Epidemiological and microbiological analysis of ventilator-associated pneumonia patients in a public teaching hospital

Abstract

Ventilator-associated pneumonia (VAP) is the most commonly-acquired infection in patients in intensive care units. We analyzed epidemiological and microbiological characteristics and the outcome, in a cohort of criticallyill patients with confirmed diagnosis of VAP. All patients who had been on mechanical ventilation (MV) for more than 48 hours were included in our study; material collection for microbiological analysis was done within the first 24 hours after beginning treatment or after changing antibiotics. There were 55/265 (20.7%) VAP cases diagnosed, at a rate of 21.6 episodes per 1,000 days of mechanical ventilation. Mean age of the patients was 66 years, with a mean APACHE II score of 26.7 + 7.0; male patients were more prevalent. The mortality rates in the intensive care unit (ICU) and during the hospital stay were 71% and 80%, respectively. MV duration in patients with VAP was 17 (range 3-43) days and among patients who had not developed VAP, 6 (2-32) days (p < 0.0001). 98.2% of the samples were positive, with a high prevalence of Gram-negative bacteria, mainly Acinetobacter calcoaceticus. Risk factors for death included age, MV duration and surgery. VAP incidence in this sample of critically-ill patients was high, with a high mortality rate. Control and prevention strategies based on continuing education of healthcare workers, developed by a multidisciplinary team, should be encouraged to minimize morbimortality of this infection.

Epidemiology and outcomes of ventilator-associated pneumonia in northern Brazil: an analytical descriptive prospective cohort study

“…The mortality rate found in patients undergoing VAP in a few studies performed in Brazil varies between 32.1% and 70.9% [18-21], which agrees with a review by Chastre and Fagon who reported rates from 24% to 76% [6]. The present study found a higher rate of mortality (78.8%) than previous studies, and that comorbidity was the only variable significantly associated with mortality in VAP patients.…”

“…Among Gram-positive bacteria, S. aureus is the predominant agent in VAP cases [4,10,11,22]. Results from Latin American studies are similar to ones obtained in this study [18,20,21,23,24]. S. maltophilia has also been frequently described in VAP cases [11,13].…”

Risk factors for acquisition of ventilator-associated pneumonia in adult intensive care units

“…Meanwhile, history of antibiotic exposure and duration of mechanical ventilation are involved. 3 VAP is also associated with considerable morbidity, including prolonged ICU hospitalization, extended mechanical ventilation and increased costs of hospitalization. 4 Risk of VAP will be significantly increased up to 1-3% in intubated patients for each day requirement for mechanical ventilation.…”

Pneumonia associada à ventilação mecânica: Impacto da resistência bacteriana, dos erros de prescrição e descalonamento de antimicrobianos na mortalidade

“…O predomínio do sexo masculino também foi encontrado em uma série de estudos que também realizaram um levantamento de gênero de pacientes internados em Unidade de Terapia Intensiva com diagnóstico de PAV (HEYLAND et al, 1999;CARNEIRO et al, 2011, PISKIN et al, 2012CHAARI et al, 2013;AVARNITIS et al, 2014). A desproporção do sexo masculino (3 homens para cada mulher), também foi evidenciada em outras UTI (RELLO et al, 2002;SILVA JUNIOR et al, 2007;AVARNITIS et al, 2014), sendo este dado provavelmente explicado pelo fato destes hospitais, assim como o Hospital de Clínicas da Universidade Federal de Uberlândia, serem referência em trauma, ocorrência que ocorre predominantemente no sexo masculino.…”

“…A idade média dos pacientes encontrada no presente estudo de aproximadamente 49 anos, foi também evidenciada em uma série de outros estudos de pacientes com PAV (SILVA et al, 2011;MEDELL et al, 2012;RESTREPO et al, 2013). No estudo descritivo observacional realizado por Medell et al (2012) de caracterização de pacientes com PAV verificaram média de idade mais elevada de 55 anos, diferentes de outros com média ainda superior de 66 anos ( SILVA JUNIOR et al, 2007), 63 anos (PISKIN et al, 2012) e 79 anos (HEYLAND et al, 1999, RODRIGUES et al, 2009. A diferença de idades ocorre pelas características próprias de cada população e região no qual os dados foram coletados (RODRIGUES et al, 2009).…”