Risk Factors For Ventilator-associated Pneumonia Research Articles

Incidence and outcomes of ventilator associated pneumonia in pediatric patients: an observational study

Background: Ventilator associated pneumonia (VAP) is very common in pediatric intensive care unit (PICU) intubated patients and also responsible for major morbidity and mortality. Usually, it develops after 48 hours of mechanically ventilated patients, its incidence increases as the duration of time increases and it is a major risk factor for VAP. The present study was carried out to know the overall incidence of VAP in mechanically ventilated patients in PICU. Methods: The study was carried out in PICU of the department of pediatrics, B. R. D. Medical College, Gorakhpur from October 2020 to October 2021. Patients aged between 1 year to 15 years were included in the study. Results: There were 50 (59.5%) patients’ male and 34 (40.5%) patients’ female under investigation. The clinical pulmonary infection score (CPIS) values ranged from the mean value of 4.38±2.30 at 36th hours to 7.33±1.92 at 96th hours of intubation. VAP was present in 23 (27.3%) patients while 62 (73.8%) patients were having no VAP. Among VAP associated patients, 14.3% were Acinetobacter positive, 5.95% were Klebsiella positive and 3.57% were E. coli positive. Conclusions: Parameters of CPIS associated with VAP revealed that Acinetobactor was comparative more common organism and the age group of 1 to 5 years was more sensitive. VAP can be reduced by decreasing the duration of mechanical ventilation.

Predicting ventilator-associated pneumonia in elderly patients requiring mechanical ventilation through the detection in tracheal aspirates

ABSTRACT Objective In this study, we evaluated the clinical utility of tracheal aspirates α-amylase (AM), pepsin, and lipid-laden macrophage index (LLMI) in the early diagnosis of ventilator-associated pneumonia (VAP) in elderly patients on mechanical ventilation. Methods Within 96 hours of tracheal intubation, tracheal aspirate specimens were collected from elderly patients on mechanical ventilation; AM, pepsin, and LLMI were detected, and we analyzed the potential of each index individually and in combination in diagnosing VAP. Results Patients with VAP had significantly higher levels of AM, pepsin, and LLMI compared to those without VAP (P < 0.001), and there was a positive correlation between the number of pre-intubation risk factors of aspiration and the detection value of each index in patients with VAP (P < 0.001). The area under a receiver operating characteristic (ROC) curve (AUC) of AM, pepsin, and LLMI in diagnosis of VAP were 0.821 (95% CI:0.713–0.904), 0.802 (95% CI:0.693–0.892), and 0.621 (95% CI:0.583–0.824), the sensitivities were 0.8815, 0.7632, and 0.6973, the specificities were 0.8495, 0.8602, and 0.6291, and the cutoff values were 4,321.5 U/L, 126.61 ng/ml, and 173.5, respectively. The AUC for the combination of indexes in diagnosing VAP was 0.905 (95% CI:0.812–0.934), and the sensitivity and specificity were 0.9211 and 0.9332, respectively. In the tracheal aspirate specimens, the detection rate of AM ≥ cutoff was the highest, while it was the lowest for LLMI (P < 0.001). The detection rates of AM ≥ cutoff and pepsin ≥ cutoff were higher within 48 hours after intubation than within 48–96 hours after intubation (P < 0.001). In contrast, the detection rate of LLMI ≥ cutoff was higher within 48–96 hours after intubation than within 48 hours after intubation (P < 0.001). The risk factors for VAP identified using logistic multivariate analysis included pre-intubation aspiration risk factors (≥3), MDR bacteria growth in tracheal aspirates, and tracheal aspirate AM ≥ 4,321.5 U/L, pepsin ≥ 126.61 ng/ml, and LLMI ≥ 173.5. Conclusion The detection of AM, pepsin, and LLMI in tracheal aspirates has promising clinical utility as an early warning biomarker of VAP in elderly patients undergoing mechanical ventilation.

