Risk factors for mortality in patients with ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae

Abstract Background: The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options. Methods: This was a retrospective study performed in two tertiary hospitals involving patients with VAP caused by CRE between January 2010 and August 2014. The outcomes were mortality within 30 days of VAP diagnosis and overall mortality during hospital admission. Risk factors for mortality were assessed by comparing variables of survivors and non-survivors. Results: One hundred and twelve patients with CRE-VAP were included, 73 (65%) male, median age 56 years. The 30-day mortality was 57.1% and the overall hospital mortality was 67%. In the binary logistic regression analysis, only age >50 years was independently associated to increased mortality. Polymyxin was the most used drug (47.5%), followed by tigecycline (29.2%) and aminoglycosides (2.4%). Combined therapy with two active drugs was used by 17 patients (20.8%). No therapeutic option was independently associated to survival. However, combined therapy with two active drugs was superior to the therapy with a single active drug when inappropriate therapy was the comparator (p = 0.044). The addition of carbapenem was not associated with increased survival. Conclusion: The best therapeutic option for VAP by CRE is still not completely defined, but the therapy with at least two active drugs was superior in this study.

Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates

Abstract Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14–70%). Aim This study evaluated factors influencing mortality of patients with Ventilator-associated pneumonia (VAP), including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy. Methods This retrospective study included 120 cases of Ventilator-associated pneumonia admitted to the adult adult intensive care unit of the Federal University of Uberlândia. The chi-square test was used to compare qualitative variables. Student's t-test was used for quantitative variables and multiple logistic regression analysis to identify independent predictors of mortality. Findings De-escalation of antibiotic therapy and resistant bacteria did not influence mortality. Mortality was 4 times and 3 times higher, respectively, in patients who received an inappropriate antibiotic loading dose and in patients whose antibiotic dose was not adjusted for renal function. Multiple logistic regression analysis revealed the incorrect adjustment for renal function was the only independent factor associated with increased mortality. Conclusion Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.

Etiología de la neumonía asociada a ventilación mecánica en un hospital clínico: Asociación con co-morbilidad, uso previo de antimicrobianos y mortalidad / Etiology of ventilator-associated pneumonia in a university hospital: Association with comorbidity, previous use of antibiotics and mortality

Ventilator-associated pneumonia (VAP) is a complication with an increased risk of morbidity and mortality. Inadequate antibiotic treatment is a risk factor of mortality which can be improved. For this reason it is important to know the local etiology of VAP. During a one year-period we investigated the etiology of VAP in a teaching hospital. Forty eight VAP were included, of which 19 were women. The median age was 59.5 (range 17-91 years), twelve VAP were early onset. Methicillin resistant Staphylococcus aureus (MRSA) was the main microorganism isolated, regardless of timing of diagnosis of VAP, followed by polimicrobial etiology, Acinetobacter sp and P. aeruginosa. Etiology was not associated with comorbidity; however previous antibiotic use was related with MRSA and polymicrobial etiology. Mortality was 35 percent and was mainly associated with P. aeruginosa isolation. Conclusion: MRSA was the main cause of VAP regardless of the timing of its occurrence.

La neumonía asociada a la ventilación mecánica (NAVM) es una complicación relacionada con un aumento de morbilidad y mortalidad. Dentro de los factores de mal pronóstico, el tratamiento antimicrobiano inadecuado es una de las variables que puede corregirse. Para esto debe conocerse la etiología institucional de la NAVM. Durante un año se recopilaron las NAVM con documentación microbiológica en un hospital universitario. En total, 48 neumonías fueron incluidas, 19 en pacientes femeninas, la mediana de la edad fue de 59,5 años (rango 17-91), 12 de ellas precoces. Staphylococcus aureus meticilina resistente (MRSA) fue el principal agente involucrado, independiente del momento de su génesis, seguido por la etiología polimicrobiana, Acinetobacter sp y Pseudomonas aeruginosa, en ese orden. La etiología no se asoció con la existencia de co-morbilidad, el uso previo de antimicrobianos se asoció con la presencia de MRSA y etiología polimicrobiana. La letalidad fue de 35 por ciento y se relacionó, principalmente, con la presencia de P. aeruginosa. Conclusión: La principal causa de NAVM en esta experiencia fue SAMR, independiente del momento evolutivo de su ocurrencia.