Ventilator-associated Pneumonia Mortality Research Articles

Association of antibiotic duration and all-cause mortality in a prospective study of patients with ventilator-associated pneumonia in a tertiary-level critical care unit in Southern India

ObjectivesTo estimate all-cause mortality in ventilator-associated pneumonia (VAP) and determine whether antibiotic duration beyond 8 days is associated with reduction in all-cause mortality in patients admitted with VAP in the...

Association of mean RDW values and changes in RDW with in-hospital mortality in ventilator-associated pneumonia (VAP): Evidence from MIMIC-IV database.

Ventilator-associated pneumonia (VAP) is a hospital-acquired infection with high mortality, and remains a challenge for clinical treatment. Red blood cell distribution width (RDW) was associated with worse outcomes in several diseases. The purpose of this study was to investigate the relationship between mean RDW values, changes in RDW (delta RDW), and in-hospital mortality among patients with VAP. In the present study, we enrolled 1266 VAP patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. All patients were categorized into low group, medium group, and high group according to tertiles of mean RDW values. The primary outcome was all-cause in-hospital mortality. Univariate logistic regression analysis, multivariate logistic regression analysis, and restricted cubic spline (RCS) curve were performed to determine the association between mean RDW values and in-hospital mortality in VAP. Moreover, RCS curve was plotted to explore the dose-response relationship between delta RDW and in-hospital mortality in VAP. Among the VAP patients included in the study, the in-hospital mortality was 20.85% with 264 non-survivors and 1002 survivors. The non-survivors exhibited significantly higher mean RDW values and delta RDW values compared to survivors. Multivariate logistic regression analysis indicated that mean RDW values were positively associated with in-hospital mortality in VAP after adjusting for relevant covariates. The RCS curve demonstrated a dose-response relationship between mean RDW and the mortality in VAP. Moreover, a linear relationship was observed between delta RDW and in-hospital mortality in VAP. Higher mean RDW values were significantly associated with an increased risk of in-hospital mortality in VAP. Additionally, a linear relationship was found between delta RDW values and in-hospital mortality. These findings suggest that RDW can be used to identify high-risk patients with poorer outcomes in VAP.

Timing of Ventilator Circuit Tubing Replacement


 In adult patients with mechanical ventilation, more frequent ventilator circuit tubing replacement may increase the odds of ventilator-associated pneumonia, but the findings are imprecise.
 In pediatric patients with mechanical ventilation, more frequent and less frequent intervals of ventilator circuit tubing replacement may result in a similar risk of ventilator-associated pneumonia, all-cause mortality, and ventilator-associated pneumonia mortality, and similar durations of mechanical ventilation and hospital stay.
 For preterm neonates, children, and adult patients, it is recommended to replace the ventilator circuit tubing if it is visibly soiled, not functioning properly, or as recommended in the manufacturer's instructions.
 We did not find any guidelines about fixed versus nonfixed ventilator circuit tubing replacement.

Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy.

Ventilator-associated pneumonia (VAP) is a serious intensive care unit (ICU)-related infection in mechanically ventilated patients that is frequent, as more than half of antibiotics prescriptions in ICU are due to VAP. Various risk factors and diagnostic criteria for VAP have been referred to in different settings. The estimated attributable mortality of VAP can go up to 50%, which is higher in cases of antimicrobial-resistant VAP. When the diagnosis of pneumonia in a mechanically ventilated patient is made, initiation of effective antimicrobial therapy must be prompt. Microbiological diagnosis of VAP is required to optimize timely therapy since effective early treatment is fundamental for better outcomes, with controversy continuing regarding optimal sampling and testing. Understanding the role of antimicrobial resistance in the context of VAP is crucial in the era of continuously evolving antimicrobial-resistant clones that represent an urgent threat to global health. This review is focused on the risk factors for antimicrobial resistance in adult VAP and its novel microbiological tools. It aims to summarize the current evidence-based knowledge about the mechanisms of resistance in VAP caused by multidrug-resistant bacteria in clinical settings with focus on Gram-negative pathogens. It highlights the evidence-based antimicrobial management and prevention of drug-resistant VAP. It also addresses emerging concepts related to predictive microbiology in VAP and sheds lights on VAP in the context of coronavirus disease 2019 (COVID-19).

