Natural History, Outcomes and Antibiotic Treatment for Ventilator-Associated Tracheobronchitis in Critical Ill Patients

Abstract

We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventilator days. We also examined pathogens, rate of progression from VAT to VAP, and impact of antibiotic therapy for VAT. Data analysis included 234 patients, 100 patients (43%) had at least moderate (+++) bacterial growth in their semi-quantitative endotracheal aspirate (SQ-ETA) cultures. VAT and VAP were each diagnosed in 34 (15%) patients. Staphylococcus aureus was the most common pathogen isolated and had the highest rate of progression from VAT to VAP. Seven (21%) of the 34 patients were diagnosed with VAT that later progressed to VAP in averaged 3 days. Patients diagnosed with VAT had significantly more ventilator days (9 vs 6, p < 0.001), ICU days (17 vs 11, p < 0.001) and hospital days (22 vs 17, p < 0.001). No significant difference was observed in the clinical outcomes of the 25 VAT patients with timely, appropriate antibiotics compared to the 9 VAT patients who did not receive timely appropriate antibiotics. VAT was a risk factor for increased ventilator days, longer length of ICU and hospital stay. The time window from VAT to VAP allowed physicians to identify the pathogens and sensitivity profile needed to treat VAT with appropriate antibiotics. Data from well-designed studies were needed to assess the impact of early, appropriate antibiotic therapy for VAT, the choice of antibiotics, as well * Corresponding author. Y. X. Lei et al. 2 as the duration and route of administration.

Frequency, Etiology, Mortality, Cost, and Prevention of Respiratory Tract Infections—Prospective, One Center Study

“…Monitoring of lower respiratory tract infections (VAT) in our hospital is a routine procedure; however, this type of infection is not included in international registers of infections such as ECDC, INICC, or the National Healthcare Safety Network (NHSN) regarding monitoring DA-HAIs in the ICU [9,12,16,30]. Published studies indicate that the frequency of VAT occurred in 7-18% of patients treated in the ICU [25,31] (higher than in our study), and the occurrence of this infection prolonged the duration of ventilation and treatment in the ICU [32]. Another promising international study in this area is the ENIRRIs project, which defines, enrolls, and analyzes RTIs from specific epidemiological, clinical, and microbiological perspectives, but the results have not been published yet [24].…”

“…Similarly, it was found in early published studies from our center, where Acinetobacter baumannii was responsible for 53.3% of VAP cases and showed an upward trend in 2011-2017 [40]. Differentiation in terms of pathogens of pulmonary infections in different countries is shown in the ECDC registry, where the dominant role in pneumonia in most European hospitals is Pseudomonas aeruginosa strain [16], while Gram-positive bacteria (GPB) MRSA and MSSA dominated in the pathogenesis of VAP and VAT in patients treated in the USA [17,25]. The percentage of multidrug-resistant strains among GNB responsible for RTI in our study is in line with the global trend of MDR infections [17,41].…”

“…VAP was diagnosed on the basis of the presence of purulent bronchial secretion and microbiological examination (mini-BAL [mini bronchoalveolar lavage] or BAL [bronchoalveolar lavage] ≥ 10 4 CFU/mL, changes in the chest X-ray examination, characteristic auscultatory changes (rales, crackles). VAT was diagnosed on the basis of auscultatory changes (wheezing), purulent discharge from the bronchial tree, microbiological examination as in pneumonia, and no changes in the lungs on chest X-ray [25]. The initial microbiological diagnosis of bronchial secretions was a PCR multitest for 20 respiratory pathogens (FilmARRAY respiratory Panel, BioFire Diagnostics, Salt Lake City, UT, USA).…”

Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review

“…Patients developing VAT or VAP may present significant increases in the ventilator, ICU, and hospital days. Compared to VAT, VAP presents more serious morbidity and has been associated with mortality [7,8].…”

“…Both VAP and VAT significantly affect patient outcomes because they increase the duration of mechanical ventilation, length of intensive care unit (ICU) stay, similarly to pneumonia, and healthcare costs, provoking antimicrobial resistance due to increased antibiotic consumption [4,5]; VAP has been significantly associated with increased morbidity and mortality in critically ill ICU patients in various studies [4,[6][7][8][9][10].…”