The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit

Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among intensive care unit infections. Despite various preventive measures, the incidence of VAP remains high. This study aimed to explore the epidemiology and risk factors for VAP associated mortality in a secondary care hospital, comparing outcomes before and after implementing a VAP prevention bundle. This retrospective study was conducted from July 1, 2021, to June 30, 2023, at a secondary care hospital. Patients over 18 years old who underwent mechanical ventilation for more than 48 hours were included. The study compared the incidence, microbiological etiology, and outcomes of VAP before and after implementing the VAP prevention bundle and analyzed risk factors for mortality from VAP. A total of 83 patients diagnosed with VAP were included. Despite concerted efforts to implement the VAP prevention bundle, there was no significant decrease in the VAP rate per 1000 ventilator days, early-onset VAP, secondary bloodstream infections, acute respiratory distress syndrome, and 30-day mortality. The microbiological etiology of VAP remained consistent between the two periods. A decrease in lymphocyte count and albumin level were identified as independent risk factors for 30-day mortality. Concerted efforts to implement a VAP prevention bundle did not significantly reduce the incidence or improve outcomes of VAP in this secondary care hospital setting. The microbiological etiology remained unchanged. Monitoring lymphocyte count and albumin level may help identify patients at high mortality risk. Further research is needed to develop more effective VAP prevention and management strategies.

Ventilation-Associated Pneumonia in Pediatric Intensive Care in Saudi Arabia: A Two-Year Retrospective Study of Incidence, Risk Factors, and Outcome

Abstract Objective This article assesses the incidence, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in pediatric intensive care unit (PICU) patients in western Saudi Arabia. Methods A retrospective cohort study enrolled 375 children admitted to the PICU of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The study data involves clinical assessment of pediatric patients admitted to the PICU who received mechanical ventilation for ≥ 48 hours to monitor the primary outcome of developing VAP. Statistical analysis with univariate and multivariate analysis, a chi-square test, and a logistic regression model were used to analyze the risk factors associated with VAP. Results The VAP incidence among 375 enrolled patients was estimated to be 29.1% (95% class interval = 24.5–34.0%), accounting for 73.6 cases per 1,000 ventilator days. An approximately 1.4-fold increased mortality risk was observed in VAP cases with no statistical significance (p = 0.248). VAP incidence was independently associated with age groups 0 to 30 days (odds ratio [OR] = 6.88, p = 0.001), 1 to 12 months (OR = 4.55, p = 0.003), and &gt; 6 years (OR = 3.45, p = 0.038), in addition to the nasogastric tube (OR = 2.23, p = 0.019), bronchoscopy (OR = 6.28, p = 0.001), and longer ICU stay including 4 to 7 days (OR = 4.08, p = 0.002) and &gt; 7 days (OR = 4.96, p = 0.002). Conclusion Given the observed high incidence of VAP, it is imperative to urgently enhance our preventive strategies and rigorously scrutinize VAP risk factors within the institution. Extra precautions and specific risk identification may be warranted in high-risk age groups. Our findings underscore the necessity for a comprehensive assessment of risk factors and etiological agents, aligning them with incidence rates. This proactive approach would facilitate the early implementation of strategic interventions and practices, potentially reducing VAP development.

Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Gram-Negative Bacteria in a Pediatric Intensive Care Unit

AbstractWe aimed to analyze risk factors of ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR), pan-drug-resistant (PDR), and extensively drug-resistant (XDR) gram-negative bacteria (GNB) in a pediatric intensive care unit (PICU). This retrospective study evaluated pediatric patients diagnosed with VAP at a tertiary referral hospital. Of the 46 children in the present study, 40 (86.9%) had VAP caused by MDR-, XDR-, and PDR-GNB. Most patients (60.9%) had spent &gt;28 days in the PICU at the time of diagnosis. Respiratory failure necessitating PICU admission was associated with XDR infection-induced VAP (p = 0.034). High rates of prior broad-spectrum antibiotic use were observed in patients with XDR GNB-induced VAP. VAP induced by MDR-, XDR-, and PDR-GNB occurred more frequently than that caused by drug-susceptible GNB in PICU patients. Long stays for more than 28 days in the PICU and past use of broad-spectrum antibiotics can lead to the development of XDR-GNB-induced VAP. The high antibiotic resistance rates detected in our study highlight the importance of strict infection control measures and antimicrobial stewardship programs in PICUs.

A Study on the Epidemiological-Molecular Role of Staphylococcus aureus Strains in the Development of Ventilator-Associated Pneumonia in a Tertiary Hospital in Brazil.