Ventilator-Associated Pneumonia in Paediatric Intensive Care Unit Patients: Microbiological Profile, Risk Factors, and Outcome.

Introduction Ventilator-associated pneumonia (VAP) is one of the dreaded events in sick children who are ventilated in the paediatric intensive care unit (PICU) and has a high mortality rate. So, there is a need to know the causative organisms, risk factors, and possible predictors in a particular PICU for prevention, early identification, and treatment to decrease morbidity and mortality. This study was planned with the objectives to determine the microbiological profile, associated risk factors, and outcome of VAP in children. Methods In this observational cross-sectional study conducted at Dr.B C Roy Post Graduate Instituteof Paediatric Science, Kolkata, India, 37 VAP cases were diagnosed using clinical pulmonary infection score >6 and confirmed by tracheal culture and X-ray. Results The number of paediatric patients suffering from VAP was 37 (36.2%).The commonest age group involvement was one to five years. The microbiological profile included Pseudomonas aeruginosa (29.8%) and Klebsiellapneumoniae (21.6%) as the commonest organisms followed by Staphylococcus aureus (18.9%) and Acinetobacter (13.5%). The factors significantly associated with the increased frequency of VAP were the use of steroids, sedation, and reintubation. The mean duration of mechanical ventilation (MV) in VAP was 15 days compared to non-VAP (seven days), and the longer duration of ventilation was significantly associated with VAP (p=0.00001). Mortality in VAP was 48.54% compared to non-VAP (55.84%) with no significant association (p=0.0843) of VAP with death occurrence. Conclusion The present study showed that VAP occurrence isassociated with prolonged duration of MV, PICU stay, and hospital stay but is not significantly associated with mortality. It also indicated that gram-negative bacteria were the most common VAP causative organisms in this cohort.

Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study.

We aimed to evaluate ventilator-associated pneumonia (VAP) incidence rate, risk factors, and isolated microorganisms in COVID-19 patients as the primary endpoint. Evaluation of VAP-associated intensive care unit (ICU) and hospital mortalities was the secondary endpoint. Records of patients admitted between March 2020- June 2021 to our pandemic ICU were reviewed and COVID-19 patients with VAP and non-VAP were evaluated retrospectively. Comorbidities, management, length of ICU stay, and outcomes of VAP and non-VAP patients, as well as risk factors for VAP mortality, were identified. During the study period, 254 patients were admitted to the ICU. After the exclusion, the data of 208 patients were reviewed. In total, 121 patients required invasive mechanical ventilation, with 78 (64.5%) developing VAP. Length of ICU and hospital stays were longer in VAP patients (p<0.01 and p<0.01 respectively). Steroid use was higher in VAP patients, although it was not statistically significant (p= 0.06). APACHE II score (p<0.01) was higher in non-VAP patients. ICU mortality was high in both groups (VAP 70%, non-VAP 77%). VAP mortality was higher in males (p= 0.03) and in patients who required renal replacement therapy (p= 0.01). Length of ICU stay (p= 0.04), and length of hospital stay (p<0.01) were both high in VAP survivors. The most common isolated microorganisms were Acinetobacter spp. and Klebsiella spp. in VAP patients and most of them were extensively drug-resistant. Critically ill COVID-19 patients who required invasive mechanical ventilation developed VAP frequently. The length of ICU stay was longer in patients who developed VAP and ICU mortality was high in both VAP and non-VAP patients. The length of hospital and ICU stays among VAP survivors were also considerably high which is probably related to the long recovery period of COVID-19. The most frequently isolated microorganisms were Acinetobacter spp. and Klebsiella spp. in VAP patients.

Multidrug-resistant VAP before and during the COVID-19 pandemic among hospitalized patients in a tertiary private hospital.

