Predictors Of Ventilator-associated Pneumonia Research Articles

Incidence and predictors of ventilator-associated pneumonia using a competing risk analysis: a single-center prospective cohort study in Egypt

BackgroundVentilator-associated pneumonia (VAP) is a challenging nosocomial problem in low- and middle-income countries (LMICs) that face barriers to healthcare delivery and resource availability. This study aimed to examine the incidence and predictors of VAP in Egypt as an example of an LMIC while considering death as a competing event.MethodsThe study included patients aged ≥ 18 years who underwent mechanical ventilation (MV) in an intensive care unit (ICU) at a tertiary care, university hospital in Egypt between May 2020 and January 2023. We excluded patients who died or were transferred from the ICU within 48 h of admission. We determined the VAP incidence based on clinical suspicion, radiological findings, and positive lower respiratory tract microbiological cultures. The multivariate Fine-Gray subdistribution hazard model was used to examine the predictors of VAP while considering death as a competing event.ResultsOverall, 315 patients were included in this analysis. Sixty-two patients (19.7%) developed VAP (17.1 per 1000 ventilator days). The Fine-Gray subdistribution hazard model, after adjustment for potential confounders, revealed that emergency surgery (subdistribution hazard ratio [SHR]: 2.11, 95% confidence interval [CI]: 1.25–3.56), reintubation (SHR: 3.74, 95% CI: 2.23–6.28), blood transfusion (SHR: 2.23, 95% CI: 1.32–3.75), and increased duration of MV (SHR: 1.04, 95% CI: 1.03–1.06) were independent risk factors for VAP development. However, the new use of corticosteroids was not associated with VAP development (SHR: 0.94, 95% CI: 0.56–1.57). Klebsiella pneumoniae was the most common causative microorganism, followed by Pseudomonas aeruginosa.ConclusionThe incidence of VAP in Egypt was high, even in the ICU at a university hospital. Emergency surgery, reintubation, blood transfusion, and increased duration of MV were independently associated with VAP. Robust antimicrobial stewardship and infection control strategies are urgently needed in Egypt.

Early Predictors of Ventilator Associated Pneumonia in Preterm Neonates Admitted in a Special Newborn Care Unit

Early Predictors of Ventilator Associated Pneumonia in Preterm Neonates Admitted in a Special Newborn Care Unit

Early Predictors of Ventilator Associated Pneumonia in Preterm Neonates Admitted in a Special Newborn Care Unit

Early Predictors of Ventilator Associated Pneumonia in Preterm Neonates Admitted in a Special Newborn Care Unit

Evaluation of the Kinetics of Pancreatic Stone Protein as a Predictor of Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is a severe condition. Early and adequate antibiotic treatment is the most important strategy for improving prognosis. Pancreatic Stone Protein (PSP) has been described as a biomarker that increases values 3-4 days before the clinical diagnosis of nosocomial sepsis in different clinical settings. We hypothesized that serial measures of PSP and its kinetics allow for an early diagnosis of VAP. The BioVAP study was a prospective observational study designed to evaluate the role of biomarker dynamics in the diagnosis of VAP. To determine the association between repeatedly measured PSP and the risk of VAP, we used joint models for longitudinal and time-to-event data. Of 209 patients, 43 (20.6%) patients developed VAP, with a median time of 4 days. Multivariate joint models with PSP, CRP, and PCT did not show an association between biomarkers and VAP for the daily absolute value, with a hazard ratio (HR) for PSP of 1.01 (95% credible interval: 0.97 to 1.05), for CRP of 1.00 (0.83 to 1.22), and for PCT of 0.95 (0.82 to 1.08). The daily change of biomarkers provided similar results, with an HR for PSP of 1.15 (0.94 to 1.41), for CRP of 0.76 (0.35 to 1.58), and for PCT of 0.77 (0.40 to 1.45). Neither absolute PSP values nor PSP kinetics alone nor in combination with other biomarkers were useful in improving the prediction diagnosis accuracy in patients with VAP. Registered retrospectively on August 3rd, 2012. NCT02078999.

Thoracic ultrasound alone or in combination with tracheal amylase as a tool predictor of ventilator-associated pneumonia in neurocritical patients

In this study, we aim to evaluate whether thoracic ultrasound (TUS) and tracheal amylase (TA) alone or in combination can predict the development of ventilator-associated pneumonia (VAP) in neurocritical patients. Consecutive adult patients with neurocritical disease with normal chest radiographs who required intensive care unit admission and mechanical ventilation between March 2015 and July 2018 were included. TUS and Amylase levels were measured during the first 24 hours and repeated 48 hours after orotracheal intubation. Forty-three patients with a median age of 34 years (17-82) were included. TUS had a sensitivity of 100% and specificity of 96.3% as a predictor of VAP within the first 48 hours when nonpattern A was observed. TA levels > 200 UI/L in the first 48 hours had a sensitivity of 87.5%, and specificity of 63% as a predictor of VAP. Moreover, no benefit of TUS plus TA compared to TUS alone as a predictor of VAP was found. The identification of abnormal TUS patterns in the first 48 hours of orotracheal intubation is a significant predictor of VAP in neurocritical patients.

