Risk factors for early-onset, ventilator-associated pneumonia in critical care patients: Selected multiresistant versus nonresistant bacteria

Ozan Akça, Kemalettin Koltka, Serdar Uzel, Nahit Çakar, Kamil Pembeci, Mehmet A. Sayan, Ahmet S. Tütüncü, Serife Eti, Semra Çalangu, Tülay Özkan, Figen Esen, Lütfi Telci, Daniel I. Sessler, Kutay Akpir

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Background: Ventilator-associated pneumonia is the leading nosocomial infection in critically ill patients. The frequency of ventilator-associated pneumonia caused by multidrug-resistant bacteria has increased in recent years, and these pathogens cause most of the deaths attributable to pneumonia. The authors, therefore, evaluated factors associated with selected multidrug-resistant ventilator-associated pneumonia in critical care patients. Methods: The authors prospectively recorded potential risk factors at the time of intensive care unit admission. An endotracheal aspirate was obtained in all patients who met clinical criteria for pneumonia. Patients were considered to have ventilator-associated pneumonia only when they met the clinical criteria and aspirate culture was positive for bacteria 48 h or more after initiation of mechanical ventilation. Pediatric patients were excluded. Adult patients with ventilator-associated pneumonia were first grouped as 'early-onset' (< 5 days) and 'late-onset,' determined by episodes of ventilator-associated pneumonia, and then, assigned to four groups based on the bacteria cultured from their tracheal aspirates: Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant staphylococci, and all others. The first three bacteria were considered to be multidrug resistant, whereas the others were considered to be antibiotic susceptible. Potential risk factors were evaluated with use of univariate statistics and multivariate regression. Results: Among 486 consecutive patients admitted during the study, 260 adults underwent mechanical ventilation for more than 48 h. Eighty-one patients (31%) experienced 99 episodes of ventilator-associated pneumonia, including Pseudomonas (33 episodes), methicillin-resistant staphylococci (17 episodes), Acinetobacter (9 episodes), and nonresistant bacteria (40 episodes). Sixty-six of these episodes were early onset and 33 episodes were late onset. Logistic regression analysis identified three factors significantly associated with early-onset ventilator-associated pneumonia caused by any one of the multidrug-resistant bacterial strains: emergency intubation (odds ratio, 6.4; 95% confidence interval, 2.0-20.2), aspiration (odds ratio, 12.7; 95% confidence interval, 2.4-64.6), and Glasgow coma score of 9 or less (odds ratio, 3.9; 95% confidence interval, 1.3-11.3). A. baumanii-related pneumonia cases were found to be significantly associated with two of these factors: aspiration (odds ratio, 14.2; 95% confidence interval, 1.5-133.8) and Glasgow coma score (odds ratio, 6.0; 95% confidence interval, 1.1-32.6). Conclusions: The authors recommend that patients undergoing emergency intubation or aspiration or who have a Glasgow coma score of 9 or less be monitored especially closely for early-onset multidrug-resistant pneumonia. The occurrence of aspiration and a Glasgow coma score of 9 or less are especially associated with pneumonia caused by A. baumanii.

Original languageEnglish (US)
Pages (from-to)638-645
Number of pages8
JournalAnesthesiology
Volume93
Issue number3
StatePublished - 2000
Externally publishedYes

Fingerprint

Ventilator-Associated Pneumonia
Critical Care
Bacteria
Pneumonia
Coma
Odds Ratio
Confidence Intervals
Methicillin Resistance
Acinetobacter
Staphylococcus
Artificial Respiration
Intubation
Emergencies
Cross Infection
Pseudomonas
Critical Illness
Pseudomonas aeruginosa
Intensive Care Units
Cause of Death
Logistic Models

Keywords

  • Anesthesia
  • Antibiotic resistance
  • Infection
  • Intensive care
  • Nosocomial

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Akça, O., Koltka, K., Uzel, S., Çakar, N., Pembeci, K., Sayan, M. A., ... Akpir, K. (2000). Risk factors for early-onset, ventilator-associated pneumonia in critical care patients: Selected multiresistant versus nonresistant bacteria. Anesthesiology, 93(3), 638-645.

Risk factors for early-onset, ventilator-associated pneumonia in critical care patients : Selected multiresistant versus nonresistant bacteria. / Akça, Ozan; Koltka, Kemalettin; Uzel, Serdar; Çakar, Nahit; Pembeci, Kamil; Sayan, Mehmet A.; Tütüncü, Ahmet S.; Eti, Serife; Çalangu, Semra; Özkan, Tülay; Esen, Figen; Telci, Lütfi; Sessler, Daniel I.; Akpir, Kutay.

In: Anesthesiology, Vol. 93, No. 3, 2000, p. 638-645.

