Ventilator-associated pneumonia in an adult clinical-surgical intensive care unit of a Brazilian university hospital: incidence, risk factors, etiology, and antibiotic resistance

Abstract

The objective of this study was to evaluate clinical characteristics, etiology, and resistance to antimicrobial agents, among patients with ventilator-associated pneumonia (VAP). A case study vs. patients control under mechanical ventilation and hospitalized into clinical-surgical adults ICU of HC-UFU was performed from March/2005 to March/2006. Patients under ventilation for over 48 h were included in the study including 84 with diagnosis of VAP, and 191 without VAP (control group). Laboratory diagnosis was carried out through quantitative microbiological evaluation of tracheal aspirate. The identification of pathogens was performed by classical microbiological tests, and the antibiotics sensitivity spectrum was determined through the CLSI technique. VAP incidence rate over 1,000 days of ventilation was 24.59. The mean (+/- SD) duration of mechanical ventilation prior to VAP diagnosis was 23.2 +/- 17.2 days. By multivariate analysis the risk factors predisposing for VAP were: mechanical ventilation time and mechanical ventilation > seven days, tracheostomy and use of > or = three antibiotics. Mortality rate was high (32.1 %) but lower than that of the control group (46.5%). Major pathogens were identified in most of patients (95.2%) and included: Pseudomonas aeruginosa (29%), Staphylococcus aureus (26%), Enterobacter/Klebsiella/Serratia (19%) and Acinetobacter spp. (18%), with expressive frequencies of P. aeruginosa (52%), S. aureus (65.4%) and Enterobacteriaceae (43.7%) resistant to imipenem, oxacillin and 3/4 generation cephalosporins, respectively. In conclusion, our observation showed VAPs caused by multiresistant microorganisms, the prescription of > or = three antibiotics, and mortality with unacceptably high rates. The practice of de-escalation therapy appears to be urgently needed in order to improve the situation.

The Impact of Tracheotomy on the Clinicalcourse of Ventilator-Associated Pneumonia

“…Although many studies have shown tracheotomy to be a major risk factor for VAP development [13][14][15][16][17][18][19] , our study results do not support that claim. Our data suggest that lower VAP incidences are to be expected in tracheotomized patients.…”

“…The impact of tracheotomy on the development of VAP is not clearly defined. Some studies found decreases in VAP rates in patients having tracheotomy [6][7][8][9][10][11][12] , others have reported tracheotomy to be a risk factor favoring VAP onset [13][14][15][16][17][18][19][20] , while some could not demonstrate any VAP-related impact whatsoever [21][22][23][24] . Because of the conflicting literature data, there is currently no consensus on tracheotomy as either a VAP-protective or VAP-causative factor 5 .…”

Ventilator-Associated Pneumonia (VAP): Clinical Strategies, Treatment Challenges and Economic Concerns

“…The decision of perspective from which the analysis should be conducted, is an important consideration in pharmacoeconomic analysis. At present the pharmacoeconomic evaluation is valuable in individual patient treatment, total cost of care, resource allocation, and effective formulary management [29][30][31].…”

Fatores De Risco Modificáveis Para Pneumonia Associada À Ventilação Mecânica Em Terapia Intensiva

“…5,7 Outros estudos indicaram que a manutenção do paciente em prótese ventilatória de sete a doze dias eleva a suscetibilidade para o desenvolvimento de PAV, principalmente aqueles que se encontram traqueostomizados. [9][10][11] Assim, o tratamento intensivo por si só mostra-se um risco. E a probabilidade aumenta quando há a necessidade de transporte, que gera manuseio excessivo do paciente podendo levar à instabilidade do tubo orotraqueal ou da cânula de traqueostomia.…”