Ventilator-associated pneumonia in critically ill patients with intensive antibiotic usage.

March 19, 2016 at 1:43 pm

Pak J Med Sci. 2015 Nov-Dec;31(6):1441-6.

Bor C1, Demirag K2, Okcu O3, Cankayali I4, Uyar M5.

Author information

1Canan Bor, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.

2Kubilay Demirag, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.

3Ozlem Okcu, Department of Radiology, Ege University School of Medicine Hospital, Izmir, Turkey.

4Ilkin Cankayali, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.

5Mehmet Uyar, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.

Abstract

OBJECTIVE:

Ventilator-associated pneumonia (VAP) is an infection with high mortality and morbidity that prolongs the length of stay in the intensive care unit (ICU) and hospitalisation. VAP is one of the most common infections in critically ill patients. This study aimed to prospectively determine the VAP rate and associated factors in critically ill patients with intensive antibiotic usage during a one-year period.

METHODS:

In total, 125 out of 360 patients admitted to the intensive care unit during the one-year study period (September 2010-2011) were included for follow-up for VAP diagnosis. Demographic data, APACHE II scores, diagnoses on admission, clinical pulmonary infection scores (CPIS), CRP, procalcitonin, risk factors for infection, time to VAP diagnosis, and bacteriological culture results were recorded. All data were assessed in terms of ICU, hospital and 28-day mortality.

RESULTS:

In total, 56 (45%) out of 125 patients were diagnosed with VAP. In addition, 91% of patients diagnosed with VAP were administered antibiotics before diagnosis. In the VAP patients, the mortality rates were 48, 68 and 71% for 28-day, ICU and hospital mortality, respectively.

CONCLUSION:

The coexistence of clinical and microbiological parameters should not be sought when diagnosing VAP in patients who use antibiotics intensively. VAP can be diagnosed when CPIS≤6 in cases with sufficient microbiological evidence. This strategy may decrease mortality by preventing a delay in therapy.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744297/pdf/PJMS-31-1441.pdf

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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Health Care-Associated Infections, Infecciones nosocomiales, Infecciones respiratorias, Metodos diagnosticos, Resistencia bacteriana, Sepsis, Update.

Comparative Study of Plasma Endotoxin with Procalcitonin Levels in Diagnosis of Bacteremia in Intensive Care Unit Patients. Antimicrobial stewardship in the intensive care setting–a review and critical appraisal of the literature.


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