Independent Risk Factors For Ventilator-associated Pneumonia Research Articles

Risk factors and clinical outcomes of ventilator associated pneumonia in neonates in the Neonatal Intensive Care Unit of Dr. Soetomo Hospital Surabaya

Link of Video Abstract: https://youtu.be/Si_Vw_cWchk Introduction: Ventilator-associated pneumonia (VAP) is a hospital-acquired infection in mechanical ventilation for more than two consecutive days, resulting in increased mortality and treatment costs. This study aimed to analyse the risk factors and clinical outcomes of neonatal with ventilator associated pneumonia in the neonatal intensive care unit (NICU). Methods: A case-control study was conducted on neonates who had mechanical ventilators installed for more than two consecutive days, from January 2020 to December 2021, at Dr. Soetomo Hospital, Surabaya. The risk factors studied were duration of stay in the NICU, reintubation, duration of ventilation before VAP, rate of prematurity, low birth weight, enteral feeding, and underlying disease. The clinical outcomes studied were the duration of hospital stay and the total ventilation duration. Results: The study subjects were 135 neonates consisting of 45 cases of VAP and 90 non-VAP. Significant risk factors were duration of NICU stay (p<0.001), duration of ventilation before VAP (p=0.002), and rate of prematurity (p=0.024). Multivariate analysis found no independent risk factors for VAP. Hospital stay duration (p<0.001) and ventilation duration were significantly correlated with the incidence of VAP (p<0.001). Conclusion: Risk factors for neonatal VAP were the duration of NICU stay, duration of ventilation prior to VAP occurrence, and degree of prematurity. The impact of VAP was longer duration of hospitalisation and duration of ventilation.

Construction and Validation of a Predictive Model for the Risk of Ventilator-Associated Pneumonia in Elderly ICU Patients.

Ventilator-associated pneumonia (VAP) is among the most important hospital-acquired infections in an intensive-care unit setting. However, clinical practice lacks effective theoretical tools for preventing VAP in the elderly. To describe the independent factors associated with VAP in elderly intensive-care unit (ICU) patients on mechanical ventilation (MV) and to construct a risk prediction model. A total of 1851 elderly patients with MV in ICUs from January 2015 to September 2019 were selected from 12 tertiary hospitals. Study subjects were divided into a model group (n = 1219) and a validation group (n = 632). Two groups of patients were divided into a VAP group and a non-VAP group and compared. Univariate and logistic regression analyses were used to explore influencing factors for VAP in elderly ICU patients with MV, establish a risk prediction model, and draw a nomogram. We used the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test to evaluate the predictive effect of the model. Findings regarding the length of ICU stay, surgery, C-reactive protein (CRP), and the number of reintubations were independent risk factors for VAP in elderly ICU patients with MV. Predictive-model verification results showed that the area under the curve (AUC) of VAP risk after MV in the modeling and verification groups was 0.859 and 0.813 (P < 0.001), respectively, while P values for the Hosmer-Lemeshow test in these two groups were 0.365 and 0.485, respectively. The model could effectively predict the occurrence of VAP in elderly patients with MV in ICUs. This study is a retrospective study, so it has not been registered as a clinical study.

Comparison of Ventilator-Associated Pneumonia and Surgical Site Infection between Two Methods of Tracheostomy.

Objective To compare the incidence of ventilator-associated pneumonia (VAP) and surgical site infection (SSI) between percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST). Methods Data on 487 patients undergoing tracheostomy between 1st January 2014 and 30th September 2020 were reviewed. Patients were divided according to the surgical techniques. Clinical characteristics and postoperative care were compared to explore the risk factors for SSI and VAP. All tracheostomies were performed by intensivists who had completed at least ten tracheostomies. ST was performed using standard techniques. PDT was performed according to a modification technique described by Ciaglia. All procedures were performed at the bedside in the ICU. Results Of all, 344 patients (70.6%) were men and 143 (29.4%) were women, and the mean age was 56 years (standard derivation [SD] 12 years). Two hundred and sixty-six patients (54.6%) received PDT, and 221 (45.4%) received SY. Patients in the PDT group had a significantly lower rate of SSI (3.4% vs. 8.5%, P = 0.01) compared with the ST group. Multivariate analysis revealed that comorbidities (P = 0.003), surgical type (P = 0.01), and cluster nursing (P < 0.001) were independent risk factors for SSI; age (P = 0.005), comorbidities (P < 0.001), smoking (P = 0.008), and cluster nursing (P = 0.01) were independent risk factors for VAP. Conclusion PDT significantly reduces the risk of SSI. Proper care should be administrated in patients with one or more risk factors of SSI or VAP to prevent the occurrence of complications.