This study aimed to explore the molecular epidemiology of Staphylococcus aureus isolated from patients on mechanical ventilation and the participation of virulence factors in the development of ventilator-associated pneumonia (VAP). A prospective cohort study was conducted on patients under mechanical ventilation, with periodic visits for the collection of tracheal aspirates and clinical data. The S. aureus isolates were analyzed regarding resistance profile, virulence, expression of protein A and alpha-toxin using Western blot, clonal profile using PFGE, sequence type using MLST, and characterization and quantification of phenol-soluble modulins. Among the 270 patients in the study, 51 S. aureus strains were isolated from 47 patients. The incidence density of S. aureus and MRSA VAP was 2.35/1000 and 1.96/1000 ventilator days, respectively; of these, 45% (n = 5) were resistant to oxacillin, with 100% (n = 5) harboring SCCmec types II and IV. The most frequent among the tested virulence factors were icaA, hla, and hld. The clonal profile showed a predominance of sequence types originating from the community. Risk factors for VAP were the presence of solid tumors and the sea gene. In conclusion, patient-related risk factors, together with microbiological factors, are involved in the development of S. aureus VAP, which is caused by the patient's own strains.

Risk factors of ventilator-associated pneumonia in intensive care patients at tertiary referral hospital

Link of Video Abstract: https://youtu.be/YEQ3ICJPmxA Background: Ventilator-associated pneumonia (VAP) occurs after endotracheal intubation and ventilator for more than 48 hours therefore it is an emerging threat to patient safety. The aim of this study is to determine the incidence and compare the risk factors of ventilator patients diagnosed with ventilator-associated pneumonia and patients with ventilators who are not diagnosed with ventilator-associated pneumonia. Methods: This study used a retrospective observational with a case-control approach. Data was collected from January 2019 to December 2021. The risk factors to be analysed were comorbidities, antibiotic therapy, length of stay in the intensive care unit, duration of ventilator use, and history of surgery. Results: There were 18 patients in the VAP and the control groups met the inclusion and exclusion criteria. The incidence of incidents in 2019 was 3.2 per 1000 ventilator days; in 2020, it was 1.2 per 1000 ventilator days; and in 2021, it was 1.2 per 1000 ventilator days. Comparison test results using Mann-Whitney showed a difference with a p&lt;0.05. Patients with prolonged use of ventilators (p&lt;0.05) and prolonged hospitalization (p&lt;0.05) have a higher risk of developing ventilator-associated pneumonia. The average VAP occurs on the fourth day on a ventilator. Gram-negative bacteria, Pseudomonas aeruginosa, Acinetobacter baumanii, and Klebsiella pneumoniae cause most bacterial infections Conclusion: There is a high risk of developing VAP in patients with prolonged use of ventilators and extended stays in the intensive care unit of the Tertiary Referral Hospital.

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&lt;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&lt;0.001) and ventilation duration were significantly correlated with the incidence of VAP (p&lt;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.

Ventilator-associated Pneumonia in the Intensive Care Unit of the Institute of Oncology Ljubljana in 2021 and the Role of Nurses in its Prevention

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common infection in critically ill patients and has the highest mortality. It prolongs ventilation time and length of stay, increases antibiotic consumption, increases the likelihood of death, increases the cost of treatment, and is difficult to diagnose. AIM: At the intensive care unit (ICU) of the Institute of Oncology, Ljubljana, we prospectively monitor risk factors for VAP and its incidence. It is a mixed surgical/internal ICU. METHODS: A centers of disease control and prevention VAP diagnosis criteria and strategies to prevent VAP were used. Registered nurses recorded risk factors in all intubated patients in all three shifts, and the diagnosis protocol was completed by the physician in case of antibiotic administration in suspected VAP. RESULTS: The expected incidence of VAP is around 18/1,000 ventilated days. In 2021, 67 patients were mechanically ventilated in our ICU (patients who completed ventilation in that year). The total time spent on ventilation was 17,143 h or 714.3 days. As the criteria for ventilator-assisted pneumonia (VAP) is &gt;48 h of ventilation, we excluded 19 patients who had been ventilated for 48 h or less. Among 48 patients who were ventilated for &gt; 48 h, the total ventilation was 16,765 h or 698.5 days. We recorded 8 VAP in 714 days, which is 1 VAP per 89 days of ventilation or 11.2/1,000 ventilation days. Healthcare staff, especially registered nurses, play a major role in VAP prevention, providing care every day, all days of the week. Most prevention interventions and strategies are part of routine nursing care. Lack of knowledge about infection prevention and appropriate nursing care among nurses can become a barrier to adherence to evidence-based guidelines for the prevention of VAP. CONCLUSION: This study will help nurses to learn about VAP and its prevention in detail so that they can apply the knowledge in clinical practice. Understanding the pathophysiology of VAP, its risk factors and the nursing care bundle is essential for appropriate prevention and treatment of VAP. Specific protocols, strategies, and active control should be available in each ICU regarding the care bundle.

