Ventilator-Associated Pneumonia in a Neurologic Intensive Care Unit Does Not Lead to Increased Mortality

Josephson, S. Andrew; Moheet, Asma M.; Gropper, Michael A.; Nichols, Amy; Smith, Wade S.

doi:10.1007/s12028-009-9285-x

Cited by 18 publications

(17 citation statements)

References 16 publications

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“…Clinical SAP studies used a wide range of criteria to define SAP starting from the Center of Disease Control and Prevention criteria to investigating ventilator-associated pneumonia after stroke to reviewing patients' diagnosis from the charts [1,5,12]. We will use the Center of Disease Control and Prevention criteria to define nosocomial pneumonia [13], as they are the most widely used ones among the studies [14,15]. According to these criteria, health care-associated pneumonia is classified into 3 categories: clinically defined pneumonia, pneumonia with common bacterial or filamentous fungal pathogens and specific laboratory findings and pneumonia in immunocompromised patients.…”

Section: Definitions and General Termsmentioning

confidence: 99%

“…Overall, cultures often remain negative without bacterial growth [15,48]. Staphylococcus aureus which resides in the nasal cavity, and aerobic Gram-negative bacilli including Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were the most frequently isolated pathogens in the studies identified by our search [11,14,15,23,48,49,50,51]. These findings are consistent with the results of a recent meta-analysis of stroke-associated infections which often showed negative cultures or the same above-isolated pathogens in addition to Escherichia coli and Enterococcus species, while Streptococcus species were occasionally isolated [52].…”

Section: Microbiologic Datamentioning

confidence: 99%

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Stroke-Associated Pneumonia: Major Advances and Obstacles

et al. 2013

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Background: Stroke-associated pneumonia (SAP) has been implicated in the morbidity, mortality and increased medical cost after acute ischemic stroke. The annual cost of SAP during hospitalization in the United States approaches USD 459 million. The incidence and prognosis of SAP among intensive care unit (ICU) patients have not been thoroughly investigated. We reviewed the pathophysiology, microbiology, incidence, risk factors, outcomes and prophylaxis of SAP with special attention to ICU studies. Methods: To determine the incidence, risk factors and prognosis of acute SAP, PubMed was searched using the terms ‘pneumonia' AND ‘neurology intensive unit' and the MeSH terms ‘stroke' AND ‘pneumonia'. Non-English literature, case reports and chronic SAP studies were excluded. Studies were classified into 5 categories according to the setting they were performed in: neurological intensive care units (NICUs), medical intensive care units (MICUs), stroke units, mixed studies combining more than one setting or when the settings were not specified and rehabilitation studies. Results: The incidences of SAP in the following settings were: NICUs 4.1-56.6%, MICUs 17-50%, stroke units 3.9-44%, mixed studies 3.9-23.8% and rehabilitation 3.2-11%. The majority of NICU and MICU studies were heterogeneous including different neurovascular diseases, which partly explains the wide range of SAP incidence. The higher incidence in the majority of ICU studies compared to stroke units or acute floor studies is likely explained by the presence of mechanical ventilation, higher stroke severity causing higher rates of aspiration and stroke-induced immunodepression among ICU patients. The short-term mortality of SAP was increased among the mixed and stroke unit studies ranging between 10.1 and 37.3%. SAP was associated with worse functional outcome in the majority of stroke unit and floor studies. Mortality was less consistent among NICU and MICU studies. This difference could be due to the heterogeneity of ICU studies and the effect of small sample size or other independent risk factors for mortality such as the larger neurological deficit, mechanical ventilation, and age, which may simultaneously increase the risk of SAP and mortality confounding the outcomes of SAP itself. The pathophysiology of SAP is likely explained by aspiration combined with stroke-induced immunodepression through complex humeral and neural pathways that include the hypothalamic-pituitary-adrenal axis, parasympathetic and sympathetic systems. Conclusions: A unified definition of SAP, strict inclusion criteria, and the presence of a long-term follow-up need to be applied to the future prospective studies to better identify the incidence and prognosis of SAP, especially among ICU patients.

