Abstract
BackgroundVentilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics.ObjectiveTo compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP.MethodA cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed.ResultsOne hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50% EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8%) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS [median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days], hospital LOS [median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days] shorter MV days [median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days] and lower hospital mortality (16.7% vs 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 [95% confidence interval (CI), 1.08–4.54, p = 0.02].ConclusionLOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.
Highlights
Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU)
The factor associated with hospital mortality was hav‐ ing simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio of 2.22 [95% confidence interval (CI), 1.08–4.54, p = 0.02]
A broad-spectrum antibiotic to cover multi-drug resistant (MDR) pathogens should be considered in late-onset VAP (LOVAP)
Summary
Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). VAP is the most common nosocomial infection, Arayasukawat et al BMC Pulm Med (2021) 21:47 developed in about 5–40% of mechanically ventilated patients [5,6,7]. Data from the International Nosocomial Infection Control Consortium (INICC) collected summary data from 50 countries including Southeast Asia during 2010–2015 indicated the VAP rate was 13.1 per 1000 mechanical ventilator (MV) days in the medical and surgical intensive care unit (ICU) [8]. This study demonstrated that more than half of the costs of nocosomial treatment in 2008 and 2009 were the costs for hospital acquired pneumonia (HAP) and VAP, 16.8 and 17.5 million Baht [9]. Melsen et al performed a meta-analysis and suggested that overall attributable mortality in mechanical ventilator patients from VAP was 13% [10]
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