Incidence rate and risk factors of ventilator-associated pneumonia in patients with traumatic brain injury: a systematic review and meta-analysis of observational studies.

Ventilator-associated pneumonia is a common complication of traumatic brain injury (TBI) patients, causing great harm to the life, health and society of patients. It is important to understand the risk factors related to ventilator-associated pneumonia for infection monitoring and control of patients. However, there are still some controversies about the risk factors in previous studies. Therefore, the purpose of this study was to explore the incidence and risk factors of ventilator-associated pneumonia in patients with TBI. Two independent researchers selected literature collected by systematically searching databases including PubMed, Ovid, Embase, and ScienceDirect using medical subject headings. The primary end points of the included literature were extracted, and the Cochrane Q test and I2 statistic were used to evaluate the heterogeneity between studies. The random effects model based on the restricted maximum likelihood method and the fixed effects model based on the reverse variance method were used to calculate and combine the relative risk or mean difference of relevant indicators. The publication bias was evaluated with the funnel plot and Egger test. All results were considered statistically significant at P<0.05. A total of 11 articles were included in this study for meta-analysis, and a total of 2,301 patients with TBI were included. The incidence of ventilator-associated pneumonia in TBI patients was approximately 42% (95% CI: 32-53%). Tracheotomy significantly increased the risk of ventilator-associated pneumonia in patients with TBI [relative risk (RR) =3.71; 95% CI: 1.48-6.94; P<0.05]; the use of prophylactic antibiotics could significantly reduce the risk of ventilator-associated pneumonia in patients with TBI. The risk of pneumonia (RR =0.53; 95% CI: 0.18-0.88; P<0.05); compared with female patients, male patients with TBI had a significantly higher risk (about 46%) of ventilator-associated pneumonia (RR =1.46; 95% CI: 1.13-1.79; P<0.05). The risk of ventilator-associated pneumonia in patients with TBI is about 42%. Posttracheotomy and mechanical ventilation are risk factors for ventilator-associated pneumonia, while prophylactic use of antibiotics is a protective factor in the development of ventilator-associated pneumonia.

Pathogen characteristics, changes in inflammation levels, and risk factors for ventilator-associated pneumonia in elderly patients with gastric cancer after surgery

Pathogen characteristics, changes in inflammation levels, and risk factors for ventilator-associated pneumonia in elderly patients with gastric cancer after surgery

ORGANISMS CAUSING VENTILATOR ASSOCIATED PNEUMONIA IN PAEDIATRIC PATIENTS OF HEAD TRAUMA- A PROSPECTIVE OBSERVATIONAL STUDY

Ventilator associated pneumonia (VAP) is the infection of the pulmonary parenchyma with onset after 48–72 hours of endotracheal intubation. VAP increases hospital stay and extra cost of the patient. It also increases mortality In Paediatrics and neonatology, the frequency of VAP is 3–19%, with a mortality rate ranging from 10 to 20% of patients. The aim of this study is to determine the commonest bacterial species in children who are mechanically ventilated for indication of head trauma in tertiary care teaching hospital having facility of NICU and PICU. The study was conducted in a tertiary care hospital. It was an observational study of 3 months. the patients, who had a new pulmonary inltration, satised 2 or more conditions among the cases of body temperature 38.3oC or higher, purulent bronchial secretions, and a leukopenia or leukocytosis (＜5,000 or ＞10,000 mm3), they were diagnosed with pneumonia. Specimens were collected from all patients with ET tip culture. Once the specimens were obtained, the sample was sent for gram stain, culture and sensitivity. Total of 50 patients were included in the study. 20 patients were below age of one year, 16 patients were in the age group of 1-10 years while 14 were above 10 years of age. Acinetobacter baumannii, klebsiella pneumoniae and candida species were found in patients. Mixed infection was also seen in 1/4th of the patients enrolled. Knowledge of risk factors for VAP may be useful in implementing simple and effective preventive measures. As mixed infection is on the rise, routine hygiene of respiratory tract and endotracheal tube with complete asepsis is required to reduce the VAP