Ventilator-Associated Pneumonia in Neonates Admitted to a Tertiary Care NICU in Bulgaria.

Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection (HAI) among neonatal patients in the intensive care units (ICUs) and is a serious challenge for neonatologists because it affects critically ill patients who need prolonged mechanical ventilation. In Bulgaria, there is no detailed data at regional and national levels on the characteristics of VAP in newborns, which imposes a necessity for specific studies of risk factors and etiology of VAP. The aim of the study was to analyze the frequency, characteristics and risk factors for the occurrence of VAP in newborns hospitalized in intensive care unit. This was a prospective study, conducted between January 2017 and June 2018 in the NICU of University Hospital “St. George” Plovdiv, Bulgaria. The sample consisted of 507 neonates, followed up prospectively, 107 of whom were placed on mechanical ventilation for ≥48 h. VAP was diagnosed in 33 out of 107 neonates (31%). The VAP incidence rate was 35.06/1.000 ventilator days. We confirmed differences between the median birth weight (1,310 vs. 1,690 g, p = 0.045) and average gestational age (31.08 g.w. vs. 33.08 g.w, p = 0.04) of the patients with and without VAP. The average stay of patients with VAP in the NICU was statistically significantly longer than the hospital stay of non-VAP patients (35.70 ± 21.84 days vs. 21.77 ± 17.27 days (t = 3.241, p = 0.002). In neonates with VAP, the duration of mechanical ventilation was statistically significantly longer compared with non-VAP patients (16.88 ± 11.99 vs. 5.42 ± 4.48; t = 5.249, p = 0.000). A statistically significant prevalence of Gram-negative bacteria among VAP patients was demonstrated (91%) compared to the Gram-positive (9%), p < 0.05. The leading causative agent of VAP was Klebsiella pneumoniae ESBLs + (27%), followed by Acinetobacter baumannii (14%), Pseudomonas aeruginosa (12%) and Escherichia coli (12%). In multivariate logistic regression, mechanical ventilation >7 days was established as an independent risk factor for VAP (OR 3.6; 95% CI: 1.7–6.5, p = 0.003). VAP remains a serious and outstanding issue in pediatric and neonatal intensive care units. The findings of the current study emphasize that the birth weight, gestational age, and duration of hospital stay have a significant association with ventilator-associated pneumonia.

RISK score for developing ventilator‐associated pneumonia in children: The RISVAP study

Ventilator-associated pneumonia (VAP) is the second most common healthcare-associated infection in children. The aim of this study was to determine the risk factors for VAP in children and to create a risk score for developing VAP (RISVAP score). It was a prospective observational study, including children who required mechanical ventilation (MV), registered in the multicentre ENVIN-HELICS database from 2014 to 2019.The regression coefficients of each independent risk factor for VAP were used to create the RISVAP score. Each factor scored 0 if it was absent, or, if it was present, an assigned value from 1 to 7, according to the regression coefficient. A total of 3798 patients were included, 97(2.5%) developing VAP. The independent risk factors for VAP were: female (odds ratio[OR]: 1.642, p = 0.024), MV > 4 days (OR: 26.79, p < 0.001), length in pediatric intensive care unit > 7 days (OR: 11.74, p < 0.001), and previous colonisation (OR: 4.18, p < 0.001).The RISVAP was calculated for each patient as the sum of all the independent risk factors. Three risk groups were obtained: low (0-5 points), intermediate (6-12 points), and high risk for VAP (13-16 points). The area under the curve for the final score was 0.905 (95%confidence interval:0.888-0.923, p < 0.001). The RISVAP is the first risk score for VAP in pediatric populations. Using this predictive score, might be helpful to detect vulnerable patients and therefore implement preventative strategies.

