Influence of Epidemiological Risk Factors in Development of Ventilator Associated Pneumonia in Hospitalized Patient Requiring Mechanical Ventilation: A Nationwide Analysis

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 218A ◽  
Author(s):  
Kathan Mehta ◽  
Ronak Soni ◽  
Tapan Mehta ◽  
Khushboo Sheth ◽  
Zeeshan Mansuri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Ventilator Associated Pneumonia ◽  
Epidemiological Risk ◽  
Hospitalized Patient

scholarly journals The Impact of Intervention-Related Risk Factors on the Risk of Ventilator-Associated Pneumonia Is High in a Neurosurgical Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s407-s409
Author(s):  
Ksenia Ershova ◽  
Oleg Khomenko ◽  
Olga Ershova ◽  
Ivan Savin ◽  
Natalia Kurdumova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Negative Slope ◽  
Infection Prevention And Control ◽  
Ventilator Associated Pneumonia ◽  
Related Factors ◽  
Icu Patients ◽  
The Impact ◽  
Adf Test ◽  
Over Time

Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None

Analysis of diagnostic criteria for ventilator-associated pneumonia: a cohort study

2021 ◽  
Vol 74 (6) ◽  
Author(s):  
Caroline Gonçalves Pustiglione Campos ◽  
Aline Pacheco ◽  
Maria Dagmar da Rocha Gaspar ◽  
Guilherme Arcaro ◽  
Péricles Martim Reche ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Diagnostic Criteria ◽  
Statistical Tests ◽  
Significant Risk ◽  
Diagnostic Methods ◽  
Ventilator Associated Pneumonia

ABSTRACT Objectives: to analyze the diagnostic criteria for ventilator-associated pneumonia recommended by the Brazilian Health Regulatory Agency and the National Healthcare Safety Network/Centers for Disease Control and Prevention, as well as its risk factors. Methods: retrospective cohort study carried out in an intensive care unit throughout 12 months, in 2017. Analyses included chi-square, simple linear regression, and Kappa statistical tests and were conducted using Stata 12 software. Results: the sample was 543 patients who were in the intensive care unit and under mechanical ventilation, of whom 330 (60.9%) were men and 213 (39.1%) were women. Variables such as gender, age, time under mechanical ventilation, and oral hygiene proved to be significant risk factors for the development of ventilator-associated pneumonia. Conclusions: patients submitted to mechanical ventilation need to be constantly evaluated so the used diagnostic methods can be accurate and applied in an objective and standardized way in Brazilian hospitals.

scholarly journals Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

2020 ◽  
Author(s):  
Ademar Takahama ◽  
Vitoria Iaros de Sousa ◽  
Elisa Emi Tanaka ◽  
Evelise Ono ◽  
Fernanda Akemi Nakanishi Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Physical Examination ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

VENTILATOR ASSOCIATED PNEUMONIA-REVIEW ARTICLE

2021 ◽  
pp. 64-65
Author(s):  
Bharti Choudhary ◽  
Nishchint Sharma
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Review Article ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Evidence Based Practices ◽  
Prolonged Duration ◽  
Vap Bundle

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated mortality of VAP is around 10%. There are many risk factors including host related, device related and personnel related. For prevention of VAP it is recommended to minimize the exposure to mechanical ventilation and encouraging early liberation. VAP bundle as a group of evidence-based practices that, results in decrease in the incidence of VAP should be used. Patients should be reassessed daily to conrm ongoing suspicion of disease, antibiotics should be guided by cultures reports, and clinicians should consider stopping antibiotics if cultures are 1 negative.

Risk Factors for Ventilator-Associated Pneumonia in Infants and Children: a Cross-sectional Cohort Study

2014 ◽  
Vol 23 (6) ◽  
pp. 469-476 ◽  
Author(s):  
Denise Miyuki Kusahara ◽  
Camila da Cruz Enz ◽  
Ariane Ferreira Machado Avelar ◽  
Maria Angélica Sorgini Peterlini ◽  
Mavilde da Luz Gonçalves Pedreira
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Odds Ratio ◽  
Pediatric Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Vasoactive Drugs ◽  
Cross Sectional

Background The epidemiology of ventilator-associated pneumonia is well described for adults, but little information is available on risk factors for this disease in children. Objective To identify predisposing factors for ventilator-associated pneumonia in children. Methods A cross-sectional prospective cohort study of 96 patients in a 9-bed pediatric intensive care unit was performed. Variables examined were demographic characteristics, inpatient care, medications, nutrition, invasive procedures, and characteristics of mechanical ventilation. Data were analyzed by using Pearson χ2 analysis, Fisher exact and Mann-Whitney tests, odds ratios, and forward stepwise logistic regression. Results Occurrence of ventilator-associated pneumonia correlated positively with use of nasoenteral tubes (odds ratio, 5.278; P < .001), intermittent administration of nutritional formula (odds ratio, 6.632; P = .005), emergency reintubation (odds ratio, 2.700; P = .02), use of vasoactive drugs (odds ratio, 5.108; P = .009), duration of mechanical ventilation (P < .001), and length of stay in the pediatric intensive care unit (P < .001) and in the hospital (P = .01). Conclusion Use of vasoactive drugs, presence of a nasoenteral tube, and duration of stay in the pediatric intensive care unit were independent risk factors for ventilator-associated pneumonia.

