Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand

Abstract

Background: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (16.7% VS 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95% confidence interval (CI), 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.

Co-immobilization of ciprofloxacin and chlorhexidine as a long-term, broad-spectrum antimicrobial dual-drug coating for polyvinyl chloride (PVC)-based endotracheal tubes

“…VAP is the commonest life-threatening nosocomial infection in the developed world accounting for an estimated 22% of prevalence [13], and contributing to up to 50% of all cases in ICUs [14]. Its discrepant morbidity/mortality rates (16-44%) ICU/hospital length of stay (13-26.6 days) [15][16][17], and incidence range (11-84%) [16,18], with ICU antibiotic prescriptions nearby 50%, are all alarming indicators of clear action needed. Given the difficulties associated with finding an effective treatment for VAP, reducing ETT bioburden through ETT surface` modification is likely the most suitable approach to avoid VAP.…”