Risk Factors and Nursing Countermeasures of Ventilator-Associated Pneumonia in Children in the Intensive Care Unit.

Objective This study discussed and analyzed the risk factors and nursing countermeasures of ventilator-associated pneumonia (VAP) in the children intensive care unit (ICU). Methods In this study, 155 children with mechanical ventilation in the pediatric intensive care unit from Oct. 2018 to Oct. 2020 were chosen as research objects. We retrospectively analyzed the clinical data of children and divided them into VAP groups and non-VAP groups according to the occurrence of VAP. Subsequently, we adopted a univariate and multivariate logistic regression model to analyze and clarify the risk factors of VAP and formulated the corresponding nursing countermeasures. Results 49 cases of total research objects had occurred VAP, with an infection rate of 31.62%. The primary pathogenic bacteria were Gram-negative bacteria (43/70, 61.43%). According to multivariate logistic regression analysis, the duration of mechanical ventilation, invasive procedures, and application of hormones and antacids are all independent risk factors for VAP in pediatric ICU. The VPA group had longer hospital stay than the non-VAP group, and the difference was statistically significant ((20.92 ± 4.16)d, (15.24 ± 3.77)d, t = 8.4383, P ≤ 0.001). The hospitalization cost of the VPA group was substantially higher than that of the non-VAP Group ((45.8 ± 10.4) thousand Yuan, (33.2 ± 4.3) thousand Yuan, t = 10.6822, P ≤ 0.001). Conclusion Children admitted to the pediatric ICU have a high VAP incidence. The primary pathogenic bacteria are Gram-negative bacteria. As the occurrence of VAP is closely related to a variety of factors, we should take targeted nursing countermeasures to reduce the duration of mechanical ventilation and the frequency of invasive operations and use the hormone and antacids rationally to reduce the risk of VAP and improve the prognosis.

A Ventilator-associated Pneumonia Prediction Model in Patients With Acute Respiratory Distress Syndrome.

Mechanical ventilation is crucial for acute respiratory distress syndrome (ARDS) patients and diagnosis of ventilator-associated pneumonia (VAP) in ARDS patients is challenging. Hence, an effective model to predict VAP in ARDS is urgently needed. We performed a secondary analysis of patient-level data from the Early versus Delayed Enteral Nutrition (EDEN) of ARDSNet randomized controlled trials. Multivariate binary logistic regression analysis established a predictive model, incorporating characteristics selected by systematic review and univariate analyses. The model's discrimination, calibration, and clinical usefulness were assessed using the C-index, calibration plot, and decision curve analysis (DCA). Of the 1000 unique patients enrolled in the EDEN trials, 70 (7%) had ARDS complicated with VAP. Mechanical ventilation duration and intensive care unit (ICU) stay were significantly longer in the VAP group than non-VAP group (P < .001 for both) but the 60-day mortality was comparable. Use of neuromuscular blocking agents, severe ARDS, admission for unscheduled surgery, and trauma as primary ARDS causes were independent risk factors for VAP. The area under the curve of the model was .744, and model fit was acceptable (Hosmer-Lemeshow P = .185). The calibration curve indicated that the model had proper discrimination and good calibration. DCA showed that the VAP prediction nomogram was clinically useful when an intervention was decided at a VAP probability threshold between 1% and 61%. The prediction nomogram for VAP development in ARDS patients can be applied after ICU admission, using available variables. Potential clinical benefits of using this model deserve further assessment.

Assessment of the sedative effects of dexmedetomidine and propofol treatment in patients undergoing mechanical ventilation in the ICU and relationship between treatment and occurrence of ventilator-associated pneumonia and detection of pathogenic bacteria.