There is limited data on ventilator-associated pneumonia (VAP) and multidrug-resistant VAP (MDR VAP) among COVID-19 patients. A retrospective study in a single, tertiary, private hospital in the Philippines was conducted comparing the incidence, profile, and patient outcomes of MDR VAP during the pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods. In total, 80/362 (22%) patients developed VAP, 27/204 (33.75%) from pre-COVID-19 and 53/158 (66.25%) from the COVID-19 period, respectively. The majority were male [20/27 (74%) vs 34/53 (64%)], with a median age of 66 (range 35-90) and 67 (range 32-92) years in each period, respectively. Comorbidities were similar, except cardiovascular disease (14/27 vs 11/53 patients, p-value 0.005) and chronic lung disease (14/27 vs 9/53 patients, p-value 0.0012). VAP incidence density was 19.3/1000 and 27.8/1000 ventilator days (p-value 0.9819)]; median length of stay before VAP for pre- and COVID-19 periods was 17 and 10 days, respectively (p-value <0.0001). Extended-spectrum β lactamase (ESBL)-producing resistance increased significantly [1/27 (3.7%) pre-COVID-19 vs 15/53 (28.3%)]during COVID-19, while Carbapenem-resistant Enterobacteriaceae resistance was higher in the pre-COVID-19 period(15/27 [56%] vs 10/53 [19%]). Mortality was high in both periods at 93% and 83%, respectively. On multivariate analysis, only female gender was associated with MDR VAP in the COVID-19 period (OR =3.47, [CI 1.019, 11.824], p-value < 0.047). The frequency of VAP and MDR VAP increased during the COVID-19 period, despite a shorter duration of hospital stay. The mortality of VAP was extremely high. Factors associated with increased risk of VAP and COVID-19 need to be studied further, and preventive measures should be prioritized.

Risk Factors for 7-Day and 21-Day Mortality in Patients with Ventilator-Associated Pneumonia Caused by Gram-Negative Multidrug Resistant Bacteria

Objective: Incidence of ventilator-associated pneumonia, caused by gram-negative multidrug resistant bacteria, is on the increase and early mortality rate is high.&#x0D; We aimed to investigate the effects of aging, comorbidities, high Charlson comobidity index score, high Acute Physiology and Chronic Health Evaluation II score, leukocytosis, high C-reactive protein level, inappropriate empirical antibiotic therapy and antibiotic resistance on mortality in ventilator-associated pneumonia caused by gram-negative multidrug-resistant bacteria.&#x0D; Methods: The study was planned as a retrospective cohort study. Patients aged 18 years and older who were hospitalized between January 01, 2015, and January 01, 2020, diagnosed with ventilator-associated pneumonia, and had Gram-negative multidrug resistant pathogen was detected in blood and/or bronchoalveolar lavage fluid specimen or quantitative endotracheal aspirate cultures were included in the study.&#x0D; Results: A total of 370 patients were included in the study. Median age of the patients was 74 (19-95) years. Most frequent bacteria was Acinetobacter baumannii (52.4%). Resistance to ceftriaxone, meropenem, and colistin was 99%, 68%, and 4%, respectively. 7-day and 21-day mortality rates were 38.3% (n=142) and 85.1% (n=315). In multivariate analysis, 7-day mortality was associated with a Charlson comorbidity index score of ≥4, and risk factors for 7-day mortality were septic shock, amikacin resistance, and white blood cell count ≥15000/mm3. Advanced age was found to be a risk factor for 21-day mortality, and a high Acute Physiology and Chronic Health Evaluation II score and a high Charlson comorbidity index score were associated with 21-day mortality. It was found that the risk of 7-day mortality in patients with tracheostomy was lower than in patients without tracheostomy.&#x0D; Conclusion:Consideration of clinical scoring systems, closer monitoring of elderly patients, following-up with tracheostomy, may provide a decrease in mortality of ventilator-associated pneumonia, caused by multidrug resistant pathogens.

