Hospital-acquired pneumonia pattern in the intensive care units of a governmental hospital: A prospective longitudinal study.

Background: Epidemiological data on Hospital-Acquired Pneumonia (HAP) are scarce inside Intensive Care Units (ICUs). Aim: This study aims to quantify the incidence of HAP, determine the predictors of HAP, calculate HAP-related mortality risk ratio as well as pinpoint the different risk factors contributing to mortality. Subjects and Methods: A prospective longitudinal study was conducted at a governmental hospital's general ICUs over 12 months. We included adult patients admitted for at least 72 h before signs appear. We utilized a logistic regression model for fatality outcome and cox proportional hazard model for HAP outcome. Results: Of 356 patients, 133 patients developed Ventilated-Acquired Pneumonia (VAP), 76 patients with Non-Ventilated HAP (NV-HAP), as well as 147 patients did not acquire HAP. The incidence of HAP was 28 cases of HAP per 1000 person-days, as well as the mortality rate was 74 per 100 days, while the Attributable Risk Percentage (ARP) was 85%. This high fatality rate was clarified by independent predictors as reintubation (odds ratio [OR] = 8.99, P < 0.001), ICU duration ≥5 days (OR = 7.29, P = 0.02), HAP outcome (OR = 6.49, P = 0.001), diabetes mellitus (DM) (OR = 2.98, P = 0.004), APACHE II ≥17 (OR = 2.76, P = 0.004), as well as neurological diseases (OR = 2.20, P = 0.03). The most common independent HAP predictors were Pseudomonas aeruginosa (Hazard Ratio [HR] = 2.27, P < 0.001), Klebsiella pneumoniae (HR = 1.81, P = 0.003), tracheostomy (HR = 1.72, P = 0.04), and APACHE II ≥17 (HR = 1.54, P = 0.04). Conclusion: High incidence rate of HAP was linked with P. aeruginosa, K. pneumoniae, tracheostomy, and APACHE II ≥17. Furthermore, a high mortality rate was strongly correlated with reintubation, duration in ICU ≥5 days, HAP outcome, DM, APACHE II ≥17, and neurological diseases.

Résumé Contexte: Les données épidémiologiques sur la pneumonie acquise dans les hôpitaux (HAP) sont rares dans les unités de soins intensifs (ICUs). Objectif: ce L'étude vise à quantifier l'incidence du HAP, à déterminer les facteurs prédictifs du HAP, à calculer le ratio de risque de mortalité lié au HAP ainsi qu'à identifier les différents facteurs de risque contribuant à la mortalité. Sujets et méthodes: Une étude longitudinale prospective a été menée à les unités de soins intensifs générales d'un hôpital gouvernemental sur 12 mois. Nous avons inclus les patients adultes admis depuis au moins 72 h avant l'apparition des signes. Nous ont utilisé un modèle de régression logistique pour les résultats en matière de décès et un modèle de risque proportionnel de Cox pour les résultats HAP. Résultats: Sur 356 patients, 133 patients ont développé une Pneumonie Acquise sous Ventilation (VAP), 76 patients avec une NV-HAP, ainsi que 147 patients n'a pas acquis HAP. L'incidence du HAP était de 28 cas de HAP pour 1000 jours-personnes, ainsi que le taux de mortalité, de 74 pour 100 jours, alors que le pourcentage de risque attribuable (ARP) était de 85 %. Ce taux de mortalité élevé a été clarifié par des prédicteurs indépendants comme réintubation (odds ratio [OR] = 8,99, P < 0,001), durée de ICU ≥ 5 jours (OR = 7,29, P = 0,02), résultat HAP (OR = 6,49, P = 0,001), le diabète sucré (DM) (OR = 2,98, P = 0,004), APACHE II ≥17 (OR = 2,76, P = 0,004), ainsi que les maladies neurologiques (OR = 2,20, P = 0,03). Les prédicteurs indépendants de HAP les plus courants étaient Pseudomonas aeruginosa (Hazard Ratio [HR] = 2,27, P < 0,001), Klebsiella pneumoniae (HR = 1,81, P = 0,003), trachéotomie (HR = 1,72, P = 0,04) et APACHE II ≥ 17 (HR = 1,54, P = 0,04). Conclusion: Le taux d'incidence élevé de HAP était lié à P. aeruginosa, K. pneumoniae, trachéotomie et APACHE II ≥17. De plus, un taux de mortalité élevé était fortement corrélé à la réintubation, à la durée en ICU ≥ 5 jours, au résultat HAP, au DM, à l'APACHE II ≥17, et maladies neurologiques. Mots-clés: Pneumonie nosocomiale, incidence, unités de soins intensifs, facteurs de risque, trachéotomie.

Applying pharmacokinetic/pharmacodynamic measurements for linezolid in critically ill patients: optimizing efficacy and reducing resistance occurrence.

PURPOSE: Linezolid (LZD) levels are frequently insufficient in intensive care unit (ICU) patients receiving standard dose, which is predictive of a poor prognosis. Alternative dosing regimens are suggested to address these insufficient levels, which are substantial factors contributing to the emergence of multidrug-resistant bacteria, resulting in increased morbidity and mortality among people who are critically ill. METHODS: Forty-eight patients admitted to the intensive care unit were enrolled in an open-label, prospective, randomized study and assigned to one of three LZD administration modes: intermittent groupI (GpI) (600 mg/12 h), continuous infusion groupII (GpII) (1200 mg/24 h) or continuous infusion with loading dose groupIII (GpIII) (on Day 1, 300 mg intravenously plus 900 mg continuous infusion, followed by 1200 mg/24 h on Day 2). We evaluated serum levels of LZD using a validated ultra-performance liquid chromatography (UPLC) technique. RESULTS: Time spent with a drug concentration more than 85% over the minimum inhibitory concentration (T > MIC) was substantially more common in GpII and III than in GpI (P < 0.01). AUC/MIC values greater than 80 were obtained more frequently with continuous infusion GpIII and GpII than with intermittent infusion GpI, at 62.5%, 37.5% and 25%, respectively (P < 0.01). In GpI, the mortality rate was significantly higher than in the other groups. CONCLUSION: In critically ill patients, continuous infusion with a loading dose (GpIII) is obviously superior to continuous infusion without a loading dose (GpII) or intermittent infusion (GpI) for infection therapy. Additionally, it might limit fluctuations in plasma concentrations, which may help overcome LZD resistance.