Risk Factors For Ventilator-associated Pneumonia Research Articles

Analysis of incidence and risk factors of neonatal ventilator associated pneumonia in a hospital in Hunan Province, 2016-2018

Objective: To investigate the incidence and risk factors of ventilator-associated pneumonia (VAP) in neonatal intensive care unit (NICU), and to provide evidence for the prevention and control of VAP. Methods: A total of 1 872 neonates, who were admitted into NICU of Hunan Provincial Maternal and Child Health Hospital and subjected to mechanical ventilation from October 2016 to June 2018, were enrolled in the study. The neonates who met the diagnostic criteria of VAP were selected as the case group, and those who were treated with ventilator for 48 hours at the same time were regarded as the control group. Multivariate logistic regression model was used to analyze the related factors of VAP. Results: Of the 1 872 neonates who underwent the mechanical ventilation, the VAP occurred in 160 cases with the incidence rate of 8.5% (160 cases). The 227 specimens were collected. Gram-positive bacteria (n=116, 51.1%) were the main pathogens. The main pathogens were Staphylococcus epidermidis, Enterococcus faecalis, Acinetobacter baumannii. By Chi-square test, birth weight, birth age, Apgar score, duration of ventilator, and whether newborn mothers with pregnancy hypertension were influencing factors. The result of logistic regression analysis showed that compared with no pregnancy included hypertension, the first aid measure at birth was initial resuscitation, and the MV time ≤ 5 days, the risk factors of ventilator-associated pneumonia in neonates included: their mothers with hypertensive disorders complicating pregnancy, using of tracheal intubation and ventilator time more than 5 days. Conclusion: The incidence of VAP in neonates receiving continuous MV therapy in neonatal intensive care unit is higher. Gram-positive bacteria are the main pathogens. VAP in neonates is related to whether newborn mothers with pregnancy hypertension, MV duration and tracheal intubation.

Incidence, Risk Factors, and Effects on Outcome of Ventilator-Associated Pneumonia in Patients With Traumatic Brain Injury: Analysis of a Large, Multicenter, Prospective, Observational Longitudinal Study

No large prospective data, to our knowledge, are available on ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI). To evaluate the incidence, timing, and risk factors of VAP after TBI and its effect on patient outcome. This analysis is of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury data set, from a large, multicenter, prospective, observational study including patients with TBI admitted to European ICUs, receiving mechanical ventilation for≥ 48 hours and with an ICU length of stay (LOS)≥ 72 hours. Characteristics of patients with VAP vscharacteristics of patients without VAP were compared, and outcome was assessed at 6months after injury by using the Glasgow Outcome Scale Extended. The study included 962 patients: 196 (20.4%) developed a VAP at a median interval of 5days (interquartile range [IQR], 3-7days) after intubation. Patients who developed VAP were younger (median age, 39.5 [IQR, 25-55] years vs51 [IQR, 30-66] years; P< .001), with a higher incidence of alcohol abuse (36.6%vs27.6%; P= .026) and drug abuse (10.1%vs4.2%; P= .009), more frequent thoracic trauma (53%vs43%; P= .014), and more episodes of respiratory failure during ICU stay (69.9%vs28.1%; P< .001). Age (hazard ratio [HR], 0.99; 95%CI, 0.98-0.99; P= .001), chest trauma (HR, 1.4; 95%CI, 1.03-1.90; P= .033), histamine-receptor antagonist intake (HR, 2.16; 95%CI, 1.37-3.39; P= .001), and antibiotic prophylaxis (HR, 0.69; 95%CI, 0.50-0.96; P= .026) were associated with the risk of VAP. Patients with VAP had a longer duration of mechanical ventilation (median, 15 [IQR, 10-22] days vs8 [IQR, 5-14] days; P< .001) and ICU LOS (median, 20 [IQR, 14-29] days vs13 [IQR, 8-21] days; P< .001). However, VAP was not associated with increased mortality or worse neurological outcome. Overall mortality at 6months was 22%. VAP occurs less often than previously described in patients after TBI and has a detrimental effect on ICU LOS but not on mortality and neurological outcome. ClinicalTrials.gov; No.: NCT02210221; URL: www.clinicaltrials.gov.

Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients.

ObjectiveThis a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU).Material and methodsData were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings.ResultsAt oral physical examination, the most frequent findings were tooth loss (568–85.67%), coated tongue (422–63.65%) and oral bleeding (192–28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14 vs 13.69%, p = 0.02; 23.44 vs 15.50%, p = 0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development (OR = 1.61 (1.03–2.51) and OR = 1.69 (1.08–2.66), respectively).ConclusionsThe presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP.Clinical relevanceThe results of this paper reinforce the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU.

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.

Risk Factor Analysis of Pan-drug Resistant Acinetobacter baumannii-induced Ventilator-associated Pneumonia in ICU

This study was to investigate the risk factors of ventilator-associated pneumonia caused by pan-drug resistant Acinetobacter baumannii in emergency intensive care unit so as to provide related basis for clinical prevention. A total of 105 intensive care unit patients, who were treated with ventilator over 48 h in the First Affiliated Hospital of Anhui Medical University and developed Acinetobacter baumannii-induced ventilator-associated pneumonia from January 2017 to December 2018 were enrolled in this study, including 70 cases with pan-drug resistant Acinetobacter baumannii infection served as the pan-drug resistant group and 35 cases with non-pan-drug resistant Acinetobacter baumannii infection served as the control group. The univariate analysis and Logistic regression method were used to explore the risk factors of ventilator-associated pneumonia caused by pan-drug resistant Acinetobacter baumannii. The result of univariate analysis showed that the risk factors of pan-drug resistant Acinetobacter baumannii-induced ventilator-associated pneumonia included tracheotomy, enteral nutrition, the use of carbapenems and use of more than 3 antibiotics before infection. Logistic regression analysis showed that enteral nutrition and the use of carbapenems were independent risk factors of pan-drug resistant Acinetobacter baumannii-induced ventilator-associated pneumonia. In conclusion, enteral malnutrition and the use of carbapenems were the two significant risk factors for pan-drug resistant Acinetobacter baumannii-induced ventilator-associated pneumonia, which are necessary to take active preventive measures in clinical practice.

Risk Factors of Pneumonia Associated with Mechanical Ventilation.

Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5–15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi2 test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP.

Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study

Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute&#x0D; Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done.&#x0D; Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin.&#x0D; Conclusion: Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP.

Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study

Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin. Conclusion: Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP.

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

Study on risk factors of ventilator-associated pneumonia

Objective To investigate the risk factors of ventilator-associated pneumonia in Intensive Care Unit (ICU) patients. Methods A total of 120 patients admitted to ICU of this hospital with invasive ventilator for mechanical ventilation from January 2016 to July 2017 were selected as research objects.According to whether they developed ventilator related pneumonia, they were divided into study group and control group.There were 62 cases of ventilator associated pneumonia in the study group and 58 cases in the control group.The relevant clinical parameters of patients during treatment were recorded, including biochemical index APACHE score for drug use and intubation time. Results Among all patients, there were 52 cases of VAP, 15 cases of early-onset VAP and 47 cases of late-onset VAP.Compared with the control group, the research group was significantly better than of the control group in terms of APACHE score and Glasgow score, with statistically significant differences(P<0.05). Logistic regression results showed that, the age of patients with longer mechanical ventilation time and longer stay in coma, the use of glucocorticoids, acid-inhibiting agents and antibiotics were important risk factors for the development of VAP. Conclusion If patients with invasive ventilator mechanical ventilation do not take scientific preventive measures, it will lead to the occurrence of ventilator-associated pneumonia and even death.The main risk factors of ventilator-associated pneumonia are the older age, mechanical ventilation time and prolonged hospital stay, and the failure to use antibiotics scientifically.Therefore, effective measures can be taken for risk factors, and corresponding preventive measures can be proposed to improve the clinical treatment effect of patients. Key words: Ventilator-associated pneumonia; Mechanical ventilation; Risk factors

Ventilator associated pneumonia due to carbapenem resistant microorganisms in children.