2170. Association Between End-of-Treatment Procalcitonin Levels with Mortality &amp; Recurrent Ventilator-Associated Pneumonia

Abstract Background In the only randomized controlled trial utilizing procalcitonin in ventilator-associated pneumonia (VAP), 30% of patients failed to normalize procalcitonin levels by the end of treatment, a finding of uncertain clinical importance. The prognostic value of procalcitonin for VAP mortality has been examined only in studies with limited sample sizes and the relationship between end-of-treatment procalcitonin (EOT-P) and VAP recurrence—which affects up to 40% of patients with VAP—has never been examined. We aimed to determine the relationship between VAP EOT-P and recurrent pneumonia or mortality. Methods Retrospective single-center cohort study of hospitalized adult patients between 2013 – 2022 with VAP (defined as use of invasive mechanical ventilation for ≥ 2 days, positive respiratory culture and treatment for ≥ 5 days with pneumonia-specific antibiotics) who had serum procalcitonin levels obtained within 48 of antibiotic completion (AC). Exclusion criteria included death or discharge to hospice within 48 hours of AC. Patients with EOT-P &amp;lt; 0.5 were compared with those with EOT-P ≥ 0.5. The primary outcome was a composite endpoint of recurrent pneumonia (defined as clinical suspicion sufficient to warrant respiratory culture collection) and/or death within 30 days of AC. Results Of 140 included patients, 79 (56.4%) had EOT-P levels &amp;lt; 0.5, and 61 (43.6%) had levels ≥ 0.5. Patients with elevated EOT-P were more likely to have renal disease, longer duration of antibiotic treatment and longer antecedent hospital length of stay than those with non-elevated EOT-P. Demographic characteristics and comorbidities were otherwise similar between groups (Table 1). After multivariable adjustment, patients with elevated EOT-P were significantly more likely to have recurrent pneumonia or death within 30 days (Table 2 and Figure 1, OR 2.39 (95% 1.19-4.80 CI), adjusted OR 2.37 (95% CI 1.09-5.17)). Patient demographics of the study group. "EOT-P" = serum procalcitonin level drawn following completion of antibiotics. Patients with EOT-P &amp;lt;0.5 were compared with those with EOT-P ≥ 0.5. "Immunocompromised" = combination of HIV/AIDS positivity, actively taking immunosuppressive medications, metastatic or hematologic malignancy, history of stem cell transplant, or organ transplantation. Patient outcomes, followed for 30 days following antibiotic completion. The primary endpoint was a composite of death or recurrent pneumonia. The secondary endpoints are death or recurrent pneumonia examined separately. "EOT-P" = serum procalcitonin level drawn following completion of antibiotics. Patients with EOT-P &amp;lt;0.5 were compared with those with EOT-P ≥ 0.5. "VAP" = ventillator-assisted pneumonia. Percentage of patients who survived without recurrence of pneumonia, followed for 30 days following antibiotic completion. "EOT-P" = serum procalcitonin level drawn following completion of antibiotics. Patients with EOT-P &amp;lt;0.5 were compared with those with EOT-P ≥ 0.5. Conclusion Elevated EOT-P in VAP was independently associated with increased VAP recurrence or mortality within 30 days. To our knowledge, this is the largest study to date of the prognostic value of procalcitonin in a ventilator-associated pneumonia cohort. Use of end-of-treatment procalcitonin in VAP may serve as a candidate biomarker to predict VAP recurrence and death. Disclosures Owen Albin, MD, Charles River Laboratory: Advisor/Consultant|Cipla Pharmaceuticals: Advisor/Consultant|Shionogi Inc: Advisor/Consultant.

Ventilator-associated pneumonia: Study of clinical outcome

Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia that develops within 48 hours or more of mechanical ventilation. It is also associated with significant morbidity including increased ventilatory days, intensive care unit (ICU) stay and higher medical cost that leads to high mortality rate in ICU. Aim: To evaluate the clinical outcome of the patients diagnosed with VAP and also to identify the risk factors for VAP. Methodology: This retrospective study included 27 patients admitted in Medical and casualty ICU's from August 2013 to April 2014 who were diagnosed with various diseases and later developed VAP. The patient's demographic data and diagnosis based on Centres for Disease Control and prevention (CDC) criteria were collected. Results: Among 27 patients, 20 were male patients and 7 were female patients. The order of organism according to the frequency in the current study was found to be Acinectobacter, Klebsiella, Pseudomonas aeruginosa, methicillin resistant Staphylococcus aureus, Streptococcus pneumonia, Hemophilus influenza, Enterobacter sp. Twenty two patients had late onset VAP and five patients had early onset VAP. Overall the survival was 52%. Conclusion: The incidence and the mortality of VAP are high in the current ICU setup. The mortality rate in the current study was 48% and the patients who survived had a longer ICU stay due to ventilator dependence.

