The Incidence and Risk Factors of Ventilator-Associated Pneumonia in ICU
Abstract
Considering the importance of ventilator-associated pneumonia (VAP) and the high mortality rate among patients diagnosed with VAP, the aim of the current study was to evaluate the incidence of VAP, and its related risk factors in patients admitted to the intensive care unit (ICU). A total of 197 patients undergoing mechanical ventilation in the ICU diagnosed with VAP was enrolled in this study. Among these patients, 59 (53.6%) cases were male, and 51 (46.4%) were female with the mean age of 69.86±14.62 years. The most common cause of ICU admission was CVA, followed by colorectal cancer, lung cancer, sepsis, and cirrhosis. Our results showed that 110 individuals (55.8%) were diagnosed with VAP. The most common bacteria were Klebsiella, which was found in 20.3% of cases. (47.7%) of patients had diabetes, 21.8% had chronic kidney disease, and 51.8% had cardiovascular disease. 32.7% of patients were bedridden before intubation. The mortality rate due to VAP was estimated at about 20%. In conclusion, the incidence of VAP in ICU is relatively high (55.8%), with a mortality rate of 20%. Among the risk factors, the presence of diabetes, bedridden, reduction in consciousness, and the time duration of mechanical ventilation are relative to this type of infection.
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2. Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2015;19(1):14.
3. Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clinical Infectious Diseases. 2010;51(Supplement_1):S81-S7.
4. Trouillet J-L, Chastre J, Vuagnat A, Joly-Guillou M-L, Combaux D, Dombret M-C, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. American journal of respiratory and critical care medicine. 1998;157(2):531-9.
5. Lawal O, Muhamadali H, Ahmed WM, White IR, Nijsen TM, Goodacre R, et al. Headspace volatile organic compounds from bacteria implicated in ventilator-associated pneumonia analysed by TD-GC/MS. Journal of breath research. 2018;12(2):026002.
6. Gruson D, Hilbert G, Vargas F, Valentino R, Bebear C, Allery A, et al. Rotation and restricted use of antibiotics in a medical intensive care unit: impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gram-negative bacteria. American journal of respiratory and critical care medicine. 2000;162(3):837-43.
7. Hunter JD. Ventilator associated pneumonia. Bmj. 2012;344:e3325.
8. Carron M, Rossi S, Carollo C, Ori C. Comparison of invasive and noninvasive positive pressure ventilation delivered by means of a helmet for weaning of patients from mechanical ventilation. Journal of critical care. 2014;29(4):580-5.
9. Nicolosi LN, del Carmen Rubio M, Martinez CD, González NN, Cruz ME. Effect of oral hygiene and 0.12% chlorhexidine gluconate oral rinse in preventing ventilator-associated pneumonia after cardiovascular surgery. Respiratory care. 2014;59(4):504-9.
10. Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle. Critical care medicine. 2014;42(5):1024.
11. Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, et al. The preventability of ventilator-associated events. The CDC prevention epicenters wake up and breathe collaborative. American journal of respiratory and critical care medicine. 2015;191(3):292-301.
12. Najafi A, Mojtahedzadeh M, Ahmadi A, Ramezani M, Shariatmoharari R, Hazrati E. Rapidly changing tachyarrhythmia in acute stroke. Basic and clinical neuroscience. 2013;4(2):169.
13. Wong T, Schlichting AB, Stoltze AJ, Fuller BM, Peacock A, Harland KK, et al. No decrease in early ventilator-associated pneumonia after early use of chlorhexidine. American Journal of Critical Care. 2016;25(2):173-7.
14. Ekren PK, Ranzani OT, Ceccato A, Li Bassi G, Muñoz Conejero E, Ferrer M, et al. Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society guideline criteria for risk of multidrug-resistant pathogens in patients with hospital-acquired and ventilator-associated pneumonia in the ICU. American journal of respiratory and critical care medicine. 2018;197(6):826-30.
15. Bassi GL, Senussi T, Xiol EA. Prevention of ventilator-associated pneumonia. Current opinion in infectious diseases. 2017;30(2):214-20.
16. Society AT, America IDSo. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American journal of respiratory and critical care medicine. 2005;171(4):388.
17. Kollef MH. Ventilator-associated pneumonia: a multivariate analysis. Jama. 1993;270(16):1965-70.
18. Sadasivan P, George L, Krishnakumar K. VENTILATOR ASSOCIATED PNEUMONIA-DIAGNOSIS AND PREVENTION STRATEGIES IN CRITICALLY ILL PATIENTS: A. 2018.