Research output: Contribution to journalArticle

Akça, O, Koltka, K, Uzel, S, Çakar, N, Pembeci, K, Sayan, MA, Tütüncü, AS, Eti, S, Çalangu, S, Özkan, T, Esen, F, Telci, L, Sessler, DI & Akpir, K 2000, 'Risk factors for early-onset, ventilator-associated pneumonia in critical care patients: Selected multiresistant versus nonresistant bacteria', Anesthesiology, vol. 93, no. 3, pp. 638-645.
Akça, Ozan ; Koltka, Kemalettin ; Uzel, Serdar ; Çakar, Nahit ; Pembeci, Kamil ; Sayan, Mehmet A. ; Tütüncü, Ahmet S. ; Eti, Serife ; Çalangu, Semra ; Özkan, Tülay ; Esen, Figen ; Telci, Lütfi ; Sessler, Daniel I. ; Akpir, Kutay. / Risk factors for early-onset, ventilator-associated pneumonia in critical care patients : Selected multiresistant versus nonresistant bacteria. In: Anesthesiology. 2000 ; Vol. 93, No. 3. pp. 638-645.
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abstract = "Background: Ventilator-associated pneumonia is the leading nosocomial infection in critically ill patients. The frequency of ventilator-associated pneumonia caused by multidrug-resistant bacteria has increased in recent years, and these pathogens cause most of the deaths attributable to pneumonia. The authors, therefore, evaluated factors associated with selected multidrug-resistant ventilator-associated pneumonia in critical care patients. Methods: The authors prospectively recorded potential risk factors at the time of intensive care unit admission. An endotracheal aspirate was obtained in all patients who met clinical criteria for pneumonia. Patients were considered to have ventilator-associated pneumonia only when they met the clinical criteria and aspirate culture was positive for bacteria 48 h or more after initiation of mechanical ventilation. Pediatric patients were excluded. Adult patients with ventilator-associated pneumonia were first grouped as 'early-onset' (< 5 days) and 'late-onset,' determined by episodes of ventilator-associated pneumonia, and then, assigned to four groups based on the bacteria cultured from their tracheal aspirates: Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant staphylococci, and all others. The first three bacteria were considered to be multidrug resistant, whereas the others were considered to be antibiotic susceptible. Potential risk factors were evaluated with use of univariate statistics and multivariate regression. Results: Among 486 consecutive patients admitted during the study, 260 adults underwent mechanical ventilation for more than 48 h. Eighty-one patients (31{\%}) experienced 99 episodes of ventilator-associated pneumonia, including Pseudomonas (33 episodes), methicillin-resistant staphylococci (17 episodes), Acinetobacter (9 episodes), and nonresistant bacteria (40 episodes). Sixty-six of these episodes were early onset and 33 episodes were late onset. Logistic regression analysis identified three factors significantly associated with early-onset ventilator-associated pneumonia caused by any one of the multidrug-resistant bacterial strains: emergency intubation (odds ratio, 6.4; 95{\%} confidence interval, 2.0-20.2), aspiration (odds ratio, 12.7; 95{\%} confidence interval, 2.4-64.6), and Glasgow coma score of 9 or less (odds ratio, 3.9; 95{\%} confidence interval, 1.3-11.3). A. baumanii-related pneumonia cases were found to be significantly associated with two of these factors: aspiration (odds ratio, 14.2; 95{\%} confidence interval, 1.5-133.8) and Glasgow coma score (odds ratio, 6.0; 95{\%} confidence interval, 1.1-32.6). Conclusions: The authors recommend that patients undergoing emergency intubation or aspiration or who have a Glasgow coma score of 9 or less be monitored especially closely for early-onset multidrug-resistant pneumonia. The occurrence of aspiration and a Glasgow coma score of 9 or less are especially associated with pneumonia caused by A. baumanii.",
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author = "Ozan Ak{\cc}a and Kemalettin Koltka and Serdar Uzel and Nahit {\cC}akar and Kamil Pembeci and Sayan, {Mehmet A.} and T{\"u}t{\"u}nc{\"u}, {Ahmet S.} and Serife Eti and Semra {\cC}alangu and T{\"u}lay {\"O}zkan and Figen Esen and L{\"u}tfi Telci and Sessler, {Daniel I.} and Kutay Akpir",
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TY - JOUR

T1 - Risk factors for early-onset, ventilator-associated pneumonia in critical care patients

T2 - Selected multiresistant versus nonresistant bacteria

AU - Akça, Ozan

AU - Koltka, Kemalettin

AU - Uzel, Serdar

AU - Çakar, Nahit

AU - Pembeci, Kamil

AU - Sayan, Mehmet A.

AU - Tütüncü, Ahmet S.

AU - Eti, Serife

AU - Çalangu, Semra

AU - Özkan, Tülay

AU - Esen, Figen

AU - Telci, Lütfi

AU - Sessler, Daniel I.

