Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital's Intensive Care Unit: A case-control study

Abstract

BackgroundVentilator-associated pneumonia (VAP) which is an important part of all nosocomial infections in intensive care unit (ICU) is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU.MethodsThis is a-three year retrospective case-control study. The data were collected between 01 January 2000 and 31 December 2002. During the study period, 132 patients were diagnosed as nosocomial pneumonia of 731 adult medical-surgical ICU patients. Of these only 37 VAP patients were assessed, and multiple nosocomially infected patients were excluded from the study. Sixty non-infected ICU patients were chosen as control patients.ResultsMedian length of stay in ICU in patients with VAP and without were 8.0 (IQR: 6.5) and 2.5 (IQR: 2.0) days respectively (P < 0.0001). Respiratory failure (OR, 11.8; 95%, CI, 2.2–62.5; P < 0.004), coma in admission (Glasgow coma scale < 9) (OR, 17.2; 95% CI, 2.7–107.7; P < 0.002), depressed consciousness (OR, 8.8; 95% CI, 2.9–62.5; P < 0.02), enteral feeding (OR, 5.3; 95% CI, 1.0–27.3; P = 0.044) and length of stay (OR, 1.3; 95% CI, 1.0–1.7; P < 0.04) were found as important risk factors. Most commonly isolated microorganism was methicillin resistant Staphylococcus aureus (30.4%). Mortality rates were higher in patients with VAP (70.3%) than the control patients (35.5%) (P < 0.003). Mean cost of patients with and without VAP were 2832.2+/-1329.0 and 868.5+/-428.0 US Dollars respectively (P < 0.0001).ConclusionRespiratory failure, coma, depressed consciousness, enteral feeding and length of stay are independent risk factors for developing VAP. The cost of VAP is approximately five-fold higher than non-infected patients.

Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens

“…This highlights the need for treatment of the VAP cases with second-line antibiotics effective against these MDR pathogens. This finding also emphasises the need for stringent preventive measures for VAP, as the treatment of an established VAP becomes very expensive [22]. Nonfermenters such as Pseudomonas spp.…”

Determination of Frequency of Bacterial Agent Causing Ventilator Associated Pneumonia in the Patients Hospitalized in the Intensive Care Unit of Tonkabon Shahid Rajaei Hospital by PCR Sequencing

“…Results of the studies show that, in majority of patients, VAP is created by the organisms such as S. aureus, H. influenza, S. pneumonia, P. aeroginosa and Entrobacter [6].…”

Costos de neumonia nosocomial en una unidad de cuidados intensivos en Cartagena, Colombia.

“…La razón de costos obtenida guarda relación con la diferencia significativa entre los casos de NAV y los controles en el estudio de Erbay 19 . Del mismo modo, aunque Mathai encontró un costo promedio más alto que Erbay, del orden de US$ 6.250 también en estos casos ese valor es inferior al del estudio actual 20 .…”

“…De igual modo, en el estudio de Erbay 19 los costos que obedecen a la ventilación mecánica, circuitos respiratorios, respiración traqueal y catéteres urinarios, entre otros, representan el 17% del total de costos de atención con este tipo de neumonía similar a lo reportado en el presente estudio.…”

“…Asimismo, el costo en antibióticos en el estudio de Rosenthal 25 en Argentina representa el doble de lo que representa en el costo total mientras que los costos por este rubro estimados por Erbay 19 tienen similar participación en el costo total de atención al encontrado en la presente investigación. Del mismo modo, la razón de uso de antibióticos hallada entre los casos de NAV y los controles supera a la encontrada en estudios en países como Bolivia y Guatemala el cual fue de solo el doble 2 .…”