The present study aimed to investigate the sedative effects of dexmedetomidine combined with propofol in patients undergoing mechanical ventilation in the intensive care unit (ICU), and to reveal the risk factors of ventilator-associated pneumonia (VAP). A retrospective analysis of 322 patients who had been subject to mechanical ventilation in the ICU ward was performed. Subjects were divided into two groups: A group treated with dexmedetomidine and propofol (combined group) and a group treated with dexmedetomidine alone (monotherapy group). Clinical data, sedative effects, the number of VAP patients and the distribution of VAP pathogens were assessed. Multivariate analysis and receiver operating characteristic (ROC) curves were used to predict VAP. Significant differences in the sedative effects between the two groups were observed (P<0.001). The incidence of VAP was significantly higher in the monotherapy group compared with the combined group (P<0.05). Multivariate logistic regression analysis demonstrated that age, acute physiology chronic health evaluation score, consciousness, invasive operations, recovery time, extubation time and sedation regimen were independent risk factors for VAP in the ICU during mechanical ventilation. ROC curves indicated that the areas under the curve for age, acute physiology chronic health score, consciousness, invasive operations, recovery time, extubation time and sedation regimen were 0.934, 0.870, 0.632, 0.677, 0.865, 0.950 and 0.603, respectively. In summary, dexmedetomidine combined with propofol can shorten the recovery and extubation times of mechanical ventilation patients in the ICU. Different sedation schemes are also independent risk factors for VAP during mechanical ventilation in the ICU.

Risk factors for ventilator-associated pneumonia following cardiac surgery

Ventilator-associated pneumonia (VAP) following cardiac surgery is a preventable complication associated with adverse outcomes. We aimed to assess risk factors and outcomes of VAP following cardiac surgery. A matched 1:3 case:control study, including adult patients undergoing cardiac surgery through sternotomy between Sep-2014 to Mar-2017 was conducted in a tertiary-care hospital in Israel. Cases included all patients developing VAP within 30 days after surgery, defined using consensus criteria. Controls were matched for age, gender and surgery type. Operative data were collected prospectively, other data were collected retrospectively. Cox regression was used for adjusted analysis of matched data. Out of 946 operated patients, we identified 57 patients with VAP after cardiac surgery (17.7 episodes per 1000 ventilator-days) matched to 149 controls. Significant independent risk factors for VAP included congestive heart failure (OR 2.357 95%CI 1.052-5.281), Chest re-exploration in ICU (OR 10.213 95%CI: 2.235-46.678), preoperative glucose levels (OR 1.1010 per 1 mg/dl increase 95%CI: 1.004-1.019) intraoperative red blood cell transfusions (OR 1.542 per 1 unit 95%CI: 1.109-2.094) and pulmonary hypertension (OR 2.261 95%CI 1.048-6.554). VAP was most commonly caused by Gram-negative pathogens. VAP was associated with higher mortality, longer length of stay, longer need for ventilator support and longer stay in ICU setting. Postoperative VAP in cardiac surgery patients is associated with severe clinical outcomes. We identified risk factors that can aid in preventive measures implementation for high risk patients.

Analysis of high risk factors and prognosis of patients with ventilator associated pneumonia treated with mechanical ventilation in ICU

Objective To analyze the high risk factors and prognosis of patients with ventilator associated pneumonia(VAP) treated with mechanical ventilation(MV) in Intensive Care Unit(ICU), and to provide theoretical evidence for effective treatment and prevention. Methods From January 2015 to January 2017, 156 MV patients treated in ICU of Shaoxing Municipal Hospital were enrolled retrospectively.According to the occurrence of VAP, the patients were divided into VAP group(76 cases) and non-VAP group(80 cases). The data including sex, age, ICU time, MV time, cases of withdrawing machine failure, prognosis, serum albumin, blood glucose levels, APACHE Ⅱ score, types of antibiotics and days of continuous applying were recorded.Single factor χ2 test and multiple factor logistic regression analysis were used to analyze the high-risk factors and prognosis related to occurrence of VAP. Results Univariate analysis showed that the age, mortality, serum albumin and blood glucose levels, MV time, weaning failure rate, APACHE Ⅱ score, antibiotic combination type and days of continuous use, application of H2 receptor antagonists time between, the VAP group and non-VAP group had statistically significant differences (χ2=6.568, 16.558, 5.132, 5.896, 27.043, 15.018, 48.863, 46.752, 27.431, 3.981, P=0.010, 0.000, 0.023, 0.015, 0.000, 0.000, 0.000, 0.000, 0.000, 0.046). After age adjustment, logistic regression analysis showed that serum albumin 5 days, APACHE Ⅱ score>15 points, antibiotics continuous use>3 days, and antibiotic combination type>2 were independent risk factors for VAP(χ2=5.115, 5.984, 21.252, 18.043, 9.008, 14.545, P=0.030, 0.026, 0.000, 0.000, 0.007, 0.001). Compared with surviving patients with VAP, death patients lived longer in ICU and MV, and APACHE Ⅱ scores were higher(t=4.136, 6.382, 7.312, P=0.000, 0.000, 0.000). Conclusion There are multiple high-risk factors of VAP in patients treated with MV in ICU.The death demonstrated longer ICU time, MV time and higher APACHE Ⅱ score, need to be strengthened monitoring, early prevention and treatment. Key words: Pneumonia, ventilator-associated; Respiration, artificial; Risk factor; Prognosis; Intensive care units; Universal precautions; Glucocorticoids; Anti-bacterial agents; Albumin