scholarly journals Investigation on Risk Factors of Ventilator-Associated Pneumonia in Acute Cerebral Hemorrhage Patients in Intensive Care Unit

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Li Chang ◽  
Yun Dong ◽  
Ping Zhou
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Coronary Heart Disease ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Heart Disease ◽  
Hospital Stay ◽  
Cerebral Hemorrhage ◽  
Chronic Obstructive ◽  
Ventilator Associated Pneumonia

Ventilator-associated pneumonia (VAP) is a predominant factor of pulmonary infection. We analyzed the risk factors of VAP with acute cerebral hemorrhage in intensive care unit (ICU) by univariate and multivariate logistic regression analyses. After comparison of 197 cases of the VAP and non-VAP patients, we found that age > 65 years (P=0.003), smoke (P=0.003), coronary heart disease (P=0.005), diabetes (P=0.001), chronic obstructive pulmonary disease (COPD) (P=0.002), ICU and hospital stay (P=0.01), and days on mechanical ventilation (P=0.01) were significantly different, indicating that they are risk factors of VAP. All the age > 65 years (OR = 3.350, 95% CI = 1.936–5.796, P≤0.001), smoke (OR = 3.206, 95% CI = 1.909–5.385, P≤0.001), coronary heart disease (OR = 3.179, 95% CI = 1.015–4.130, P=0.017), diabetes (OR = 5.042, 95% CI = 3.518–7.342, P≤0.001), COPD (OR = 1.942, 95% CI = 1.258–2.843, P=0.012), ICU and hospital stay (OR = 2.34, 95% CI = 1.145–3.892, P=0.038), and days on mechanical ventilation (OR = 1.992, 95% CI = 1.107–3.287, P=0.007) are independent risk factors of VAP. After observation of patients with 6 months of follow-up, the BI score was significantly lower in VAP than that in non-VAP, and the rebleeding rate and mortality rate were significantly higher in VAP than those in non-VAP. Thus, the prognosis of the patients with acute cerebral hemorrhage and VAP in ICU is poor.

Ventilator-Associated Pneumonia: Incidence and risk factors six intensive care units in Tunisia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Ben Cheikh ◽  
S Bhiri ◽  
N ketaka ◽  
A Gara ◽  
S Khefacha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Factors Associated ◽  
History Of ◽  
Independent Risk Factors ◽  
The University ◽  
Very High

Abstract Background Ventilator-Associated Pneumonia (VAP) continues to cause significant morbidity, mortality, and hospital costs, especially in the intensive care unit (ICU). This study aimed to determine incidence and factors associated with VAP in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. Methods We conducted a prospective observational cohort study over a three months period in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. All patients hospitalized with mechanical ventilation (MV) for more than 48 hours in the ICUs were included. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify factors associated with VAP. Results Overall, 110 patients were enrolled. The mean age of patients was 44 ± 25 years. Of them, 66.4% were male. The median duration of MV was 5 days [2-16]. The incidence of VAP was 32% and the density incidence was 33/1000 ventilator days. The most common organism were Pseudomonas aeruginosa (n = 14). Of them, 12 were ceftazidime-resistant and thee were resistant to imipenem. Independent risk factors associated with VAP in ICU were history of antibiotic therapy during last 6 months (p = 0.007), tracheotomy (p < 0.001) and reintubation (p < 0.001). Conclusions VAP rates in our ICUs were very high. Antimicrobial stewardship programs involving pharmacists and physicians must be elaborated to optimize the antibiotic prescribing. Mechanical ventilation require more-effective interventions control in our hospital. Key messages Ventilator-Associated Pneumonia rates were very high. Independent risk factors associated with Ventilator-Associated Pneumonia were history of antibiotic therapy during last 6 months, tracheotomy and reintubation.

scholarly journals Comparative study of incidence, risk factors, etiological agents and outcome of early and late ventilator associated pneumonia in paediatric intensive care unit at a tertiary care centre

