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Ventilator-associated pneumonia in a Greek ICU: prevalence and etiology

Introduction

Nosocomial pneumonia is the leading cause of death from hospital-acquired infections. Ventilator-associated pneumonia (VAP) is the most frequent ICU-acquired infection in mechanically ventilated patients. The purpose of our study is to assess the prevalence and the etiologic pathogens of VAP in our ICU, as well as its impact on morbidity and mortality.

Methods

A prospective observational study in a multidisciplinary eight-bed ICU. During an 18-month period, 160 consecutive patients with a length of stay (LOS) ≥ 48 hours were enrolled in the study. Data were collected using a specially designed software and included age, gender, APACHE II score on admission, days on mechanical ventilation, LOS and ICU outcome. Patients were stratified into two groups: Group A included patients who did not develop VAP (n = 144), and Group B patients in whom VAP diagnosis was confirmed (n = 16). In Group B, isolated pathogens and their in vitro susceptibilities were also recorded. VAP diagnosis was established on the basis of clinical criteria and positive quantitative cultures of bronchial aspirates (≥ 105 colony-forming units/ml). Data were analyzed using Student's t test and the Mann–Whitney rank-sum test.

Results

Age (64 ± 18 vs. 70 ± 13 years, P = 0.257) and APACHE II score on admission (18.9 ± 7.6 vs. 18.8 ± 9.7, P = 0.965) were similar in both groups. Calculated VAP incidence was 5.87/1,000 ventilator-days (four early and 12 late-onset VAP). Duration of mechanical ventilation (17 ± 22 vs. 30 ± 12 days, P < 0.001) and LOS (19 ± 22 vs. 34 ± 15 days, P < 0.001) were statistically longer in Group B. Isolated pathogens included: Acinetobacter baumannii (10 patients), Klebsiella pneumoniae (four patients), Pseudomonas aeruginosa (two patients), other Gram-negative (one patient). Overall antibiotic resistance to carbapenemes was 88%, to aminoglycosides 82%, to aztreonam 94%, to piperacillin/tazobactam 82% and to colimycin 6%. ICU mortality was considerably higher in Group B (24.3% vs. 43.8%).

Conclusion

All VAP cases in our ICU were caused by Gram-negative multidrug-resistant bacteria. Colimycin seems to be our major therapeutic weapon against these strains. VAP prolongs the duration of mechanical ventilation and LOS, and contributes to higher mortality rates in ICU patients requiring mechanical ventilation.

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Katsiari, M., Apostolakou, E., Nikolaou, C. et al. Ventilator-associated pneumonia in a Greek ICU: prevalence and etiology. Crit Care 13, P297 (2009). https://doi.org/10.1186/cc7461

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Keywords

  • Mechanical Ventilation
  • Carbapenemes
  • Aztreonam
  • Nosocomial Pneumonia
  • Acinetobacter Baumannii