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The Effect of Late-Onset : Ventilator-Associated Pneumonia in Determining Patient Mortality FREE TO VIEW

Marin H. Kollef; Patricia Silver; Denise M. Murphy; Ellen Trovillion
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Affiliations: From the Department of Internal Medicine, Pulmonary and Critical Care Division, Washington University School of Medicine, Barnes and lewish Hospitals, St. Louis,  From the Department of Respiratory Therapy Barnes and lewish Hospitals, St. Louis,  From the Department of Infection Control, Barnes and lewish Hospitals, St. Louis

Affiliations: From the Department of Internal Medicine, Pulmonary and Critical Care Division, Washington University School of Medicine, Barnes and lewish Hospitals, St. Louis,  From the Department of Respiratory Therapy Barnes and lewish Hospitals, St. Louis,  From the Department of Infection Control, Barnes and lewish Hospitals, St. Louis

Affiliations: From the Department of Internal Medicine, Pulmonary and Critical Care Division, Washington University School of Medicine, Barnes and lewish Hospitals, St. Louis,  From the Department of Respiratory Therapy Barnes and lewish Hospitals, St. Louis,  From the Department of Infection Control, Barnes and lewish Hospitals, St. Louis


1995 BY THE AMERICAN COLLEGE OF CHEST PHYSICIANS


Chest. 1995;108(6):1655-1662. doi:10.1378/chest.108.6.1655
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Abstract

Study objective: To determine whether the development of late-onset ventilator-associated pneumonia (VAP) is associated with an increased risk of hospital mortality.

Design: Prospective cohort study. Setting: ICUs of two university-affiliated teaching hospitals.

Patients: Three hundred fourteen patients admitted to an ICU who required mechanical ventilation for greater than 5 days.

Interventions: Prospective patient surveillance and data collection.

Measurements: The primary outcome measures were the development of late-onset VAP (ie, occurring >96 h after intubation) and hospital mortality.

Results: Late-onset VAP was observed in 87 patients (27.7%). Thirty-four (39.1%) patients with late-onset VAP died during hospitalization compared with 85 patients (37.4%) without late-onset VAP (relative risk, 1.04; 95% confidence interval [CI], 0.76 to 1.43). Twenty patients (6.4%) developed late-onset VAP due to a "high-risk" pathogen (ie, Pseudomonas aeruginosa, Acinetobacter sp, Xanthomonas maltophilia) with an associated mortality rate of 65%. Stepwise logistic regression analysis identified five variables as independent risk factors for hospital mortality (p<0.05): an organ system failure index of 3 or greater (adjusted odds ratio [AOR], 3.4; 95% CI, 2.0 to 5.8; p<0.001), having a nonsurgical diagnosis (AOR, 2.1; 95% CI, 1.3 to 3.6; p=0.002), a premorbid lifestyle score of 2 or greater (AOR, 1.8; 95% CI, 1.1 to 2.9; p=0.015), acquiring late-onset VAP due to a "high-risk" pathogen (AOR, 3.4; 95% CI, 1.2 to 10.0; p=0.025), and having received antacids or histamine type-2 receptor antagonists (AOR, 1.7; 95% CI, 1.0 to 2.9; p=0.034). Additionally, we found the occurrence of late-onset VAP due to high-risk pathogens to be the most important predictor of hospital mortality among patients developing VAP (AOR, 5.4; 95% CI, 2.8 to 10.3; p=0.009).

Conclusions: Nosocomial pneumonia due to certain high-risk microorganisms is an independent risk factor for hospital mortality among patients requiring prolonged mechanical ventilation. We suggest that future investigations of late-onset VAP stratify patient outcomes according to the distribution of high-risk pathogens when reporting their results.


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