Ventilator-Associated Pneumonia: Epidemiology and Prognostic Indicators of 30-Day Mortality

Abstract

SUMMARY:We conducted a retrospective cohort study in the medical intensive care unit of Chaing Mai University Hospital to describe the epidemiology of ventilator-associated pneumonia (VAP) and identify prognostic indicators of 30-day VAP mortality. A total of 621 patients diagnosed with VAP between January 2005 and December 2011 were included. The overall 30-day mortality rate was 44.4z. The major causative pathogens were Acinetobacter baumannii (54.3z), Pseudomonas aeruginosa (35.2z), and methicillin-resistant Staphylococcus aureus (15.1z). Most A. baumannii (90.2z) comprised drug-resistant strains. Identified prognostic indicators were co-morbid malignancy (hazard ratio [HR] ＝ 1.60; 95z confidence interval [CI] 1.02-2.42; P ＝ 0.040), septic shock (HR ＝ 2.51; 95z CI, 1.60-4.00; P ＜ 0.001), Simplified Acute Physiology Score II ＞45 (HR ＝ 1.62; 95z CI, 1.03-2.56; P ＝ 0.041), Sequential Organ Failure Assessment score ＞5 (HR ＝ 3.40; 95z CI 2.00-5.81; P ＜ 0.001), and delayed inappropriate empirical antibiotic treatment (HR ＝ 2.23; 95z CI, 1.12-4.45; P ＝ 0.022). VAP was associated with high mortality. The major causative pathogen was drug-resistant A. baumannii. Therefore, early detection of VAP by surveillance in mechanically ventilated patients leading to earlier treatment may improve patient outcomes. Guidelines for prescribing appropriate empirical antibiotics to cover drug-resistant bacteria could be established using local epidemiological data.

Epidemiology and Outcome of Ventilator-Associated Pneumonia in a Heterogeneous ICU Population in Qatar

“…Similar results are seen in our analysis where preexisting hypertension, diabetes mellitus, chronic respiratory disease, presence of ≥1 comorbid condition, and poor functional status have been associated with increased mortality (Table 3). In agreement with many reports, our data showed a significant association between inappropriate empirical therapy and increased mortality [2, 5, 20, 21]. This highlights the importance of local studies in providing information about the most likely causative organisms and their resistance patterns to assist clinicians in selecting appropriate empirical treatment, if VAP is suspected.…”

Infection Management in Patients with Sepsis and Septic Shock in Resource-Limited Settings

“…In many resource-limited settings, community infections are more likely to be caused by resistant organisms than in resource-rich settings [77]. Prior antibiotic use is known to affect the gut microflora which is the main source of pathogens for ICU-acquired infection; thus widespread unregulated community use of antibiotics is likely to lead to increased resistance, and this is reflected in the resistance profiles of organisms causing healthcare-associated infection in resource-limited settings [30,[78][79][80]. Limitation of laboratory and diagnostic facilities prevents definitive diagnosis or de-escalation of antibiotic treatment, and empiric therapy may remain the only therapeutic option.…”

Continuous Versus Intermittent Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia: A Systematic Review

“…In addition, guidelines encourage and recommend SSD in general but do not indicate whether CSSD or ISSD should be used. 17,21,22 Given the increased number of studies about CSSD and ISSD and the lack of a meta-analysis of randomized controlled trials comparing the efficacy of the 2 techniques, we conducted this systematic review and metaanalysis with the following purposes: (1) to review the current evidence for using CSSD and ISSD, (2) to compare the complication rates of CSSD and ISSD,and (3) to analyze the choice between CSSD and ISSD.…”