Infections due to carbapenem resistant pathogens have become a major health threat especially for hospitalized patients. Acinetobacter baumanii (AB) and Pseudomonas aeruginosa (PA) are important pathogens causing ventilator-associated pneumonia (VAP) with a trend of high resistance to carbapenems. The aim of this study is to investigate the risk factors for VAP due to carbapenem resistant Acinetobacter baumanii (CRAB) and Pseudomonas aeruginosa (CRPA) in children. Between 2009 and 2013, an active, prospective observational study was conducted in Gazi University Hospital. Patients from Pediatric Intensive Care Unit (PICU), between 1 month and 12 years of age with VAP due to AB and PA were included. During this period, 74 children experienced 126 VAP episodes due to Acinetobacter baumanii (N.=58) and Pseudomonas aeruginosa (N.=68). Among these, 93.1% (N.=54) of AB and 51.5% (N.=35) of PA were carbapenem resistant. In univariate analysis, length of stay in PICU until the diagnosis of VAP, presence of central venous catheters, prior use of cefepime, ciprofloxacin, colistin, and teicoplanin were associated with VAP due to CRPA (P=0.02, P=0.02, P=0.006, P=0.01, P=0.001, and P=0.009 respectively). Significant association was not found between the development of VAP due to CRAB and the investigated risk factors. Regression analyses revealed previous use of cefepime (OR, 2.11; 95% CI, 0.016-0.595, P=0.039) and colistin (OR: 2.33; 95% CI: 0.061-0.789, P=0.023) to be independently associated with VAP due to CRPA. This study suggests that broad spectrum antibiotic usage was the most important risk factor for the development of VAP due to CRPA.

Using flexible methods to determine risk factors for ventilator-associated pneumonia in the Netherlands.

Seven hospitals participated in the Dutch national surveillance for ventilator-associated pneumonia (VAP) and its risk factors. We analysed time-independent and time-dependent risk factors for VAP using the standard Cox regression and the flexible Weighted Cumulative Effects method (WCE) that evaluates both current and past exposures. The prospective surveillance of intensive care patients aged ≥16 years and ventilated ≥48 hours resulted in the inclusion of 940 primary ventilation periods, comprising 7872 ventilation days. The average VAP incidence density was 10.3/1000 ventilation days. Independent risk factors were age (16–40 years at increased risk: HR 2.42 95% confidence interval 1.07–5.50), COPD (HR 0.19 [0.04–0.78]), current sedation score (higher scores at increased risk), current selective oropharyngeal decontamination (HR 0.19 [0.04–0.91]), jet nebulizer (WCE, decreased risk), intravenous antibiotics for selective decontamination of the digestive tract (ivSDD, WCE, decreased risk), and intravenous antibiotics not for SDD (WCE, decreased risk). The protective effect of ivSDD was afforded for 24 days with a delay of 3 days. For some time-dependent variables, the WCE model was preferable over standard Cox proportional hazard regression. The WCE method can furthermore increase insight into the active time frame and possible delay herein of a time-dependent risk factor.

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

Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation.

Purpose: The aim of this study was to verify the potential risk factors of ventilator-associated pneumonia (VAP) in elderly Chinese patients receiving mechanical ventilation (MV). The secondary aim of this study was to present logistical regression prediction models of VAP occurrence in elderly Chinese patients receiving MV.Methods: Patients (aged 80 years or above) receiving MV for ≥48 h were enrolled from the Chinese People’s Liberation Army (PLA) General Hospital from January 2011 to December 2015. A chi-squared test and Mann–Whitney U-test were used to compare the data between participants with VAP and without VAP. Univariate logistic regression models were performed to explore the relationship between risk factors and VAP.Results: A total of 901 patients were included in the study, of which 156 were diagnosed as VAP (17.3%). The incidence density of VAP was 4.25/1,000 ventilator days. Logistic regression analysis showed that the independent risk factors for elderly patients with VAP were COPD (OR =1.526, Pn lt n0.05), intensive care unit (ICU) admission (OR=1.947, Pn lt n0.01), the MV methods (Pn lt n0.023), the number of antibiotics administered (OR=4.947, Pn lt n0.01), the number of central venous catheters (OR=1.809, Pn lt n0.05), the duration of indwelling urinary catheter (OR=1.805, Pn lt n0.01) and the use of corticosteroids prior to MV (OR=1.618, Pn lt n0.05). Logistic regression prediction model of VAP occurrence in the Chinese elderly patients with mechanical ventilation: neqalign{ & {rm{Logit}} left( {rm{P}} right) {rm{ = }} left( {{rm{ - 6}}.{rm{468}}} right){rm{ + 0}}.{rm{423X1 + 0}}.{rm{666X2 + 0}}.{rm{871X3}},{rm{ + }}left( {{rm{ - 0}}.{rm{501}}} right){rm{X5 + 0}}.{rm{122X6 + 0}}.{rm{593X7}} cr & ,,,,,,,,,,,,,,,,,,,,,,,,,,, {rm{ + 0}}.{rm{590X8 + 1}}.{rm{599X9}}. cr} nConclusion: VAP occurrence is associated with a variety of controllable factors including the MV methods and the number of antibiotics administered. A model was established to predict VAP occurrence so that high-risk patients could be identified as early as possible.

Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients.

Ventilator-associated pneumonia (VAP), a hospital acquired pneumonia that occurs more than 48 h after mechanical ventilation, is a common complication of mechanical ventilation with a high mortality rate. VAP can cause patients to have difficulty weaning off the ventilator and to stay in the hospital longer, which results in a huge financial burden to patients and a huge demand for medical resources. Several strategies, such as drugs including chlorhexidine, β-lactam antibiotics and probiotics, have been used to prevent VAP in clinic. The incidence and the mortality rate of VAP have been decreased with the development of preventative strategies in the past decades, but VAP remains one of the most common causes of nosocomial infections and death in the intensive care unit. Current challenges in the management of VAP involved the lack of a gold standard for diagnosis, the absence of effective preventative strategies, and the rise in antibiotic resistance. Therefore, in order to reduce the incidence of VAP and improve the outcome of patients with mechanical ventilation, it is necessary to clarify the risk factors of VAP for clinical prevention and control of VAP. This paper reviews the international risk factors of VAP occurrence reported in recent years, including patient characteristics, increased mechanical ventilation time and prolonged length of hospital stay, disorders of consciousness, burns, comorbidities, prior antibiotic therapy, invasive operations, gene polymorphisms, and mentions the corresponding preventive measures. Each factor is not only an independent risk factor of VAP, but also has an influence on each other. A better understanding of risk factors for VAP is helpful for predicting the occurrence of VAP, improving the prevention and control of VAP, and reducing the morbidity and mortality rates of patients with VAP.

Ventilator-Associated Pneumonia due to Drug-Resistant Acinetobacter baumannii: Risk Factors and Mortality Relation with Resistance Profiles, and Independent Predictors of In-Hospital Mortality.

Background and objectives: High mortality and healthcare costs area associated with ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii (A. baumannii). The data concerning the link between multidrug-resistance of A. baumannii strains and outcomes remains controversial. Therefore, we aimed to identify the relation of risk factors for ventilator-associated pneumonia (VAP) and mortality with the drug resistance profiles of Acinetobacter baumannii (A. baumannii) and independent predictors of in-hospital mortality. Methods: A retrospective ongoing cohort study of 60 patients that were treated for VAP due to drug-resistant A. baumannii in medical-surgical intensive care units (ICU) over a two-year period was conducted. Results: The proportions of multidrug-resistant (MDR), extensively drug-resistant (XDR), and potentially pandrug-resistant (pPDR) A. baumannii were 13.3%, 68.3%, and 18.3%, respectively. The SAPS II scores on ICU admission were 42.6, 48.7, and 49 (p = 0.048); hospital length of stay (LOS) prior to ICU was 0, one, and two days (p = 0.036), prior to mechanical ventilation (MV)—0, 0, and three days (p = 0.013), and carbapenem use prior to VAP—50%, 29.3%, and 18.2% (p = 0.036), respectively. The overall in-hospital mortality rate was 63.3%. In MDR, XDR, and pPDR A. baumannii VAP groups, it was 62.5%, 61.3%, and 72.7% (p = 0.772), respectively. Binary logistic regression analysis showed that female gender (95% OR 5.26; CI: 1.21–22.83), SOFA score on ICU admission (95% OR 1.28; CI: 1.06–1.53), and RBC transfusion (95% OR 5.98; CI: 1.41–25.27) were all independent predictors of in-hospital mortality. Conclusions: The VAP risk factors: higher SAPS II score, increased hospital LOS prior to ICU, and MV were related to the higher resistance profile of A. baumannii. Carbapenem use was found to be associated with the risk of MDR A. baumannii VAP. Mortality due to drug-resistant A. baumannii VAP was high, but it was not associated with the A. baumannii resistance profile. Female gender, SOFA score, and RBC transfusion were found to be independent predictors of in-hospital mortality.