Prevention and treatment of ventilator-associated pneumonia in COVID-19.

Ventilator-associated pneumonia (VAP) is the most common acquired infection in the intensive care unit. Recent studies showed that the critical COVID-19 patients with invasive mechanical ventilation have a high risk of developing VAP, which result in a worse outcome and an increasing economic burden. With the development of critical care medicine, the morbidity and mortality of VAP remains high. Especially since the outbreak of COVID-19, the healthcare system is facing unprecedented challenges. Therefore, many efforts have been made in effective prevention, early diagnosis, and early treatment of VAP. This review focuses on the treatment and prevention drugs of VAP in COVID-19 patients. In general, prevention is more important than treatment for VAP. Prevention of VAP is based on minimizing exposure to mechanical ventilation and encouraging early release. There is little difference in drug prophylaxis from non-COVID-19. In term of treatment of VAP, empirical antibiotics is the main treatment, special attention should be paid to the antimicrobial spectrum and duration of antibiotics because of the existence of drug-resistant bacteria. Further studies with well-designed and large sample size were needed to demonstrate the prevention and treatment of ventilator-associated pneumonia in COVID-19 based on the specificity of COVID-19.

The Association Between Bronchoscopy and the Prognoses of Patients With Ventilator-Associated Pneumonia in Intensive Care Units: A Retrospective Study Based on the MIMIC-IV Database.

Background: In intensive care units (ICUs), the morbidity and mortality of ventilator-associated pneumonia (VAP) are relatively high, and this condition also increases medical expenses for mechanically ventilated patients, which will seriously affect the prognoses of critically ill patients. The purpose of this study was to determine the impact of bronchoscopy on the prognosis of patients with VAP undergoing invasive mechanical ventilation (IMV). Methods: This was a retrospective study based on patients with VAP from the Medical Information Mart for Intensive Care IV database. The outcomes were ICU and in-hospital mortality. Patients were divided based on whether or not they had undergone bronchoscopy during IMV. Kaplan-Meier (KM) survival curves and Cox proportional-hazards regression models were used to analyze the association between groups and outcomes. Propensity score matching (PSM) and propensity score based inverse probability of treatment weighting (IPTW) were used to further verify the stability of the results. The effect of bronchoscopy on prognosis was further analyzed by causal mediation analysis (CMA). Results: This study enrolled 1,560 patients with VAP: 1,355 in the no-bronchoscopy group and 205 in the bronchoscopy group. The KM survival curve indicated a significant difference in survival probability between the two groups. The survival probabilities in both the ICU and hospital were significantly higher in the bronchoscopy group than in the no bronchoscopy group. After adjusting all covariates as confounding factors in the Cox model, the HRs (95% CI) for ICU and in-hospital mortality in the bronchoscopy group were 0.33 (0.20–0.55) and 0.40 (0.26–0.60), respectively, indicating that the risks of ICU and in-hospital mortality were 0.67 and 0.60 lower than in the no-bronchoscopy group. The same trend was obtained after using PSM and IPTW. CMA showed that delta-red blood cell distribution width (RDW) mediated 8 and 7% of the beneficial effects of bronchoscopy in ICU mortality and in-hospital mortality. Conclusion: Bronchoscopy during IMV was associated with reducing the risk of ICU and in-hospital mortality in patients with VAP in ICUs, and this beneficial effect was partially mediated by changes in RDW levels.

Developing and validating a prediction model for in-hospital mortality in patients with ventilator-associated pneumonia in the ICU.