Ventilator-associated pneumonia: incidence and risk factors in the paediatric intensive care unit

Background Ventilator-associated pneumonia (VAP) is one of the endless research topics that is always under focus, as it represents a major problem in the medical and surgical ICUs, especially with the growing problem of continuous settlement of resistant bacterial strains that influence all prevention bundles. Objective The aim of this study was to update the incidence, risk factors, and outcome of VAP in PICU. Patients and methods This prospective observational study was conducted on 300 cases admitted to the PICU in Zagazig University Hospitals, Egypt. All children were radiologically free means have no abnormal lung aeration findings. And connected to mechanical ventilation due to non-pulmonary cause. Follow-up of the cases was scheduled, and radiological, clinical and laboratory data were obtained throughout their ICU stay and according to their days of MV. Results The incidence of VAP was 37.56 per 1000 ventilation days of PICU patients. The commonest significant risk factors for VAP among the studied group were reintubation [relative risk (RR)=1.53; 95% confidence interval (CI): 1.01–32.24], exposure to sedation (RR=8.13; 95% CI: 2.05–32.24), rate of suction greater than or equal to 3 h interval (RR=2.72; 95% CI: 1.62–4.54), recumbent position (RR=2.69; 95% CI: 1.54–4.71), interval of oral hygiene (RR=1.84; 95% CI: 1.21–2.8), and ineffective hand hygiene (RR=1.51; 95% CI: 1.01–2.5). Multivariate regression analysis revealed that reintubation, rate of oral hygiene greater than 3 h, and duration of MV greater than 7 days are independent risk factors for VAP. Moreover, there was a nonsignificant relation between presence of VAP and mortality among studied patients. Conclusions The main risk factors for VAP are reintubation, longevity of MV, and the rate of oral hygiene. Close monitoring and training of all ICU staff is recommended.

Pre-intensive care unit intubation and subsequent delayed intensive care unit admission is independently associated with increased occurrence of ventilator-associated pneumonia.

Critically ill intubated patients are at risk for ventilator-associated pneumonia. However, intubation may not occur in intensive care unit (ICU) and subsequent ICU admission may be delayed. To evaluate whether intubation >24 h prior ICU admission and delay in ICU admission is associated with ventilator-associated pneumonia (VAP) in non-trauma critically ill patients. Prospective observational study conducted in a medical-surgical ICU of a tertiary hospital. Consecutive patients with >48 h of invasive mechanical ventilation and >72 h hospitalization, were recruited in the study. Pre-ICU intubation and delay in ICU admission, demographical, clinical, microbiological data and ICU interventions were assessed as risk factors for VAP and ICU mortality. 100 patients were included in the study. Pre-ICU intubation and delayed (>24 h) ICU admission (PDA patients) (P=0.014, OR=3.294, confidence interval 1.268-8.557) and SOFA score on ICU admission (P=0.045, OR=1.154, confidence interval 1.003-1.328) were independent risk factors for VAP in ICU care setting. Yet, PDA patients, presented significantly increased incidence of VAP due to MDR bacteria, mainly from Acinetobacter baumannii. Acinetobacter baumannii infection was the only independent risk factor for ICU mortality (P=0.049, OR=3.253, confidence interval 1.006-10.521). SOFA score on ICU admission, presented a fair prognostic accuracy of overall ICU mortality (SOFA≥8.5, AUC=0.850, P<0.001). Pre-ICU intubation and delayed ICU admission was independent risk factor for VAP Acinetobacter baumannii infection and a high SOFA score on ICU admission were predictors of increased ICU mortality.

