Risk Factors for Early-onset, Ventilator-associated Pneumonia in Critical Care Patients

Akça, Ozan; Koltka, Kemalettin; Uzel, Serdar; Çakar, Nahit; Pembeci, Kamil; Sayan, Mehmet A.; Tütüncü, Ahmet; Karakas, Serife Eti; Çalangu, Semra; Özkan, Türker; Esen, Figen; Telci, Lütfi; Sessler, Daniel I.; Akpir, K.

doi:10.1097/00000542-200009000-00011

Cited by 86 publications

(40 citation statements)

References 1 publication

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“…24 In unselected populations of mixed ICU patients, an incidence of early-onset pneumonia between 5% and 25% has usually been reported. [25][26][27][28][29] Our rate of 15.5% among liver recipients agrees with previously reported rates of pneumonia after LT ranging from 5% to 34%. [4][5][6][7][8][9][10]30 Two recent studies showed a rate of pneumonia of 21.1% in liver recipients receiving a 3-day prophylactic regimen of CTX and ampicillin and a rate of 18% in living donor-related recipients receiving selective digestive decontamination.…”

Section: Discussionsupporting

confidence: 92%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum b-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed. Orthotopic liver transplantation (LT) is a widely accepted treatment for patients with end-stage liver disease. Despite global improvements in survival over the last few decades, sepsis remains the leading cause of early postoperative mortality. 1,2 Lower respiratory tract infections are a major concern in this context.

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Section: Discussionsupporting

confidence: 92%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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“…The need for reintubation is a risk factor for the development of pulmonary infection (5,18,19) because it favors bronchoaspiration and alterations in mucociliary clearance, which may lead to bacterial contamination and colonization of the airways (14,20). Also, extubation failure is directly related to altered level of consciousness (2), probably due to the fact that patients with a lower level of consciousness exhibit large amounts of secretions, cough deficiency and swallowing deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of the occurrence of extubation failure, patients with neurological disorders are usually susceptible to pulmonary complications with pneumonia being the most frequent condition (7,19,(21)(22)(23). Respiratory infection also occurs frequently after surgery and especially after neurosurgery (9,24-27).…”

Section: Discussionmentioning

confidence: 99%

Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery

Vidotto

Sogame

Gazzotti

et al. 2011

Braz J Med Biol Res

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48 h) until discharge from the hospital or death. The occurrence of PPC, incidence of death, the need for reoperation and tracheostomy, and the length of hospitalization were assessed during the postoperative period. Twenty-six patients (8.2%) experienced extubation failure and 30 (9.5%) needed prolonged MV after surgery. Multivariate analysis showed that extubation failure was significant for the occurrence of death (OR = 8.05 [1.88; 34.36]), PPC (OR = 11.18 [2.27; 55.02]) and tracheostomy (OR = 7.8 [1.12; 55.07]). Prolonged MV was significant only for the occurrence of PPC (OR = 4.87 [1.3; 18.18]). Elective intracranial surgery patients who experienced extubation failure or required prolonged MV had a higher incidence of PPC, reoperation and tracheostomy and required a longer period of time in the ICU. Level of consciousness and extubation failure were associated with death and PPC. Patients who required prolonged MV had a higher incidence of extubation failure.]]>

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“…In patients with a decreased level of consciousness, conditions are created that encourage the aspiration of germs to the lower airways, causing pneumonia. In a study using multivariate analyses, Akca et al [1] identified a decrease in the level of consciousness (OR = 3.9) and the aspiration of large volumes (OR = 12.7) among other factors responsible for hospital-acquired pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…These infections are among the main causes of in-hospital morbidity and mortality, and result in a significant increase in the mean duration of hospitalization and consequently in higher cost [1].…”

mentioning

confidence: 99%

Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units

Carrilho¹,

Grion²,

Bonametti³

et al. 2007

Braz J Infect Dis

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Pneumonia is the most frequent hospital infection in patients admitted to intensive care units (ICU) and is also responsible for the highest lethality rates, as well as an increase in both the duration and costs of hospitalization. The objective of this study was to identify predisposing factors for pneumonia. A prospective cohort study was carried out between June 1996 and June 1997, and included 540 patients admitted consecutively for periods greater than 24 hours to the adult ICU of the Londrina State University's Teaching Hospital. Of these, 83 (15.4%) developed pneumonia. All patients were analyzed with respect to various risk factors for hospital-acquired pneumonia. Univariate analysis identified the following factors: decreased level of consciousness, craniotomy, prior use of antibiotics, mechanical ventilation, nasogastric tube feeding, enteral feeding, aspiration of gastric contents, central venous catheter and the time spent in the ICU. Multivariate analysis identified four risk factors for pneumonia in the ICU: tracheotomy (RR = 1.09; 95%CI = 1.04-1.17), nasogastric tube feeding (RR = 1.11; 95%CI = 1.05-1.18), H2-blocker use (RR = 1.09; 95%CI = 1.05-1.14) and decreased level of consciousness (RR = 2.67; 95%CI = 1.43-5.04). In 56.6% of patients, pneumonia occurred within the first four days following ICU admission. The risk factors identified were all necessary for the treatment of the patient except for decreased level of consciousness, either present at admission or occurring during hospitalization due to deterioration in the clinical condition of the patient or to the use of sedatives.

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Risk Factors for Early-onset, Ventilator-associated Pneumonia in Critical Care Patients

Cited by 86 publications

References 1 publication

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery

Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units

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