmonary aspiration and respiratory infections (18) . VAP is one of the consequences of bronchopulmonary aspiration and results in high in-hospital mortality rates (35)(36) . The VAP prevention bundle, which includes (i) elevated position at 30 and 45°, (ii) daily interruption of sedation and daily assessment of extubation conditions, (iv) peptic ulcer prophylaxis (stress ulcer) and (v) deep vein thrombosis prophylaxis (unless contraindicated) (37) , being an important strategy that, when used efficiently, positively impacts patient outcomes and quality of care (25) , because it allows nurses and other healthcare professionals to provide the best possible care, supported by evidence-based research and practices (32) .…”