AU - Akpir, Kutay

PY - 2000

Y1 - 2000

N2 - Background: Ventilator-associated pneumonia is the leading nosocomial infection in critically ill patients. The frequency of ventilator-associated pneumonia caused by multidrug-resistant bacteria has increased in recent years, and these pathogens cause most of the deaths attributable to pneumonia. The authors, therefore, evaluated factors associated with selected multidrug-resistant ventilator-associated pneumonia in critical care patients. Methods: The authors prospectively recorded potential risk factors at the time of intensive care unit admission. An endotracheal aspirate was obtained in all patients who met clinical criteria for pneumonia. Patients were considered to have ventilator-associated pneumonia only when they met the clinical criteria and aspirate culture was positive for bacteria 48 h or more after initiation of mechanical ventilation. Pediatric patients were excluded. Adult patients with ventilator-associated pneumonia were first grouped as 'early-onset' (< 5 days) and 'late-onset,' determined by episodes of ventilator-associated pneumonia, and then, assigned to four groups based on the bacteria cultured from their tracheal aspirates: Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant staphylococci, and all others. The first three bacteria were considered to be multidrug resistant, whereas the others were considered to be antibiotic susceptible. Potential risk factors were evaluated with use of univariate statistics and multivariate regression. Results: Among 486 consecutive patients admitted during the study, 260 adults underwent mechanical ventilation for more than 48 h. Eighty-one patients (31%) experienced 99 episodes of ventilator-associated pneumonia, including Pseudomonas (33 episodes), methicillin-resistant staphylococci (17 episodes), Acinetobacter (9 episodes), and nonresistant bacteria (40 episodes). Sixty-six of these episodes were early onset and 33 episodes were late onset. Logistic regression analysis identified three factors significantly associated with early-onset ventilator-associated pneumonia caused by any one of the multidrug-resistant bacterial strains: emergency intubation (odds ratio, 6.4; 95% confidence interval, 2.0-20.2), aspiration (odds ratio, 12.7; 95% confidence interval, 2.4-64.6), and Glasgow coma score of 9 or less (odds ratio, 3.9; 95% confidence interval, 1.3-11.3). A. baumanii-related pneumonia cases were found to be significantly associated with two of these factors: aspiration (odds ratio, 14.2; 95% confidence interval, 1.5-133.8) and Glasgow coma score (odds ratio, 6.0; 95% confidence interval, 1.1-32.6). Conclusions: The authors recommend that patients undergoing emergency intubation or aspiration or who have a Glasgow coma score of 9 or less be monitored especially closely for early-onset multidrug-resistant pneumonia. The occurrence of aspiration and a Glasgow coma score of 9 or less are especially associated with pneumonia caused by A. baumanii.

AB - Background: Ventilator-associated pneumonia is the leading nosocomial infection in critically ill patients. The frequency of ventilator-associated pneumonia caused by multidrug-resistant bacteria has increased in recent years, and these pathogens cause most of the deaths attributable to pneumonia. The authors, therefore, evaluated factors associated with selected multidrug-resistant ventilator-associated pneumonia in critical care patients. Methods: The authors prospectively recorded potential risk factors at the time of intensive care unit admission. An endotracheal aspirate was obtained in all patients who met clinical criteria for pneumonia. Patients were considered to have ventilator-associated pneumonia only when they met the clinical criteria and aspirate culture was positive for bacteria 48 h or more after initiation of mechanical ventilation. Pediatric patients were excluded. Adult patients with ventilator-associated pneumonia were first grouped as 'early-onset' (< 5 days) and 'late-onset,' determined by episodes of ventilator-associated pneumonia, and then, assigned to four groups based on the bacteria cultured from their tracheal aspirates: Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant staphylococci, and all others. The first three bacteria were considered to be multidrug resistant, whereas the others were considered to be antibiotic susceptible. Potential risk factors were evaluated with use of univariate statistics and multivariate regression. Results: Among 486 consecutive patients admitted during the study, 260 adults underwent mechanical ventilation for more than 48 h. Eighty-one patients (31%) experienced 99 episodes of ventilator-associated pneumonia, including Pseudomonas (33 episodes), methicillin-resistant staphylococci (17 episodes), Acinetobacter (9 episodes), and nonresistant bacteria (40 episodes). Sixty-six of these episodes were early onset and 33 episodes were late onset. Logistic regression analysis identified three factors significantly associated with early-onset ventilator-associated pneumonia caused by any one of the multidrug-resistant bacterial strains: emergency intubation (odds ratio, 6.4; 95% confidence interval, 2.0-20.2), aspiration (odds ratio, 12.7; 95% confidence interval, 2.4-64.6), and Glasgow coma score of 9 or less (odds ratio, 3.9; 95% confidence interval, 1.3-11.3). A. baumanii-related pneumonia cases were found to be significantly associated with two of these factors: aspiration (odds ratio, 14.2; 95% confidence interval, 1.5-133.8) and Glasgow coma score (odds ratio, 6.0; 95% confidence interval, 1.1-32.6). Conclusions: The authors recommend that patients undergoing emergency intubation or aspiration or who have a Glasgow coma score of 9 or less be monitored especially closely for early-onset multidrug-resistant pneumonia. The occurrence of aspiration and a Glasgow coma score of 9 or less are especially associated with pneumonia caused by A. baumanii.

KW - Anesthesia

KW - Antibiotic resistance

KW - Infection

KW - Intensive care

KW - Nosocomial

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