Ventilator-associated pneumonia (VAP) is a common nosocomial infection in the intensive care unit (ICU), with high in-hospital mortality. Current scoring systems are limited in predicting nosocomial death of VAP. This study aimed to develop and validate a more accurate and effective prediction model for in-hospital mortality in ICU patients with VAP. This was a retrospective cohort study. The demographic and clinical data of 8,182 adult patients with VAP were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. All patients were randomly classified as a training set (n=4,629) and a test set (n=1,984) with a ratio of 7:3. The outcome was in-hospital mortality and the follow-up was terminated at discharge. Univariate and multivariate logistic regression analyses were used to identify the independent predictors and develop the prediction model in the training set, and internal validation was carried out in the test set. The receiver operating characteristic (ROC) curve and calibration curve were plotted to evaluate the performance of the model. Ethnicity, lung cancer history, septicemia history, hospital length of stay (LOS), fraction of inspired oxygen (FIO2) level, oxygen saturation (SPO2) level, Simplified Acute Physiology Score (SAPS II) score, Sequential Organ Failure Assessment (SOFA) score, and duration of invasive ventilation were all independently associated with the mortality of VAP. The algorithm of the prediction model was as follows: lnP/(1-P) = -0.700 + 0.493 Other Ethnicity + 0.789 Lung Cancer (Yes) + 0.693 Septicemia (Yes) - 0.074 Hospital LOS - 0.008 FIO2 - 0.032 SPO2 + 0.104 SOFA Score + 0.047 SAPS II + 0.004 Invasive Ventilation. The AUC was 0.837 in the training set and 0.817 in the test set, which indicated that the model performed well. The calibration curve also confirmed good calibration. A model with good performance was developed to predict the individual death risk of VAP patients in the ICU, which might have the potential to provide ancillary data to support decision-making by physicians. External validation requires further evaluation of the model performance.

Outcome of Ventilator-Associated Pneumonia in Children Post Cardiac Surgery: A Prospective Observational Study

Abstract Background Ventilator-associated pneumonia (VAP) is a serious complication in post congenital cardiac repair in children leading to high morbidity and mortality. We conducted this study with an aim to determine incidence, risk factors, and mortality of VAP in pediatric cardiac surgical patients. Methodology This prospective observational study included 371 children aged less than 12 years who underwent elective cardiac surgery for congenital heart disease from March 2020 to September 2021. Patients were categorized into two groups: those with VAP and without VAP. Results Out of 371 patients, 67 patients (18%) developed VAP. The VAP incidence density was 36.3 episodes per 1,000 mechanical ventilation days. Age less than 1 year (p &lt;0.001), prolonged preoperative hospital stay (odds ratio: 2.25; 95% CI:1.11–4.52; p = 0.007), and higher RACHS1 (risk adjustment in congenital heart surgery) category, prolonged invasive mechanical ventilation (p &lt;0.001), delayed sternal closure, tracheostomy, reintubation, use of uncuffed ET tube, and peritoneal dialysis were associated with higher incidence of VAP. Total 86 tracheal samples were taken. Most frequently isolated microorganisms were Acinetobacter baumannii (43%) and Klebsiella pneumoniae (23%). Antibiotic resistance was alarming as Acinetobacter and Klebsiella species were highly resistant to commonly used broad spectrum antibiotics like cephalosporins, aminoglycosides, and carbapenems. Conclusion VAP incidence in our study was 18% and VAP incidence density was 36.3 per 1,000 mechanical ventilation days. Patients with VAP had higher mortality (32%) as compared with patients without VAP (12%).

Temporal trends of ventilatorassociated pneumonia in adult intensive care units in the municipality of Goiânia, Goiás, Brazil

Given the potential for morbidity and mortality of ventilator-associated pneumonia (VAP), the profile of these infections in adult intensive care units was evaluated in the city of Goiânia. Data were collected from a secondary base in the Department of Prevention and Control of Infection in Health Services, of the Municipal Health Department of Goiânia, from 2014 to 2016, in private (82.7%), public (17.2%), and philanthropic (6.0%) health care services. The rate of use of mechanical ventilation did not change significantly over the three years (32.6%). However, there was a decrease in the mean of VAP incidence density, and in 2016 there was a reduction of 7% in the 90th percentile. These reductions highlight the benefit of the implementation and adherence to bundles by the multidisciplinary team. KEY WORDS: Pneumonia; ventilator-associated; ventilators; mechanical; disease notification.