2018 ◽  
Vol 5 (3) ◽  
pp. 708
Author(s):  
Preeti Malhotra ◽  
Naresh Kumar ◽  
Karuna Thapar ◽  
Amanjeet Kaur Bagga
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Paediatric Intensive Care Unit ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Acinetobacter Baumanii ◽  
Gram Negative ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Background: Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection in the paediatric intensive care unit (PICU). VAP occurring within 96 hours of initiation of mechanical ventilation is termed as early VAP and later than that is known as late VAP. The aim of this study was to determine the incidence rate, risk factors and bacteriological profile and outcome of early and late ventilator associated pneumonia in PICU.Methods: The study was conducted from December 2015 to November 2017 in which 89 children beyond 1 year of age were ventilated for more than 48 hours of which those who developed VAP as per CDC criteria were enrolled in the study. The endotracheal secretions were collected, processed and recorded as per standard microbiological methods. Statistical associations were further evaluated between various parameters of VAP and time of development of VAP.Results: Of all the mechanically ventilated patients, 33.7% developed VAP. Incidence of Early VAP was 23.3% and that of Late VAP was 76.67%. Duration of mechanical ventilation and re-intubation were significantly associated with the time of development of VAP. Micro-organisms identified by culture, involved in the aetiology of VAP were: gram-negative bacteria in 74.9% and gram-positive bacteria in 25.1%. The overall mortality rate was 43.33%.Conclusions: Re-intubation and duration of mechanical ventilation are a significant risk factor for development of late VAP. Overall the most common Gram-negative bacteria associated with VAP was Acinetobacter baumanii. The most common isolate in early VAP was Acinetobacter baumanii whereas infections by Pseudomonas and E. coli are common in late VAP. population.

scholarly journals Incidence of ventilator associated pneumonia and its risk factors

2016 ◽  
Vol 1 (3) ◽  
pp. 44
Author(s):  
Kavitha Chandran C ◽  
Sujith Kumar R ◽  
Sujamol Scaria
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cause Of Death ◽  
Tertiary Care ◽  
Diagnostic Methods ◽  
Ventilator Associated Pneumonia ◽  
Care Centre ◽  
Tertiary Care Centre

Hospitals are intended to heal the sick; but they are also sources of infection. Ironically, the advances in medicine are partly responsible for the fact that today; hospital infections are the leading cause of death worldwide. Newer technology and latest surgical and medical diagnostic methods and treatment procedures have increased the number of invasive techniques leading to higher chances of nosocomial infection. Pneumonia is the leading cause of death due to nosocomial infections. Intubation & mechanical ventilation greatly increases the risk for ventilator-associated pneumonia (VAP). In developing country like India, such hospital-acquired infections have a significant impact on patient’s morbidity, mortality, hospital stay and on financial concerns of the patient, hospital and community. The present investigation was aimed to determine the incidence of ventilator associated pneumonia in the neurosurgery intensive care unit of a tertiary care centre and to determine the risk factors of ventilator associated pneumonia. A total of 30 samples belonging to the age group of 15 to 75 years who where on mechanical ventilator for more than 48 hours in the neurosurgery intensive care unit of a tertiary care centre were selected using convenience sampling. The incidence of VAP was estimated to be 30%. The risk factors identified for the development of VAP was found to be combined head and cervical spine injury (P=0.001), associated injuries (P=0.035), additional surgeries (P=0.025), nasogastric feeding (P=0.001), intake of immuno suppressive drugs (P=0.004), pre operative antibiotics (p=0.000) and duration of mechanical ventilation >5 days (P=0.000). The mortality among patients with VAP was found to be higher than patients without VAP (88.9% than non VAP patients).

scholarly journals Incidence, determinants and outcomes of ventilator associated pneumonia in medical intensive care unit: a prospective cohort study from South Western India

2021 ◽  
Vol 9 (5) ◽  
pp. 1306
Author(s):  
Shivaram Rao ◽  
Nitin Bhat ◽  
Adarsha Gopadi Krishna Bhat ◽  
H. Manjunatha Hande
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Developing Countries ◽  
Intensive Care ◽  
Organ Failure ◽  
Medical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Emergency Intubation ◽  
Medical Intensive Care

Background: Ventilators are being increasingly used in developing countries as a result of which complications like ventilator associated pneumonia is also increasing. Present study is being undertaken to evaluate the impact of risk factors and their changing trends for Ventilator associated pneumonia.Methods: A prospective observational study was conducted in mechanically ventilated patients of medical intensive care unit from October 2013 to April 2015.Results: In present study 166 patients receiving mechanical ventilation in a medical ICU were observed. Incidence of VAP in present study is 43.5 for 1000 days of mechanical ventilation. The risk factors that were significant in the study are organ failure (p=0.001), emergency intubation (p=0.001), reintubation (p=0.023) and COPD (p=0.026). The common organisms responsible for VAP were Acinetobacter (30%), Klebsiella pneumoniae (27.1%) and Pseudomonas aeruginosa (20%). The mortality was higher in VAP group (31.3%) compared to the non VAP group (15.7%).Conclusions: There is high incidence of VAP in the developing countries. The risk factors that were found to be associated with VAP in the present study were the presence of COPD, reintubation, organ failure and emergency intubation. VAP is associated with significantly increased duration of hospital stay, morbidity and mortality.

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