Bacteriological profile of ventilator-associated pneumonia in a tertiary care hospital

Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection. The etiology of VAP and their antimicrobial susceptibility pattern varies with different patient populations and types of ICUs. An observational cross-sectional study was performed over a period of 2 years in a tertiary care hospital to determine the various etiological agents causing VAP and to detect the presence of multidrug-resistant (MDR) pathogens in these VAP patients. Combination disk method, Modified Hodge test, ethylenediaminetetraacetic acid disk synergy test, and AmpC disk test were performed for the detection of extended-spectrum beta-lactamase (ESBL), carbapenemases, metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. The prevalence of VAP was 35%. Enterobacteriaceae (66.66%) and Staphylococcus aureus (20%) were common in early-onset VAP, while nonfermenters (50%) and Enterobacteriaceae (40.61%) were predominant from late-onset VAP. Nearly 60.87% of the bacterial pathogens were MDR. ESBL was produced by 21.74% of Enterobacteriaceae. AmpC β-lactamase was positive in 35.29% nonfermenters and 26.08% Enterobacteriaceae. MBL was positive in 17.64% nonfermenters and 17.39% Enterobacteriaceae. Among the S. aureus isolates, 75% were cefoxitin resistant. Prior antibiotic therapy (P = 0.001) and hospitalization of 5 days or more (P = 0.001) were independent risk factors for VAP by MDR pathogens. polymyxin B, tigecycline, and vancomycin were the most sensitive drugs for Gram-negative and positive isolates respectively from VAP. SPSS for Windows Version SPSS 17.0 (SPSS Inc., Chicago, IL, USA) and Chi-square with Yates correction. Late-onset VAP is increasingly associated with MDR pathogens. Treatment with polymyxin B, tigecycline, and vancomycin should be kept as last-line reserve drugs against most of the MDR pathogens.

Relationship between hyperoxemia and ventilator associated pneumonia.

Previous studies suggest a relationship between hyperoxemia and ventilator-associated pneumonia (VAP). Hyperoxemia is responsible for denitrogenation phenomena, and inhibition of surfactant production, promoting atelectasis in mechanically ventilated patients. Further, hyperoxemia impairs the efficacy of alveolar macrophages to migrate, phagocyte and kill bacteria. Oxygen can also cause pulmonary-specific toxic effect called hyperoxic acute lung injury leading to longer duration of mechanical ventilation. All these hyperoxic effects are well-known risk factors for VAP. A recent retrospective large single center study identified hyperoxemia as an independent risk factor for VAP. However, two recent randomized controlled trials evaluated the impact of conservative oxygen strategy versus a liberal strategy, but did not confirm the role of hyperoxemia in lower respiratory tract infection occurrence. In this review, we discuss animal and human studies suggesting a relationship between these two common conditions in mechanically ventilated patients and potential interventions that should be evaluated. Further large prospective studies in carefully selected groups of patients are required to confirm the potential role of hyperoxemia in VAP pathogenesis and to evaluate the impact of a conservative oxygen strategy vs. a conventional strategy on the incidence of VAP.

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures.

BackgroundVentilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures.MethodsWe retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score.ResultsForty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029).ConclusionSevere pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

Risk factors for ventilator-associated pneumonia among patients undergoing major oncological surgery for head and neck cancer.

Patients undergoing major oncological surgery for head and neck cancer (SHNC) have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia (VAP) in patients undergoing SHNC. The study included 465 patients who underwent SHNC between June 2011 and June 2014. The rate of VAP, risk factors for VAP, and biological aspects of VAP were retrospectively evaluated. The incidence of VAP was 19.6% (n = 95) in patients who required more than 48 h of mechanical ventilation. Staphylococcus (37.7%), Enterobacteriaceae (32.1%), Pseudomonas (20.8%), and Haemophilus (16.9%) were the major bacterial species that caused VAP. The independent risk factors for VAP were advanced age, current smoking status, chronic obstructive pulmonary disease, and a higher simplified acute physiology score system II upon admission. Tracheostomy was an independent protective factor for VAP. The median length of stay in the ICU for patients who did or did not develop VAP was 8.0 and 6.5 days, respectively (P = 0.006). Mortality among patients who did or did not develop VAP was 16.8% and 8.4%, respectively (P < 0.001). The potential economic impact of VAP was high because of the significantly extended duration of ventilation. A predictive regression model was developed with a sensitivity of 95.3% and a specificity of 69.4%. VAP is common in patients who are undergoing SHNC and who require more than 48 h of mechanical ventilation. Therefore, innovative preventive measures should be developed and applied in this high-risk population.

