Case fatality rate related to nosocomial and ventilator-associated pneumonia in an ICU: a single-centre retrospective cohort study

Yalçınsoy, Murat; Saltürk, Cüneyt; Takır, Hurıye Berk; Kutlu, Semra Bati; Oguz, Ayşegul; Aksoy, Emine; Balcı, Merih Kalamanoğlu; Kargın, Feyza; Moçin, Özlem Yazıcıoğlu; Adıgüzel, Nalan; Güngör, Gökay; Karakurt, Zühal

doi:10.1007/s00508-015-0884-6

Cited by 7 publications

(5 citation statements)

References 50 publications

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“…Several factors affect VAP-associated mortality, including the microorganism, comorbid disease, immune response, and the time of VAP onset. Yalçınsoy et al [15] estimated VAP-related mortality as 42% in an adult ICU. Bor et al [16] found that VAP-related in-hospital mortality was 71.4%.…”

Section: (2)mentioning

confidence: 99%

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

et al. 2017

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Objective: The aim of this study was to identify microorganisms causing ventilator-associated pneumonia (VAP) and also study the antibiotic resistance/susceptibility. Materials and Methods:We retrospectively assessed microorganisms isolated from patients diagnosed with VAP in a pediatric intensive care unit between January 1, 2014, and June 30, 2016. Results:We included 44 patients diagnosed with VAP. The prevalence thereof was 8.6 patients per 1,000 ventilator days. Mechanical ventilation was required for 56.5% of patients. Thirty-three patients (75%) died. An underlying chronic disease was detected in 75% of patients (n=33). Fifty microorganisms were isolated from 44 patients. Single microorganisms were isolated from 86.4% (n=38) and two from 13.6% (n=6) of patients. Of all the isolated bacteria, 96% (n=48) were gram-negative; the most common was Pseudomonas aeruginosa (32%), followed by Klebsiella pneumoniae (24%) and Acinetobacter baumannii (22%). The isolates were most susceptible to colistin (92.6%), followed by piperacillin-tazobactam (71.4%), amikacin (65.2%), and gentamicin (52.2%). No enterobacterium or Acinetobacter strain was resistant to colistin; however, 13% of P. aeruginosa isolates were resistant. Conclusion:In VAP, it is essential to catalog antibiotic resistance patterns of bacteria present in the unit to ensure that empirical antibiotic therapy is effective.Keywords: Ventilator-associated pneumonia, pediatric intensive care, microorganism, antibiotic Bulgular: Çalışmaya VİP tanısı alan 44 hasta alındı. VİP hızı 1000 ventilatör gününde 8,6 olarak saptandı. Mekanik ventilatör kullanım oranı %56,5 idi. VİP tanısı alan olguların %75 (n=33)'nin öldüğü saptandı. VİP tanısı alan hastaların %75 (n=33)'inde altta yatan kronik hastalık tespit edildi. VİP tespit edilen 44 olguda 50 mikroorganizma izole edildi. Olguların %86,4'nda (n=38) tek mikroorganizma, %13.6 (n=6)'nda iki mikroorganizma etken olarak izole edildi. İzole edilen suşların %96' sının (n=48) gram negatif bakteri olduğu saptandı. Çalış-mamızda en sık izole edilen gram negatif ajan Pseudomonas Aeruginosa (%32) iken bunu Klebsiella pneumonia (%24) ve Acinetobacter baumannii (%22) izlemekte idi. Genel antibiyotik duyarlılığı incelendiğinde mikroorganizmaların en hassas olduğu antibiyotikler sırasıyla Kolistin (%92,6), Piperasilin-tazobaktam (% 71,4), Amikasin (%65,2) ve Gentamisin (%52,2) olarak saptandı. Enterobacteriaceae ve Acinetobacter suşlarında Kolistin direnci görülmezken P. aeruginosa izolatlarında, kolistin direnci %13 olarak saptandı.Sonuç: Ventilatör ilişkili pnömonidee, etkili ampirik antibiyotik tedavisi için her ünitenin kendi florasının direnç özelliklerini bilmesi gerekmektedir.Anahtar Kelimeler: Ventilatör ilişkili pnömoni, çocuk yoğun bakım, mikroorganizma, antibiyotik Eurasian J Med

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Section: (2)mentioning

confidence: 99%

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

et al. 2017

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“…This allows us to infer, considering the factors "unconsciousness" and "MV time", that these dysfunctions could have been associated with the development of VAP in the subjects of this study [33]. Specifically, the Chronic Obstructive Pulmonary Disease and the presence of septic shock are independently associated with a lower survival rate, in other words, a higher mortality rate [35].…”

