Meltem Arzu YETKİN, Aliye BAŞTUĞ, Esragül AKINCI, Hürrem BODUR, Dilek KANYILMAZ, Pınar ÖNGÜRÜ, Adalet AYPAK, Halide ASLANER, Ayşe BUT, Nevzat Mehmet MUTLU

Analysis of epidemiology and risk factors for mortality in ventilator-associated pneumonia attacks in intensive care unit patients

Background/aim: The aim of this study was to investigate the epidemiologic characteristics, the causative microorganisms and their antimicrobial susceptibility patterns, and the prognostic risk factors for mortality in critically ill patients with ventilator-associated pneumonia (VAP). Materials and methods: In this retrospective observational study, all the critically ill patients with VAP hospitalized in a medical/surgical intensive care unit (ICU) between January 2010 and June 2015 were evaluated. Patients demographic features and microbiological data were reviewed. Results: A total of 417 patients were clinically diagnosed with VAP; 51.1% of them were male and the average age was found as 69.9 ± 15.9 years. VAP was detected at approximately 25.0 ± 18.0 days of ICU stay and 17.9 ± 12.6 days after intubation. Acinetobacter baumannii (69.5%) was isolated as the most frequent VAP agent, and the most effective antibiotic was colistin. The crude mortality rate was detected as 39.8% among the patients. The presence of dyspnea at admission, coronary heart disease as a comorbidity, unconsciousness at admission, steroid usage, and prolonged hospital stay were observed as independent risk factors in multivariate analysis (P < 0.01). Conclusion: According to the etiological microorganisms and antimicrobial susceptibility patterns, colistin was found to be the most reliable antibiotic for empirical antimicrobial therapy.

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1. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, Hooton TM. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985; 121: 182-205.
2. Shaw MJ. Ventilator-associated pneumonia. Curr Opin Pulm Med 2005; 11: 236-241.
3. Luna CM, Blanzaco D, Niederman MS, Matarucco W, Baredes NC, Desmery P, Palizas F, Menga G, Rios F, Apezteguia C. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 2003; 31: 676-682.
4. Yelken B, Memiş D, Durmaz G, Yosunkaya A, Aygün G. Türk Yoğun Bakım Derneği Ventilatörle İlişkili Pnömonide Tanı ve Tedavi Rehberi. İstanbul, Turkey: Özgün Ofset; 2011 (in Turkish).
5. Rumbak MJ. Pneumonia in patients who require prolonged mechanical ventilation. Microbes Infect 2005; 7: 275-278.
6. Kollef MH. What is ventilator-associated pneumonia and why is it important? Respir Care 2005; 50: 714-721.
7. Chastre J. Conference summary: ventilator-associated pneumonia. Respiratory Care 2005; 50: 975-983.
8. Alp E, Güven M, Yıldız O, Aygen B, Voss A, Doganay M. Incidence, risk factors and mortality of nosocomial pneumonia in intensive care units: a prospective study. Ann Clin Microbiol Antimicrob 2004; 3: 17-23.
9. Gürdoğan K, Arslan H, Nazlıer S. Ventilatörle ilişkili pnömoniler. Klimik Dergisi 1999; 12: 58-59 (in Turkish).
10. Agarwal R, Gupta D, Ray P, Agarwal A, Jindal S. Epidemiology, risk factors and outcome of nosocomial infections in a respiratory intensive care unit in North India. J Infect 2006; 53: 98-105.
11. Meric M, Willke A, Caglayan C, Toker K. Intensive care unitacquired ınfections: incidence, risk factors and associated mortality in a Turkish university hospital. Jpn J Infect Dis 2005; 58: 297-302.
12. Giard M, Lepape A, Allaouchiche B. Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit: comparison of risk factors. J Crit Care 2008; 23: 27-33.
13. Ibrahim EH, Ward S, Sherman G, Kollef MH. A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting. Chest 2000; 117: 1434-1442.
14. Ergin F, Kurt Azap Ö, Yapar G, Arslan H, Dikmen Ö. Başkent Üniversitesi Hastanesinde saptanan ventilatörle ilişkili pnömoniler insidans, risk faktörleri, etken dağılımı ve antibiyotik direnç paternleri. Flora 2004; 9: 119-124 (in Turkish).
15. Gusmão ME, Dourado I, Fiaccone RL. Nosocomial pneumonia in the intensive care unit of a Brazilian university hospital: an analysis of the time span from admission to disease onset. Am J Infect Control 2004; 32: 209-214.
16. Erbay RH, Yalçın AN, Zencir M, Serin S, Atalay H. Costs and risk factors for ventilator-associated pneumonia in a Turkish university hospitals intensive care unit: a case-control study. BMC Pulm Med 2004; 4: 3.
17. Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest 2001; 120: 555-561.
18. Biberoğlu K. Nozokomiyal pnömoni. In: Doğanay M, Ünal S, editors. Hastane İnfeksiyonları. 1st ed. Ankara, Turkey: Bilimsel Tıp Yayınevi; 2003. pp. 519-530 (in Turkish).
19. Carrilho CM, Grion CM, Bonametti AM, Medeiros EA, Matsuo T. Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units. Braz J Infect Dis 2007; 11: 339-344.
20. Lorente L, Lecuona M, Galván R, Ramos MJ, Mora ML, Sierra A. Periodically changing ventilator circuits is not necessary to prevent ventilator-associated pneumonia when a heat and moisture exchanger is used. Infect Control Hosp Epidemiol 2004; 25: 1077-1082.
21. Esen S, Leblebicioglu H. Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study. Scand J Infect Dis 2004; 36: 144-148.
22. Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece. Respir Care 2003; 48: 681-688.
23. Alp E. Yoğun Bakım Ünitelerinde Nozokomiyal Pnömoniler Kayseri. Uzmanlık Tezi. Kayseri, Turkey: Erciyes Üniversitesi Tıp Fakültesi Klinik Bakteriyoloji ve İnfeksiyon Hastalıkları Anabilim Dalı; 2002 (in Turkish).
24. Hugonnet S, Uckay I, Pittet D. Staffing level: a determinant of late onset ventilator-associated pneumonia. Crit Care 2007; 11: R80.
25. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165: 867-903.
26. Leblebicioğlu H, Rosenthal VD, Arıkan ÖA, Özgültekin A, Yalçın AN, Koksal I, Usluer G, Sardan YC, Ulusoy S. Deviceassociated hospital acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (INCC). J Hosp Infect 2007; 65: 251-257.
27. Dizbay M, Baş S, Gürsoy A, Şimşek H, Maral I, Aktaş F. Invasive device-related infection surveillance in intensive care units of Gazi University Hospital in 2006-2007. Turk Klin Tip Bilim 2009; 29:140-145 (in Turkish with English abstract).