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Section: Definitions and General Termsmentioning

confidence: 99%

Section: Microbiologic Datamentioning

confidence: 99%

Stroke-Associated Pneumonia: Major Advances and Obstacles

et al. 2013

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“…In the present study, the VAP patients had significantly (P<0/005) longer ICU stay, longer mechanical ventilation time, and longer intubation time compared to the non-VAP patients, nevertheless, there was no statistically significant difference between the two groups regarding mortality rate, indicating that VAP has not caused any increase in the mortality rate of traumatic in-patients in ICUs. In the study by Josephson et al (2009) conducted in ICU of neurology, VAP did not increase mortality rate of this group of patients, but it increased the length of ICU stay during mechanical ventilation.10 In our study, the VAP patients had greater repeated intratracheal intubation compared to the non-VAP group (51.1% vs. 17.8%) which was statistically significant (P=0.000). This may not be merely due to the nature of VAP; since the VAP patients have longer intubation and mechanical ventilation times, this may be attributed to this subject.…”

Section: Ap Ache IImentioning

confidence: 46%

“…Hence, it is mandatory to determine vividly the rate of incidence and the relation between VAP and mortality in ICUs, specifically surgical ICUs, so that with prompt and suitable diagnosis and treatment, the rate of mortality could be reduced in critical wards and the time of ICU stay and costs would be decreased. [8][9][10][11] Considering the significance of the issue , the researchers decided to determine the correlation between VAP and mortality rate in traumatic in-patients in the ICUs of Be'that Hospital in Hamedan, Iran.…”

Section: Introductionmentioning

confidence: 99%

A study of the correlation between ventilator associated pneumonia and mortality rate of traumatic in patients in intensive care units

2015

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“…Neurosurgical patients are at risk of developing VAP and other nosocomial infections in ICU due to serious nature of their illnesses and the use of invasive devices. 19,20 Hence, it is important to assess the practice of antibiotic de-escalation and how it is executed in neurosurgical patients. We designed a study to examine the practice of antibiotic de-escalation in neurosurgical patients diagnosed with VAP in ICU and the outcome on ICU-mortality and 28-day mortality.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic De-escalation Therapy in Neurosurgical Patients with Ventilator-Associated Pneumonia in Intensive Care Unit: A Retrospective Observational Study

Khan¹,

Aziz²

2017

IJPER

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Context: Antibiotic de-escalation practice is gaining interest in the intensive care units (ICU). However, there is limited evidence to support this approach in neurosurgical patients with Ventilator-Associated Pneumonia (VAP) in ICU. Aims: This study examined the practice of antibiotic de-escalation in neurosurgical patients with VAP in ICU and its impact on mortality. Settings and Design: Retrospective cross-sectional study conducted in an ICU of a public hospital in Malaysia. Methods and Material: The electronic medical records of the patients diagnosed with VAP in the ICU were retrieved and relevant data was collected for analysis. Statistical analysis used: Mann-Whitney U-test and ChiSquare Test were used to compare the differences of continuous and categorical data while Logistic Regression and Cox Regression were used to estimate the influence of de-escalation on mortality. Results: Of the 125 VAP patients identified, only 53 (42.4%) were neurosurgical patients. The mean age of these patients was 40.5±15.3 years old. The patients mainly had late-onset VAP. The most common organisms identified included Pseudomonas aeruginosa (19.6%) and Acinetobacter Multidrug-Resistant Organisms (17.9%) while the most commonly used empirical antibiotic was Cefepime (32%). The proportion of patients with antibiotic de-escalation (10 out of 53) was statistically lower than patients without antibiotic de-escalation (43 out of 53). There was no statistically significant difference in ICU-mortality between the de-escalation (2 out of 10) and non-deescalation groups (6 out of 43). Similarly, for the 28-day mortality and survival analysis, no significant difference was found between the two groups. Conclusions: Antibiotic de-escalation practice in neurosurgical patients with VAP in ICU was not associated with a deleterious effect on survival.

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Ventilator-Associated Pneumonia in a Neurologic Intensive Care Unit Does Not Lead to Increased Mortality

Abstract: VAP in neurocritical care patients is associated with increased LOS and ventilator hours, but is not associated with increased mortality, contrary to prior studies in medical ICU patients.

Cited by 18 publications

References 16 publications

Stroke-Associated Pneumonia: Major Advances and Obstacles

Stroke-Associated Pneumonia: Major Advances and Obstacles

A study of the correlation between ventilator associated pneumonia and mortality rate of traumatic in patients in intensive care units

Antibiotic De-escalation Therapy in Neurosurgical Patients with Ventilator-Associated Pneumonia in Intensive Care Unit: A Retrospective Observational Study

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