VENTILATOR ASSOCIATED PNEUMONIA-REVIEW ARTICLE

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated mortality of VAP is around 10%. There are many risk factors including host related, device related and personnel related. For prevention of VAP it is recommended to minimize the exposure to mechanical ventilation and encouraging early liberation. VAP bundle as a group of evidence-based practices that, results in decrease in the incidence of VAP should be used. Patients should be reassessed daily to conrm ongoing suspicion of disease, antibiotics should be guided by cultures reports, and clinicians should consider stopping antibiotics if cultures are 1 negative.

Evaluation of risk factors in patients with ventilator-associated pneumonia caused by Acinetobacter baumannii

Purpose:  Ventilator-associated pneumonia is a significant disease with high mortality rates. Acinetobacter baumannii is one of the most critical pathogens leading to ventilator-associated pneumonia. This study aims to evaluate the underlying risk factors in patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in intensive care units of our hospital.Patients and Methods:  The data of 112 patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in Intensive Care Units other than Pediatric Intensive Care Unit of our hospital from 2013 to 2017, were evaluated retrospectively.Results: Of the cases included in our study, 70.5% were male, and 29.5% were female patients. Of the cases, 87.5% were followed in Anaesthesiology and Reanimation Intensive Care Unit. The most common modifiable risk factors are mechanical ventilation, antacid use, and the most common non-modifiable risk factors were the presence of trauma and a history of cardiovascular disease.Conclusion: Ventilator-associated pneumonia is a clinical condition with high mortality and morbidity in intensive care units. Incidence and mortality of ventilator-associated pneumonia can be reduced through the implementation of some necessary policies for the prevention of ventilator-associated pneumonia and the practices for the reduction or elimination of modifiable risk factors.

Ventilator-associated pneumonia in adults: a narrative review.

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections. Reported incidences vary widely from 5 to 40% depending on the setting and diagnostic criteria. VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated attributable mortality of VAP is around 10%, with higher mortality rates in surgical ICU patients and in patients with mid-range severity scores at admission. Microbiological confirmation of infection is strongly encouraged. Which sampling method to use is still a matter of controversy. Emerging microbiological tools will likely modify our routine approach to diagnosing and treating VAP in the next future. Prevention of VAP is based on minimizing the exposure to mechanical ventilation and encouraging early liberation. Bundles that combine multiple prevention strategies may improve outcomes, but large randomized trials are needed to confirm this. Treatment should be limited to 7 days in the vast majority of the cases. Patients should be reassessed daily to confirm ongoing suspicion of disease, antibiotics should be narrowed as soon as antibiotic susceptibility results are available, and clinicians should consider stopping antibiotics if cultures are negative.

Ventilatör ile İlişkili Pnömonide Epidemiyoloji ve Mortalite ile İlişkili Risk Faktörleri

Ventilatör ile İlişkili Pnömonide Epidemiyoloji ve Mortalite ile İlişkili Risk Faktörleri

Efficacy and safety of nebulized antibiotics in treating ventilator-associated pneumonia

Background Development of ventilator-associated pneumonia (VAP) is associated with high morbidity and mortality rates. VAP mortality ranges between 5.8 and 27%. When administrating intravenous antibiotics they are mainly detected in respiratory segments of the lungs, but not in the sputum and does not reach an effective bactericidal concentrations in the lung tissues. The objective of this study was to evaluate the efficacy and safety of nebulized antibiotics in treating VAP. Patients and methods This study included 60 patients who were admitted to the Critical Care Department at Benha University Hospital and diagnosed with VAP. Patients were divided into two groups: group A included 30 patients who have received only systemic antibiotics and group B included 30 patients who have received systemic and nebulized antibiotics. Results A significant difference was observed between both groups as regards organism clearance (50 vs 70%, P=0.03), resistance was 20 vs 6.7% and superinfection was 16.7 vs 0.0%, in groups A vs B, respectively. Clinical pulmonary infection score was less than 6 in 53.3% of group A vs 73.3% of group B but without significant statistical difference, P value was 0.108. There was no serious adverse effects on renal or respiratory system in both groups. Regarding ICU mortality, there was no significant difference, P value was 0.091. Conclusion Nebulized amikacin and ceftazidime are safe and effective in the treatment of VAP especially at the level of eradicating infection with multidrug resistant organisms and this benefit is obvious when used as an adjunct to systemic antibiotics and with proper nebulizing techniques.