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Ventilator-associated pneumonia and Clinical Pulmonary Infection Score validation in a Greek general intensive care unit

Background

Ventilator-associated pneumonia (VAP) is a significant clinical problem in the ICUs and accurate diagnosis remains problematic. The purpose of the study was to examine the characteristics of VAP in a general Greek ICU.

Methods

We prospectively recorded the characteristics of VAP for a period of 5 months in a seven-bed ICU. We collected 1032 ventilator days (VD) concerning 64 patients admitted to our ICU. Data collected included demographics, VAP episodes, pathogens, resistance characteristics and outcomes. We also validated the Clinical Pulmonary Infection Score (CPIS) as a guide for VAP diagnosis [1]. We defined VAP as having CPIS ≥ 6.

Results

We included 64 patients admitted to our ICU (43 men) of mean age 50.8 ± 4.6 years. Patients were admitted from the emergency department, wards, other ICUs and the operating room suffering from multiple trauma including head injury (25), stroke (14), postoperative respiratory failure (10), heart failure (seven), sepsis (five), and other medical conditions (three). We recorded 1032 VD. Twenty-one patients (21/64, 32.8%) developed VAP. Four patients developed two separate episodes of VAP. We in total recorded 25 episodes of VAP. The incidence of VAP was 24.2 episodes per 1000 VD. The duration of VAP until resolution was 11.4 ± 0.9 days. The total duration of mechanical ventilation (MV) was 29.7 ± 5.3 days and the mean duration of MV before the development of VAP was 19.9 ± 4.8 days.

We identified multidrug resistant pathogens (Acinetobacter baumanii) in two patients and one of them died due to VAP. We also identified pathogens sensitive only to colistin (A. baumanii in eight patients and Pseudomonas aeruginosa in two patients) in 10 patients, five of them died and one of them died due to VAP (Table 1).

Table 1

The VAP-attributable mortality was 23.8% (5/21). VAP was successfully resolved in 20/25 episodes. Management of VAP was guided according to culture results and in the case of multidrug resistance or single antibiotic sensitivity by the use of combination antibiotic therapy including meropenem, high-dose ampicillin-sulbactam and collistin.

CPIS sensitivity was 82.7%, specificity was 89.2%, positive predictive value was 73.2% and negative predictive value was 93.5%.

Conclusions

VAP significantly contributes to morbidity and mortality of critically ill ICU patients. However, VAP may be successfully treated even in the case of multidrug resistance or single antibiotic sensitivity by combination therapy. CPIS may be a significant tool in the diagnosis of VAP in our ICU.

References

  1. 1.

    Singh N, et al: Am J Respir Crit Care Med. 2000, 162: 505-511.

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Myrianthefs, P., Ioannidis, K., Mis, M. et al. Ventilator-associated pneumonia and Clinical Pulmonary Infection Score validation in a Greek general intensive care unit. Crit Care 9, P4 (2005). https://doi.org/10.1186/cc3067

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Keywords

  • Mechanical Ventilation
  • Multidrug Resistance
  • Meropenem
  • Colistin
  • Multiple Trauma