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.

Targeted temperature management at 36°C is a risk factor for ventilator-associated pneumonia.

In contrast to the adult population, limited information is currently available on risk factors for ventilator-associated pneumonia (VAP) in children. Therapeutic hypothermia has been identified as a risk factor for the early onset of VAP in adults; however, the relationship between VAP and normothermia remains unclear. The present study investigated risk factors for VAP in children, with a focus on the deleterious effects of therapeutic normothermia on VAP. We retrospectively investigated the clinical characteristics of children treated with mechanical ventilation for more than 48 h and analyzed risk factors for VAP. The endpoint was the onset of VAP by the seventh day after the initiation of mechanical ventilation. Among the 288 patients enrolled, seven (2.4%) developed VAP. No significant differences were observed in clinical backgrounds between the VAP and non-VAP groups. A univariate analysis identified target temperature management (TTM) at 36°C (p < 0.0001) and methylprednisolone (mPSL) pulse therapy (p = 0.02) as risk factors for VAP. An analysis of the time to the onset of VAP by the Kaplan-Meier plot and log-rank test revealed a significantly higher incidence of VAP in the TTM group (p < 0.0001) and mPSL pulse group (p = 0.001). TTM at 36°C and mPSL pulse therapy may be risk factors for VAP in the pediatric population.

Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC).

Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Prospective cohort study. This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. The study included patients admitted to ICUs across 24 years. In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16-1.28; P < .0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07-1.08; P < .0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23-1.31; P < .0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57-15.48; P < .0001); tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31; 95% CI, 7.21-9.58; P < .0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34-7.21; P < .0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17-1.29; P < .0001); admission to a public hospital (aOR, 1.59; 95% CI, 1.35-1.86; P < .0001); middle-income country (aOR, 1.22; 95% CI, 15-1.29; P < .0001); admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05; 95% CI, 3.22-5.09; P < .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48; 95% CI, 1.78-3.45; P < .0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79-3.07; P < .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51-0.77; P < .0001). Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.

Multinational prospective cohort study over 24 years of the risk factors for ventilator-associated pneumonia in 187 ICUs in 12 Latin American countries: Findings of INICC

Multinational prospective cohort study over 24 years of the risk factors for ventilator-associated pneumonia in 187 ICUs in 12 Latin American countries: Findings of INICC

Epidemiology, risk factors and prognosis of ventilator-associated pneumonia during severe COVID-19: Multicenter observational study across 149 European Intensive Care Units

BackgroundCOVID-19 patients requiring mechanical ventilation are particularly at risk of developing ventilator-associated pneumonia (VAP). Risk factors and the prognostic impact of developing VAP during critical COVID-19 have not been fully documented. MethodsPatients invasively ventilated for at least 48 h from the prospective multicentre COVID-ICU database were included in the analyses. Cause-specific Cox regression models were used to determine factors associated with the occurrence of VAP. Cox-regression multivariable models were used to determine VAP prognosis. Risk factors and the prognostic impact of early vs. late VAP, and Pseudomonas-related vs. non-Pseudomonas-related VAP were also determined. Main findings3388 patients were analysed (63 [55–70] years, 75.8% males). VAP occurred in 1523/3388 (45.5%) patients after 7 [5–9] days of ventilation. Identified bacteria were mainly Enterobacteriaceae followed by Staphylococcus aureus and Pseudomonas aeruginosa. VAP risk factors were male gender (Hazard Ratio (HR) 1.26, 95% Confidence Interval [1.09–1.46]), concomitant bacterial pneumonia at ICU admission (HR 1.36 [1.10–1.67]), PaO2/FiO2 ratio at intubation (HR 0.99 [0.98–0.99] per 10 mmHg increase), neuromuscular-blocking agents (HR 0.89 [0.76–0.998]), and corticosteroids (HR 1.27 [1.09–1.47]). VAP was associated with 90-mortality (HR 1.34 [1.16–1.55]), predominantly due to late VAP (HR 1.51 [1.26–1.81]). The impact of Pseudomonas-related and non-Pseudomonas-related VAP on mortality was similar. ConclusionVAP affected almost half of mechanically ventilated COVID-19 patients. Several risk factors have been identified, among which modifiable risk factors deserve further investigation. VAP had a specific negative impact on 90-day mortality, particularly when it occurred between the end of the first week and the third week of ventilation.