TEMPORAL TRENDS AND PREDICTORS OF VENTILATOR-ASSOCIATED PNEUMONIA IN HOSPITALIZED PATIENTS: NATIONAL PERSPECTIVE

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Ventilator-associated pneumonia (VAP) is a hospital acquired pneumonia that occurs more than 48 hours after mechanical ventilation. Previous epidemiological studies reported temporal trends, predictors, and outcomes of VAP based on regional data or in specific subgroups of patients. In our study we used the National database to delineate the trends and predictors of VAP from 2009 to 2017. METHODS: We analyzed data from the Nationwide Inpatient Sample (NIS) for the years 2009-2017 for adult hospitalizations who received mechanical ventilation by using International Classification of Diseases (9th/10th Editions) Clinical Modification Procedural codes (ICD-9-CM/ICD-10-CM) procedures codes. We excluded hospitalizations with length of stay (LOS <2 days). VAP and other diagnosis of interests were identified by ICD-9-CM diagnosis codes and Elixhauser comorbidity software. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze temporal incidence trends, predictors. RESULTS: Out of a total 5,155,068 hospitalizations who received mechanical ventilation, 93432(1.81%) developed VAP. Incidence of VAP decreased from 20/1000 in 2008 to 17/1000 in 2017 with 5% decrease (OR 0.95; 95%CI 0.92-0.96; p<0.001). Patients who developed VAP had lower mean age (59 vs 61; p<0.001) and higher LOS (25d Vs. 12d; p<0.001). Furthermore, in multivariable regression analysis, predictors of VAP are males(OR 1.4; 95% CI 1.35-1.45; p<0.0001) and African Americans (OR 1.22; 95% CI 1.14-1.31;p<0.001), paralysis (OR 2.1; 95% CI 2.02-2.21; p<0.001) and congestive heart failure (OR 1.22; CI 1.17-1.27; p<0.0001). Also, age < 65, teaching hospital status and co-morbidities like neurological disorders, pulmonary circulation disorders, anemia and electrolyte disorders are associated with the increased odds of developing VAP. Amongst the patients who developed VAP, 62% were discharged to long term facilities and 19% died during the hospitalization. CONCLUSIONS: In this nationally representative study, we observed incidence of VAP has been decreasing in the last decade. We were also able to delineate several factors that were associated with development of VAP, which are potentially modifiable. CLINICAL IMPLICATIONS: There has been a paucity of nationwide data regarding VAP in the U.S.. Our study identified the trends along with the modifiable or non-modifiable risk predictors of VAP in MV patients. Our goal is to lay foundation for further in-depth analysis of this trend for better risk stratification and development of preventive strategies to further reduce the incidence of VAP among MV patients. DISCLOSURES: No relevant relationships by TANVEER DABRIA, source=Web Response No relevant relationships by Wonkyung Hur, source=Web Response no disclosure on file for Preetam Jolepalem; No relevant relationships by Faizan Malik, source=Web Response No relevant relationships by Uvesh Mansuri, source=Web Response No relevant relationships by Achint Patel, source=Web Response No relevant relationships by Hafsa Sabzposh, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by Chail Shah, source=Web Response

Predictors of Ventilator Associated Pneumonia of Neonate in a Neonatal and Paediatric Intensive Care Unit