19. Sadeghi K, Hamishehkar H, Najmeddin F, Ahmadi A, Hazrati E, Honarmand H, et al. High-dose amikacin for achieving serum target levels in critically ill elderly patients. Infection and drug resistance. 2018;11:223.
20. Afkhamzadeh A, Lahoorpour F, Delpisheh A, Janmardi R. Incidence of ventilator-associated pneumonia (VAP) and bacterial resistance pattern in adult patients hospitalised at the intensive care unit of Besat Hospital in Sanandaj. Scientific Journal of Kurdistan University of Medical Sciences. 2011;16(1):20-6.
21. Naderi H, Sheybani F, Sarvghad M, Nooghabi MJ. Can procalcitonin add to the prognostic power of the severity scoring system in adults with pneumonia? Tanaffos. 2015;14(2):95.
22. Eggimann P, Pittet D. Infection control in the ICU. Chest. 2001;120(6):2059-93.
23. Gastmeier P, Geffers C. Prevention of ventilator-associated pneumonia: analysis of studies published since 2004. Journal of Hospital Infection. 2007;67(1):1-8.
24. Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, Martínez-Alonso M, Álvarez-Rodríguez J, Lorente L, et al. Prevention of ventilator-associated pneumonia: the multimodal approach of the Spanish ICU “Pneumonia Zero” Program. Critical care medicine. 2018;46(2):181.
25. Aminjan HH, Abtahi SR, Hazrati E, Chamanara M, Jalili M, Paknejad B. Targeting of oxidative stress and inflammation through ROS/NF-kappaB pathway in phosphine-induced hepatotoxicity mitigation. Life Sciences. 2019:116607.
26. Raad II, Mohamed JA, Reitzel RA, Jiang Y, Dvorak TL, Ghannoum MA, et al. The prevention of biofilm colonization by multidrug-resistant pathogens that cause ventilator-associated pneumonia with antimicrobial-coated endotracheal tubes. Biomaterials. 2011;32(11):2689-94.
27. Nadi E, Nekouii B, Mobin A, Nekouii A, Moghim Beigi A. Frequency of Nosocomial Pneumonia in ICUs of Hospitals of Hamadan University of Medical Sciences. Journal of Isfahan Medical School. 2011;29(153).
28. Kalin G, Alp E, Coskun R, Demiraslan H, Gündogan K, Doganay M. Use of high-dose IV and aerosolized colistin for the treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia: do we really need this treatment? Journal of Infection and Chemotherapy. 2012;18(6):872-7.
29. Grindlinger GA, Cairo SB, Duperre CB. Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitors and/or histamine II receptor blockers. journal of surgical research. 2016;206(2):398-404.
2. Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2015;19(1):14.
3. Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clinical Infectious Diseases. 2010;51(Supplement_1):S81-S7.
4. Trouillet J-L, Chastre J, Vuagnat A, Joly-Guillou M-L, Combaux D, Dombret M-C, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. American journal of respiratory and critical care medicine. 1998;157(2):531-9.
5. Lawal O, Muhamadali H, Ahmed WM, White IR, Nijsen TM, Goodacre R, et al. Headspace volatile organic compounds from bacteria implicated in ventilator-associated pneumonia analysed by TD-GC/MS. Journal of breath research. 2018;12(2):026002.
6. Gruson D, Hilbert G, Vargas F, Valentino R, Bebear C, Allery A, et al. Rotation and restricted use of antibiotics in a medical intensive care unit: impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gram-negative bacteria. American journal of respiratory and critical care medicine. 2000;162(3):837-43.
7. Hunter JD. Ventilator associated pneumonia. Bmj. 2012;344:e3325.
8. Carron M, Rossi S, Carollo C, Ori C. Comparison of invasive and noninvasive positive pressure ventilation delivered by means of a helmet for weaning of patients from mechanical ventilation. Journal of critical care. 2014;29(4):580-5.
9. Nicolosi LN, del Carmen Rubio M, Martinez CD, González NN, Cruz ME. Effect of oral hygiene and 0.12% chlorhexidine gluconate oral rinse in preventing ventilator-associated pneumonia after cardiovascular surgery. Respiratory care. 2014;59(4):504-9.
10. Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle. Critical care medicine. 2014;42(5):1024.
11. Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, et al. The preventability of ventilator-associated events. The CDC prevention epicenters wake up and breathe collaborative. American journal of respiratory and critical care medicine. 2015;191(3):292-301.