Section: Discussionmentioning

confidence: 90%

Clinical outcomes related to the incidence of ventilator-associated pneumonia in adults - a cohort study

et al. 2018

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Introduction: Ventilator-Associated Pneumonia (VAP) is a common complication found in the Intensive Care Unit (ICU) and is associated with increased mortality, length of hospital stay and mechanical ventilation (MV) time. Objective: To determine the incidence of VAP and its impact on the clinical course of the subject undergoing invasive MV in the ICU. Methods: This is a cohort study of hospitalized subjects in the general adult ICU of the State Hospital of Bauru / SP. The clinical information for the period of 19 months were collected. Stratification for the groups was based on the presence or absence of VAP, free_VAP and VAP, respectively. The Hotelling T² with 95% confidence, chi-square and the Mann-Whitney tests were executed using the "R" software and the results showed as mean ± standard deviation and absolute and relative distribution (p < 0.05). Results: The sample was of 322 subjects; the VAP group consisted of 73 (22.67%), 54.79% male, age: 62.31±16.96 years and the APACHE II: 29.98 ± 8.64. The VAP group had longer time of the MV and of the ICU compared to free VAP group; even in this group, the highest incidence of death in the ICU occurred between the 16th and 20th day of hospitalization. The free VAP group was older and 50% of the patients discharged from hospital. Conclusion: VAP and their interfaces still impact on the clinical evolution of the subjects mainly on the time factor of MV and ICU stay. The highest incidence of death in the ICU occurs in the first weeks.

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“…Some studies have described Gram-negative bacilli as the most common group of VAP-associated pathogens, accounting for over 50% of cases; Acinetobacter baumannii , Pseudomonas aeruginosa , in addition to S. aureus [ 4 , 12 ]. We found that 95% of Gram-negative bacteria in this series were Klebsiella spp., P. aeruginosa , Enterobacter spp., and E. coli the most common pathogens.…”

Section: Discussionmentioning

confidence: 99%

“…MDRB strains have been related with widespread use of antimicrobials, prolonged use of MV, longer length of hospitalization, and prior antibiotic therapy[ 12 ]. In this study, only longer ICU stay was more frequent in patients with these bacteria ( P = 0.02).…”

Section: Discussionmentioning

confidence: 99%

Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

Cornejo‐Juárez

González-Oros

Mota-Castañeda

et al. 2020

WJCCM

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BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation (MV). The emergence of multidrug resistant bacteria (MDRB) has become a public health problem, creating a new burden on medical care in hospitals, particularly for patients admitted to the intensive care unit (ICU). AIM To describe risk factors for ventilator-acquired pneumonia (VAP) in patients with cancer and to evaluate the impact of MDRB. METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City, which included all patients who were admitted to the ICU and required MV ≥ 48 h. They were classified as those who developed VAP versus those who did not; pathogens isolated, including MDRB. Clinical evolution at 60-d was assessed. Descriptive analysis was carried out; comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB. RESULTS Two hundred sixty-three patients were included in the study; mean age was 51.9 years; 52.1% were male; 68.4% had solid tumors. There were 32 episodes of VAP with a rate of 12.2%; 11.5 episodes/1000 ventilation-days. The most frequent bacteria isolated were the following: Klebsiella spp. [ n = 9, four were Extended-Spectrum Beta-Lactamase (ESBL) producers, one was Carbapenem-resistant (CR)]; Escherichia coli ( n = 5, one was ESBL), and P se udomonas aeruginosa ( n = 8, two were CR). One Methicillin-susceptible Staphylococcus aureus was identified. In multivariate analysis, the sole risk factor associated for VAP was length of ICU stay (OR = 1.1; 95%CI: 1.03-1.17; P = 0.003). Sixty-day mortality was 53% in VAP and 43% without VAP ( P = 0.342). There was not higher mortality in those patients with MDRB. CONCLUSION This study highlights the high percentage of Gram-negative bacteria, which allows the initiation of empiric antibiotic coverage for these pathogens. In this retrospective, single center, observational study, MDRB VAP was not directly linked to increased mortality at 60 days.

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Case fatality rate related to nosocomial and ventilator-associated pneumonia in an ICU: a single-centre retrospective cohort study

Cited by 7 publications

References 50 publications

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

Clinical outcomes related to the incidence of ventilator-associated pneumonia in adults - a cohort study

Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

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