Repositioning of endotracheal tube and risk of ventilator-associated pneumonia among adult patients: A matched case-control study.

INTRODUCTION:Ventilator-associated pneumonia (VAP) is one of the most serious hospital-acquired infections to occur among mechanically ventilated patients. Many risk factors for VAP have been identified in the literature; however, there is a lack of studies examining the association between endotracheal tube (ETT) repositioning and an increase in the risk of VAP. The aim of the present study, therefore, was to investigate the effect of ETT repositioning and the risk of developing VAP.METHODS:Matched case-control studies were conducted among mechanically ventilated patients admitted to the intensive care unit (ICU) at King Abdulaziz Medical City from 2016 to 2018. Patients who had a documented VAP diagnosis were identified and matched to four controls (within a 10-year age band). The history of ETT repositioning (defined as changes in the positioned ETTs from the first reading at the time of ETT insertion) was explored in the medical files of the sample, as were other demographic and comorbidity risk factors. Logistic regression analysis was used to test the association between ETT repositioning and VAP.RESULTS:A total of 24 cases were identified with documented VAP diagnosis during the study. Those cases were matched to 81 controls. The mean age was 55 (standard deviation 21) for both cases and controls. VAP patients had a greater history of ETT repositioning (46%) compared to controls (29%). Patients who had a history of ETT repositioning were twice as likely to develop VAP as patients who had no history of ETT repositioning (P = 0.13). After adjustment of a potential confounder, the results showed evidence of an increased risk of VAP after ETT repositioning (odds ratio 3.1, 95% confidence interval 1.0–9.6).CONCLUSION:Reposition of ETT considers as a risk factor for VAP in ICU patients, and appropriate measures should be applied to reduce movements of the ETT tube.

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.

Exploring Risk Factors with Ventilator Associated Pneumonia among Infants in Intensive Care Units

AbstractBackground: Ventilator Associated Pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after child is intubated and ventilated mechanically; VAP is the second most common hospital-acquired infection in pediatric Intensive Care Units, which linked to increased morbidity, mortality, lengths of stay in the hospital and intensive care unit with high costs.Aim of Study: The current study aimed to explore the risk factors of VAP among infants in Intensive Care Units.Subjects and Methods: A descriptive exploratory design was used to achieve the current study.Setting: The current study conducted at Pediatric Intensive Care Units at Pediatric University Hospital and Specialized Pediatric Hospital which affiliated to Cairo University Hos-pitals.Sample: A convenience sample of 54 mechanically ven-tilated infants for more than 48 hours enrolled in the study.Tools: The required data was collected by using risk factors assessment sheet and standardized observational checklists which consist of three parts: General infection control measures, nasogastric tube feeding and endotracheal tube suctioning.Results: The current study results revealed that, more than half of infants were less than 6 months of age, nearly two-thirds are males, and near to three quarters of infants developed VAP. Prior antibiotic use, sedatives administration, absence of routine oral care, previous non-invasive ventilation, reintubation, length of stay on mechanical ventilation and PICUs, coma, inadequate general infection control measures, inadequate endotracheal tube suctioning technique, supine position, inadequate nasogastric tube feeding technique, presence of nasogastric tube and oral route of endotracheal tube were statistically significant risk factors associated with VAP. More than half of VAP infants died during period of hospitalization.Conclusion: Prior antibiotic use was the only independent risk factor for incidence of VAP; and sedatives administration, absence of routine oral care, previous non-invasive ventilation, reintubation, length of stay on mechanical ventilation and PICUs were the major risk factors of VAP among infants in pediatric Intensive Care Units.Recommendations: Inservice training program should be conducted for pediatric intensive care nurses about prevention of VAP among infants. Also, similar studies should be con-ducted on large sample and different settings.