Ventilator-associated pneumonia in Iranian intensive care units

Abstract

Introduction: Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) occur most frequently in intensive care units (ICU). This study seeks to determine the etiological agents of NP and VAP along with their antibacterial susceptibility patterns, and to evaluate the factors contributing to patient mortality. The impact of appropriate therapy in terms of three parameters (body temperature, PaO2/FiO2 ratio and leukocyte count) was also assessed. Methodology: This study involved 836 adult patients admitted to ICUs at the Nemazee Hospital, Shiraz, Iran, over nine months during 2008 and 2009. The inclusion criterion was the commencement of infection at least 48 hours following hospital admission. Clinical parameters including core temperature, leukocyte count. and PaO2/FiO2 ratio were evaluated. Antibiotic sensitivities of the isolated bacteria to a panel of antibiotics were determined using E-test. Results: Of 836 cases, only 58 (6.9 %) cases of NP were diagnosed, of which 42 (72 %) were VAP. A. baumannii, MRSA, P. aeruginosa and MSSA were the most prevalent bacteria. Significant correlations between previous antibiotic therapy (p = 0.04), use of corticosteroids (p = 0.02) and attributable mortality were found. A strong correlation between fever abatement and the ratio of PaO2/FiO2 with responses to treatment and outcomes was also evident. Conclusions: Combined treatment with meropenem/imipenem, ciprofloxacin and vancomycin seems to be appropriate and could cover all possible infective agents. To reduce mortality rate, reasonable prescription of antibiotics and corticosteroids could be effective. Furthermore, adopting a strategy to reduce body temperature and PaO2/FiO2 ratio could be beneficial in patients' outcomes.

The Impact of Tracheotomy on the Clinicalcourse of Ventilator-Associated Pneumonia

“…According to our data, in VAP patients not tracheotomized during ICU stay, the mortality was approximately two-fold higher than in patients tracheotomized either before or after VAP onset. Other predictors positively correlated with lethal outcomes were duration of MV and use of corticosteroids, which is consistent with the results of many other studies 3,[13][14][15]29 . Koleff et al also found the mortality of patients receiving tracheotomy to be lower than the mortality of non-tracheotomized patients 17 .…”

Drug resistance patterns of bacteria isolated from patients with nosocomial pneumonia at Tehran hospitals during 2009-2011

“…In another study conducted in southern Iran, A. baumannii was also ranked as the first agent. However, S. aureus was found to be the second most common agent of ventilator-associated pneumonia [8].…”

Nosocomial Pneumonia in Patients Admitted to the Intensive Care Unit of a Tertiary Care Center in Mashhad, Northeast of Iran; an Etiologic Survey

“…were more common in patients with HAP (15). This difference might be due to different local epidemiology, different patient populations and study designs, since the current study evaluated ICU admitted patients with HAP, but Japoni et al (15) studied patients with VAP.…”

“…In the current study, carbapenem was the most widely used antibiotic while in the study by Japoni et al (15) carbapenem was the most common form of antibiotic. Salehifar et al (14) showed that ceftazidime was used more frequently and most effective antibiotic on Pseudomonas spp.…”