Background: Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia develops 48 hours or more after initiation of mechanical ventilation. Hospital acquired infection (HAI) is the second most common infection for the pediatric population. VAP about 20% of all HAI among patients in NICU &amp; PICU. Higher mortality and morbidity rate for mechanically ventilated pediatric patients with VAP compared to those without VAP. Few data &amp; very few researches exist regarding VAP in pediatric patients to identify risk factors of VAP and that might be helpful for preventing VAP. This study was done to find out the predictors of VAP of neonate in Neonatal and Pediatric Intensive Care Unit.&#x0D; Methodology: A prospective cohort study was carried out in NICU &amp; PICU of Dhaka Shishu (Children) Hospital, Dhaka. Neonates those not had pneumonia; requiring mechanical ventilation at least 48 hours in the NICU or PICU were taken for this study. Then VAP patients were selected by radiographic changes after 48 hours of intubation. Portable chest x-ray was done after 48 hours and as required after initiation of ventilation. Then details history were taken and some relevant investigation were done.&#x0D; Result: Majority (51.4%) of the neonates belonged to age group 0-10 days. Male female ratio was 2.8:1. More than half (51.4%) were of gestational age 34 to &lt; 37 weeks. Sixty nine point four percent of the neonates had Weight &lt; 2.5 kg. Transferred from other NICU or PICU was found in 34.7% , prolonged mechanical ventilation was found in 40.3%, reintubation were 36.1%, prior antibiotics use were 73.6%, nosocomial infection were 76.4%, oropharyngeal aspiration were 11.1% and those having VAP were 79.2%. Age group 11-20 days (RR=1.41; 95% CI 1.18 to 1.67), gestational age &lt;37 weeks (RR=1.48; 95% CI 1.12 to 1.96), weight &lt;2.5 kg (RR=2.24; 95% CI 1.20 to 4.18%), nosocomial infection (RR= 3.21; 95% CI 1.53 to 6.73%), transferred from other NICU &amp; PICU (RR=1.47; 95% CI 1.21 to 1.79), Prolonged Mechanical Ventilation (RR=1.50; 95% CI 1.01 to 2.23%) and Reintubation (RR=1.48; 95% CI 1.21 to 1.81%) were found independent predictors for developing VAP. P value was found statistically significant (p&lt;0.05).&#x0D; Conclusion: Age group 11-20 days, gestational age &lt;37 weeks, weight &lt;2.5 kg, transferred from other NICU &amp; PICU, prolonged mechanical ventilation, reintubation and nosocomial infection were regarded as predictors for VAP and those predictors were significantly associated with VAP.&#x0D; Bangladesh J Child Health 2019; VOL 43 (2) :90-96

C-reactive protein and procalcitonin as predictors of survival and septic shock in ventilator-associated pneumonia

We evaluated the performance of procalcitonin (PCT) and C-reactive protein (CRP) threshold values and kinetics as predictors of ventilator-associated pneumonia (VAP) survival and septic shock development. 45 adult patients with VAP were studied. Serum CRP and PCT levels and the Sequential Organ Failure Assessment (SOFA) score were measured on days 1, 4 and 7 (D1, D4, D7) of VAP and their variations between different days (kinetics) were calculated (DeltaPCT, DeltaCRP). A multivariate logistic regression model was constructed with either VAP 28-day survival or septic shock development as dependent variables, and PCT values, CRP values, kinetics, age, sex, SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) II score as independent variables. No difference was found in CRP levels between survivors and nonsurvivors. Nonsurvivors had significantly higher PCT levels on D1 and D7. In the multivariate analysis, the only factors predicting VAP survival were DeltaPCT(7-1) (OR 7.23, 95% CI 0.008-0.468) and DeltaCRP(7-4) (OR 4.59, 95% CI 0.013-0.824). VAP patients who developed septic shock had significantly higher CRP levels on D1 and D7 and higher PCT levels on D1 and D4. The only factor predicting the development of septic shock was SOFA on D1 (OR 7.44, 95% CI 1.330-5.715). Neither PCT and CRP threshold values nor their kinetics can predict VAP survival or septic shock development.

C-reactive protein and procalcitonin concentrations in bronchoalveolar lavage fluid as a predictor of ventilator-associated pneumonia

Diagnosis of ventilator-associated pneumonia (VAP) is difficult. The usefulness of high-sensitivity procalcitonin (ProCa-S) and high-sensitivity C-reactive protein (CRPH) in bronchoalveolar lavage (BAL) fluid and serum in the prediction of VAP was determined. The study was conducted over a 28-month period (November 1999-June 2002) at the University Hospital Maastricht. BAL fluid samples were collected from patients admitted to the intensive care unit. Differential cell count and quantitative culture of BAL fluid were performed. C-reactive protein (CRP) and procalcitonin (PCT) on BAL fluid were determined by means of two high-sensitivity kits (CRPH and ProCa-S, respectively). Since both kits were designed for use on serum, validation for use on BAL fluid was performed. A total of 117 patients were included. 43.6% (51/117) had microbiologically confirmed VAP. Both CRPH and ProCa-S showed good matrix effect, linearity and intra- and inter-assay variation. No significant differences in PCT and CRP concentrations in serum and BAL fluid were found between the VAP and the non-VAP group. Both the ProCa-S and the CRPH kits can be used for assessing the concentration of PCT and CRP in BAL fluid, respectively. PCT and CRP concentrations in BAL fluid appeared to be of no additional value in the diagnosis of VAP.