Ventilator Associated Pneumonia a challenge in intensive care unit acquired infection

Background: Ventilator-Associated Pneumonia (VAP) is one of the frequent intensive-care-unit (ICU)-acquired infection. The aetiology of VAP varies with patients’ profiles and ICU settings. Due to the increasing incidence of multidrug-resistant organisms in ICUs, early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment. The aim of the study was to assess the incidence of VAP in different patients by various organisms to create a database of the causative agents of VAP, their drug resistance profile in that area.Methodology: A prospective study was done over a period of 12 months in a rural tertiary care hospital enrolling patients undergoing mechanical ventilation (MV) for &gt;48 h. Samples were collected from patients with suspected VAP, cultures were performed on all samples. VAP was diagnosed by the growth of significant pathogens. Combination disk method, EDTA disk synergy (EDS) test and cefoxitin double disc synergy test were performed for the detection of different patterns of drug resistance.Results: Culture positive cases were 52.29% of total. Acinetobacter spp, Klebsiella pneumoniae and Staphylococcus aureus were most frequent pathogen in early-onset VAP, while Pseudomonas spp. and Acinetobacter spp. dominated the list of pathogens responsible for lateonset VAP. Prior antibiotic therapy and hospitalization of five days or more were independent risk factors for VAP by MDR pathogens.Conclusions: This study highlighted high incidence of VAP in our setup. Production of ESBL, AmpC beta-lactamases and metallo beta-lactamases were responsible for the multi-drug resistance of the pathogens causing VAP, implicating the injudicious use of antimicrobial therapy. Combined approaches of rotational antibiotic therapy and education programs might be beneficial to fight against these MDR pathogens to decrease the incidence of VAP.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.588-595

Hyperoxemia as a risk factor for ventilator-associated pneumonia

BackgroundConsequences of hyperoxemia, such as acute lung injury, atelectasis, and reduced bacterial clearance, might promote ventilator-associated pneumonia (VAP). The aim of our study was to determine the relationship between hyperoxemia and VAP.MethodsThis retrospective observational study was performed in a 30-bed mixed ICU. All patients receiving invasive mechanical ventilation for more than 48 hours were eligible. VAP was defined using clinical, radiologic, and quantitative microbiological criteria. Hyperoxemia was defined as PaO2 > 120 mmHg. All data, except those related to hyperoxemia, were prospectively collected. Risk factors for VAP were determined using univariate and multivariate analysis.ResultsVAP was diagnosed in 141 of the 503 enrolled patients (28 %). The incidence rate of VAP was 14.7 per 1000 ventilator days. Hyperoxemia at intensive care unit admission (67 % vs 53 %, OR = 1.8, 95 % CI (1.2, 29), p <0.05) and number of days spent with hyperoxemia were significantly more frequent in patients with VAP, compared with those with no VAP. Multivariate analysis identified number of days spent with hyperoxemia (OR = 1.1, 95 % CI (1.04, 1.2) per day, p = 0.004), simplified acute physiology score (SAPS) II (OR = 1.01, 95 % CI (1.002, 1.024) per point, p < 0 .05), red blood cell transfusion (OR = 1.8, 95 % CI (1.2, 2.7), p = 0.01), and proton pomp inhibitor use (OR = 1.9, 95 % CI (1.03, 1.2), p < 0.05) as independent risk factors for VAP. Other multiple regression models also identified hyperoxemia at ICU admission (OR = 1.89, 95 % CI (1.23, 2.89), p = 0.004), and percentage of days with hyperoxemia (OR = 2.2, 95 % CI (1.08, 4.48), p = 0.029) as independent risk factors for VAP.ConclusionHyperoxemia is independently associated with VAP. Further studies are required to confirm our results.

