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- Title
Ventilator-associated pneumonia in long-term ventilator-assisted individuals.
- Authors
García-Leoni, M E; Moreno, S; García-Garrote, F; Cercenado, E
- Abstract
Background:Information on the characteristics of pneumonia in long-term ventilator-assisted individuals is scarce. We evaluate the incidence, risk factors and outcome of ventilator-associated pneumonia (VAP) in a large series of chronically ventilated patients.Methods:All patients assisted in a chronic ventilator-dependent unit were prospectively followed up for the development of VAP. Patients with a new and persistent lung infiltrate and a purulent tracheal aspirate were suspected to have VAP. Pneumonia was considered microbiologically confirmed in the presence of (1) a positive blood culture and/or (2) 105 CFU ml−1 in quantitative bacterial culture of tracheal aspirates or 103 CFU ml−1 in quantitative mini-bronchoalveolar lavage cultures.Results:In total, 100 consecutive long-term ventilated individuals with spinal cord injury (mean age 49 years) were prospectively followed up. The length of mechanical ventilation before admission in the unit was 54±37 days, and the follow-up after admission was 119±127 days. There were 32 episodes of VAP in 27 patients (1.74 episodes per 1000 days of mechanical ventilation). By logistic regression analysis, hypoalbuminaemia (P=0.03), administration of antacids (P=0.002) and length of mechanical ventilation (P=0.05) were independent risk factors for VAP. The most frequently isolated organisms were Pseudomonas aeruginosa (62%), methicillin-resistant Staphylococcus aureus (25%) and Acinetobacter baumannii (15%); 9 (28%) episodes were polymicrobial. Antimicrobial treatment, including monotherapy in 66%, was successful in most patients. Only three patients (11%) died in relation to VAP.Conclusions:Patients on long-term ventilation are at significant risk for the development of VAP, but the mortality is low.
- Subjects
ANTIBIOTICS; ACINETOBACTER infections; ANALYSIS of variance; ARTIFICIAL respiration; CHI-squared test; COMPUTER software; FISHER exact test; LONGITUDINAL method; METHICILLIN resistance; MULTIVARIATE analysis; PNEUMONIA; PSEUDOMONAS diseases; SPINAL cord injuries; STAPHYLOCOCCUS aureus; STATISTICS; TIME; U-statistics; MECHANICAL ventilators; LOGISTIC regression analysis; DATA analysis; DISEASE incidence; DISEASE complications
- Publication
Spinal Cord, 2010, Vol 48, Issue 12, p876
- ISSN
1362-4393
- Publication type
Article
- DOI
10.1038/sc.2010.43