12. Najafi A, Mojtahedzadeh M, Ahmadi A, Ramezani M, Shariatmoharari R, Hazrati E. Rapidly changing tachyarrhythmia in acute stroke. Basic and clinical neuroscience. 2013;4(2):169.
13. Wong T, Schlichting AB, Stoltze AJ, Fuller BM, Peacock A, Harland KK, et al. No decrease in early ventilator-associated pneumonia after early use of chlorhexidine. American Journal of Critical Care. 2016;25(2):173-7.
14. Ekren PK, Ranzani OT, Ceccato A, Li Bassi G, Muñoz Conejero E, Ferrer M, et al. Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society guideline criteria for risk of multidrug-resistant pathogens in patients with hospital-acquired and ventilator-associated pneumonia in the ICU. American journal of respiratory and critical care medicine. 2018;197(6):826-30.
15. Bassi GL, Senussi T, Xiol EA. Prevention of ventilator-associated pneumonia. Current opinion in infectious diseases. 2017;30(2):214-20.
16. Society AT, America IDSo. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American journal of respiratory and critical care medicine. 2005;171(4):388.
17. Kollef MH. Ventilator-associated pneumonia: a multivariate analysis. Jama. 1993;270(16):1965-70.
18. Sadasivan P, George L, Krishnakumar K. VENTILATOR ASSOCIATED PNEUMONIA-DIAGNOSIS AND PREVENTION STRATEGIES IN CRITICALLY ILL PATIENTS: A. 2018.
19. Sadeghi K, Hamishehkar H, Najmeddin F, Ahmadi A, Hazrati E, Honarmand H, et al. High-dose amikacin for achieving serum target levels in critically ill elderly patients. Infection and drug resistance. 2018;11:223.
20. Afkhamzadeh A, Lahoorpour F, Delpisheh A, Janmardi R. Incidence of ventilator-associated pneumonia (VAP) and bacterial resistance pattern in adult patients hospitalised at the intensive care unit of Besat Hospital in Sanandaj. Scientific Journal of Kurdistan University of Medical Sciences. 2011;16(1):20-6.
21. Naderi H, Sheybani F, Sarvghad M, Nooghabi MJ. Can procalcitonin add to the prognostic power of the severity scoring system in adults with pneumonia? Tanaffos. 2015;14(2):95.
22. Eggimann P, Pittet D. Infection control in the ICU. Chest. 2001;120(6):2059-93.
23. Gastmeier P, Geffers C. Prevention of ventilator-associated pneumonia: analysis of studies published since 2004. Journal of Hospital Infection. 2007;67(1):1-8.
24. Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, Martínez-Alonso M, Álvarez-Rodríguez J, Lorente L, et al. Prevention of ventilator-associated pneumonia: the multimodal approach of the Spanish ICU “Pneumonia Zero” Program. Critical care medicine. 2018;46(2):181.
25. Aminjan HH, Abtahi SR, Hazrati E, Chamanara M, Jalili M, Paknejad B. Targeting of oxidative stress and inflammation through ROS/NF-kappaB pathway in phosphine-induced hepatotoxicity mitigation. Life Sciences. 2019:116607.
26. Raad II, Mohamed JA, Reitzel RA, Jiang Y, Dvorak TL, Ghannoum MA, et al. The prevention of biofilm colonization by multidrug-resistant pathogens that cause ventilator-associated pneumonia with antimicrobial-coated endotracheal tubes. Biomaterials. 2011;32(11):2689-94.
27. Nadi E, Nekouii B, Mobin A, Nekouii A, Moghim Beigi A. Frequency of Nosocomial Pneumonia in ICUs of Hospitals of Hamadan University of Medical Sciences. Journal of Isfahan Medical School. 2011;29(153).
28. Kalin G, Alp E, Coskun R, Demiraslan H, Gündogan K, Doganay M. Use of high-dose IV and aerosolized colistin for the treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia: do we really need this treatment? Journal of Infection and Chemotherapy. 2012;18(6):872-7.
29. Grindlinger GA, Cairo SB, Duperre CB. Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitors and/or histamine II receptor blockers. journal of surgical research. 2016;206(2):398-404.
| Files | ||
| Issue | Vol 58, No 9 (2020) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v58i9.4765 | |
| Keywords | ||
| Ventilator-associated pneumonia Risk factors Intensive care unit | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Noorifard M, Hamidi Farahani R, Hazrati E. The Incidence and Risk Factors of Ventilator-Associated Pneumonia in ICU. Acta Med Iran. 2020;58(9):439-444.