Central Nervous System Depressants Poisoning and Ventilator Associated Pneumonia: An Underrated Risk Factor at the Toxicological Intensive Care Unit.

Background:Ventilator-Associated Pneumonia (VAP) is the main cause of nosocomial infection at intensive care units (ICUs), which causes high mortality and morbidity.Objectives:The objective of the present survey was to identify the VAP risk and prognostic factors among poisoned patients, who were admitted to the toxicological ICU (TICU), especially central nervous system (CNS) depressants due to their prevalence and importance.Patients and Methods:A case-control study was conducted at the Loghman Hakim hospital between March 2013 and March 2014. Among 300 poisoned patients with mechanical ventilator ≥ 48 hours, 150 patients, who had developed microbiologically-confirmed VAP were considered as the VAP group and 150 without VAP were defined as the control group. The following data were collected; age, gender, type of poisoning, glasgow coma score, Acute physiology and chronic health evaluation (APACHE) II score, length of hospital stay, previous antibiotic use, microbial culture of the trachea, body temperature, leukocyte count, and patients’ outcome. Based on the type of poisoning, patients were divided into three groups including: opioid, CNS depressants and others. All data were expressed as means (SD) for continuous variables and frequencies for categorical variables. Logistic regression was used to determine the relationship between risk factors and VAP.Results:The mean age of the patients was 33.9 ± 14.3 years. The probable VAP incidence and mortality were 22% and 18.6%, respectively. The rate of CNS depressant versus opioid use (odds ratio, 3.74; P < 0.027), APACHE II (odds ratio, 1.28; P < 0.000) and length of hospital stay (odds ratio, 2.15; P < 0.000) were the independent risk factors for VAP. While, the APACHE II score (odds ratio, 1.12; P < 0.044) and length of hospital stay (odds ratio, 2.15; P < 0.000) were the independent predictors of VAP mortality among these patients. The most common microorganisms in VAP cases were Methicillin-Resistant Staphylococcus aureus (MRSA) and Acinetobacter sp. (56.7% and 12.7%, respectively).Conclusions:Central nervous system depressant was an important risk factor for VAP among poisoned patients. Hypoventilation due to CNS depression can lead to VAP. The APACHE II and length of hospital stay were shown as independent predictors of VAP and mortality among these patients.

Ventilator associated pneumonia in intensive care unit of a secondary care industrial hospital

Abstract Aims and objectives To study incidence, etiology, risk factors, and outcome of ventilator-associated pneumonia (VAP). Study design Cross-sectional study using data from intensive care unit (ICU) inpatients database. Patients 913 patients admitted to our ICU between April 2010 and April 2011. Methods All ICU patients requiring mechanical ventilation for more than 48 h formed the study group. We used clinical pulmonary infection score of more than 6 to diagnose VAP. Statistical analysis was done with SPSS version 16. Tests used were descriptive statistics, Student's t -test, and chi-square test. Results Out of 240 patients fulfilling the study criteria, VAP developed in 36 patients i.e. 15%. Identified independent risk factors for VAP were male sex and medical illness as admission diagnosis. In contrast to other studies, Klebsiella pneumoniae was the most common causative agent (52.4%) in our study. Patients with COPD (23 out of 36 i.e. 63.9% vs. 13 out of 36 i.e. 36.1%) ( p value 0.006) and diabetes (22 out of 36 i.e. 61.1% vs. 14 out of 36 i.e. 38.9%, with p value of 0.001) had higher incidence of VAP as compared to non-COPD and non-diabetic patients. VAP was associated with increased mean hospital expenses of Rs. 34,415 INR (104,380 ± 42,931 vs. 69,965 ± 15,325, p value of 0.001) compared to patients who did not develop VAP. VAP was also associated with higher mortality (20 out of 36 i.e. 55% vs. 71 out of 204 i.e. 34% with p value of 0.025) in ICU patients. Conclusion VAP is responsible for increased hospital mortality and healthcare expenses to the patients. Male patients and those with COPD and diabetes are at higher risk of developing VAP. Hence judicious use of assisted invasive ventilation and implementation of preventive strategies is of immense importance to reduce the incidence of VAP, especially in high risk patients.