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.

Effects of systemic antibiotics in early onset ventilator-associated pneumonia in trauma patients: A single-centre retrospective cohort study

Background: Ventilator-associated pneumonia is one of the commonest complications encountered in intubated patients: its incidence ranges from 20% to 60%, with higher incidences seen in patients with polytrauma. Ventilator-associated pneumonia can result in poor neurological outcomes upon discharge, longer duration of mechanical ventilation and prolonged intensive care unit stays. The use of systemic antibiotics has been proposed as one method to reduce this complication. However, its effectiveness remains to be determined, and concerns about bacterial resistance hinder its use. This study aims to evaluate the effects of systemic antibiotics on early ventilator-associated pneumonia prevention. Methods: This is a single-centred retrospective cohort study, using data in the local trauma registry from 2015 to 2020. Patients aged ⩾18 years who suffered from injury to the head or trunk and were intubated within 12 h of hospitalization were evaluated for early ventilator-associated pneumonia to determine the effectiveness of systemic antibiotics on the incidence of ventilator-associated pneumonia and to identify other risk factors for ventilator-associated pneumonia in patients suffering from trauma. Result: A total of 250 patients were recruited; 59 of them met the criteria for early onset ventilator-associated pneumonia. Early use of broad-spectrum antibiotics with potent anaerobic coverage was found to be protective for early onset ventilator-associated pneumonia (adjusted odds ratio = 0.228, p = 0.044). Increasing age and severe thoracic or abdominal injury were also found to be strong non-modifiable predictors for the development of early onset ventilator-associated pneumonia. Conclusion: Use of systemic antibiotics with potent anaerobic coverage within 3 h of injury was found to prevent early onset ventilator-associated pneumonia in those intubated within 12 h of injury. However, a large-scale randomized control trial may be needed to further evaluate its benefit and its potential side effects, most notably the risk of antibiotic resistance.

Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings

BackgroundVentilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors. MethodsWe conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam). Results153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables.Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P<.0001); male gender (OR=1.17; 95%CI=1.08-1.26, P<.0001); length of stay, rising VAP risk 7% daily (aOR=1.07; 95%CI=1.06-1.07, P<.0001); mechanical ventilation (MV) device utilization (DU) ratio (OR=1.43; 95%CI=1.36-1.51; p<.0001); tracheostomy connected to a MV (OR=11.17; 95%CI=9.55-14.27; p<.0001); public (OR=1.84; 95%CI=1.49-2.26, P<.0001), and private (OR=1.57; 95%CI=1.29-1.91, P<.0001) compared with teaching hospitals; upper-middle income country (OR=1.86; 95%CI=1.63-2.14, P<.0001). Regarding ICUs, Medical-Surgical (OR=4.61; 95%CI=3.43-6.17; P<.0001), Neurologic (OR=3.76; 95%CI=2.43-5.82; P<.0001), Medical (OR=2.78; 95%CI=2.04-3.79; P<.0001), and Neuro-Surgical (OR=2.33; 95%CI=1.61-3.92; P<.0001) showed the highest risk. ConclusionsSome identified VAP RFs are unlikely to change= age, gender, ICU type, facility ownership, country income level. Based on our results, we recommend limit use of tracheostomy, reducing LOS, reducing the MV/DU ratio, and implementing an evidence-based set of VAP prevention recommendations.