Determinants and Prognosis of Ventilator-Associated Pneumonia PDF

Determinants and Prognosis of Ventilator-Associated Pneumonia Results Risk Factors \- Prior steroid use was significantly more common in VAP patients (19.2%) compared to controls (1.9%). Steroids suppress the immune system and increase pneumonia risk. \- Reintubation occurred more frequently amo...

Determinants and Prognosis of Ventilator-Associated Pneumonia Results Risk Factors \- Prior steroid use was significantly more common in VAP patients (19.2%) compared to controls (1.9%). Steroids suppress the immune system and increase pneumonia risk. \- Reintubation occurred more frequently among VAP patients (17.3%) versus controls (1.9%). Reintubation can introduce bacteria into the lungs. \- Bacteremia was also more prevalent in the VAP group (28.8%) compared to controls (3.8%). This could be either a cause or consequence of VAP. Microbiology \- Acinetobacter was the most common organism, isolated from 50% of VAP patients. It was more associated with late-onset VAP. \- Klebsiella was the second most common organism, found in 42.3% of VAP patients. \- Pseudomonas caused 40.4% of VAP cases, more often in late-onset VAP. \- 76.9% of all isolates were multidrug resistant. Even early onset VAP had a very high resistance rate of 70.4%. \- 84.5% of Acinetobacter isolates were multidrug resistant, showing extremely high resistance. In summary, VAP was linked to steroid use, reintubation, and bacteremia. Extremely high resistance rates were found. VAP increased duration of ventilation and ICU stay but overall mortality was unchanged, except for higher deaths with resistant Pseudomonas Inclusion Criteria: \- Patients aged 18 years or older \- On mechanical ventilation \- Developed pneumonia after 48 hours of ventilation (for VAP cases) \- Matched on APACHE II score (±5 points) \- Matched on duration of ventilation prior to VAP onset (for controls) Exclusion Criteria: \- Patients with pneumonia prior to starting mechanical ventilation \- Patients who developed pneumonia within 48 hours of ventilation \- The exclusion criteria aimed to isolate patients who developed ventilator-associated pneumonia (VAP) versus community-acquired or hospital-acquired pneumonia not related to the ventilator. \- Matching on APACHE II score and ventilation duration prior to VAP aimed to control for severity of illness and exposure time on the ventilator when selecting the control group. In summary, the inclusion criteria identified adult patients on mechanical ventilation who developed VAP after 48 hours. The exclusion criteria excluded patients with pneumonia not associated with ventilation. Matching criteria were used to select comparable control patients without VAP. Methodology \- Case-control study conducted at a tertiary care hospital in India from 2009-2011. \- 52 patients who developed VAP after 48 hours of mechanical ventilation were identified as cases. \- 52 control patients were matched to cases based on APACHE II score (±5 points) and duration of ventilation prior to VAP onset. \- Data collected included demographics, diagnosis, risk factors, clinical findings, microbiological testing, chest x-rays, ventilation duration, ICU length of stay, and mortality. \- VAP was defined clinically as new infiltrates on chest x-ray plus 2 of: fever, leukocytosis, purulent secretions. \- Early VAP was defined as occurring within 96 hours and late VAP after 96 hours. \- Multidrug resistance was defined as resistance to 3 or more antibiotic classes. Outcomes \- Median onset of VAP was 4 days after intubation. 51.9% of cases were early VAP. \- Prior steroid use (19.2% vs 1.9%, p=0.004), reintubation (17.3% vs 1.9%, p=0.021), and bacteremia (28.8% vs 3.8%, p=0.002) were associated with VAP. \- 76.9% of isolates were multidrug resistant. Late VAP had higher resistance rates. \- Most common organisms were Acinetobacter (50%), Klebsiella (42.3%), and Pseudomonas (40.4%). \- Duration of ventilation (16.1 vs 11 days, p=0.001) and ICU stay (22.7 vs 17 days, p=0.049) were longer in VAP patients. \- Mortality was similar between VAP and non-VAP groups (36.5% vs 36.5%). \- Multidrug resistant Pseudomonas was associated with higher mortality risk. In summary, this case-control study found very high rates of multidrug resistant VAP, with risk factors identified. VAP was associated with increased healthcare utilization but not overall mortality. However, drug resistant Pseudomonas was linked to higher mortality.