Case fatality rate related to nosocomial and ventilator-associated pneumonia in an ICU: a single-centre retrospective cohort study

Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

BACKGROUND

Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation (MV). The emergence of multidrug resistant bacteria (MDRB) has become a public health problem, creating a new burden on medical care in hospitals, particularly for patients admitted to the intensive care unit (ICU).

AIM

To describe risk factors for ventilator-acquired pneumonia (VAP) in patients with cancer and to evaluate the impact of MDRB.

METHODS

A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City, which included all patients who were admitted to the ICU and required MV ≥ 48 h. They were classified as those who developed VAP versus those who did not; pathogens isolated, including MDRB. Clinical evolution at 60-d was assessed. Descriptive analysis was carried out; comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.

RESULTS

Two hundred sixty-three patients were included in the study; mean age was 51.9 years; 52.1% were male; 68.4% had solid tumors. There were 32 episodes of VAP with a rate of 12.2%; 11.5 episodes/1000 ventilation-days. The most frequent bacteria isolated were the following: Klebsiella spp. [n = 9, four were Extended-Spectrum Beta-Lactamase (ESBL) producers, one was Carbapenem-resistant (CR)]; Escherichia coli (n = 5, one was ESBL), and Pseudomonas aeruginosa (n = 8, two were CR). One Methicillin-susceptible Staphylococcus aureus was identified. In multivariate analysis, the sole risk factor associated for VAP was length of ICU stay (OR = 1.1; 95%CI: 1.03-1.17; P = 0.003). Sixty-day mortality was 53% in VAP and 43% without VAP (P = 0.342). There was not higher mortality in those patients with MDRB.

CONCLUSION

This study highlights the high percentage of Gram-negative bacteria, which allows the initiation of empiric antibiotic coverage for these pathogens. In this retrospective, single center, observational study, MDRB VAP was not directly linked to increased mortality at 60 days.

Clinical effects of lentinan combined with budesonide inhalation in treating acute exacerbation of chronic obstructive pulmonary disease under mechanical ventilation

In the present study, the clinical efficacy of the immune modulator lentinan combined with inhalation of the corticosteroid budesonide in treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD) under mechanical ventilation was assessed. A total of 72 cases of AECOPD treated at Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Shanghai, China) between June 2016 and September 2017 were enrolled. The AECOPD patients were randomly divided into an experimental group (n=36) and a control group (n=36). All of the patients received ventilator support and endotracheal intubation was performed. The experimental group was orally administered lentinan and budesonide was administered via atomization inhalation through a Y-tube and the control group received only budesonide via Y-tube. After the treatment, airway pressure, the time of mechanical ventilation and the time of stay at the intensive care unit for the experimental group were significantly lower than those for the control group (P<0.001). The plasma levels of adiponectin, D-dimer, interleukin-17 and high-sensitivity C-reactive protein, as well as the pressure of CO₂ in the experimental group were significantly lower than those in control group (P<0.001). Furthermore, the partial O₂ pressure in the experimental group was significantly higher than that in the control group (P<0.001). After the combined treatment, the proportions of CD3⁺ and CD4⁺T-cells in the blood were elevated, while the proportion of CD8⁺T-cells was decreased, compared with those in the experimental group at baseline or the control group post-treatment. In conclusion, the strategy of lentinan treatment combined with budesonide inhalation for AECOPD patients under mechanical ventilation demonstrated improved clinical efficacy compared with budesonide alone. (Chinese Clinical Trial Registry no. ChiCTR1800019088).

Clinical outcomes related to the incidence of ventilator-associated pneumonia in adults - a cohort study

Abstract Introduction: Ventilator-Associated Pneumonia (VAP) is a common complication found in the Intensive Care Unit (ICU) and is associated with increased mortality, length of hospital stay and mechanical ventilation (MV) time. Objective: To determine the incidence of VAP and its impact on the clinical course of the subject undergoing invasive MV in the ICU. Methods: This is a cohort study of hospitalized subjects in the general adult ICU of the State Hospital of Bauru / SP. The clinical information for the period of 19 months were collected. Stratification for the groups was based on the presence or absence of VAP, free_VAP and VAP, respectively. The Hotelling T² with 95% confidence, chi-square and the Mann-Whitney tests were executed using the "R" software and the results showed as mean ± standard deviation and absolute and relative distribution (p < 0.05). Results: The sample was of 322 subjects; the VAP group consisted of 73 (22.67%), 54.79% male, age: 62.31±16.96 years and the APACHE II: 29.98 ± 8.64. The VAP group had longer time of the MV and of the ICU compared to free VAP group; even in this group, the highest incidence of death in the ICU occurred between the 16th and 20th day of hospitalization. The free VAP group was older and 50% of the patients discharged from hospital. Conclusion: VAP and their interfaces still impact on the clinical evolution of the subjects mainly on the time factor of MV and ICU stay. The highest incidence of death in the ICU occurs in the first weeks.

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

OBJECTIVE

The aim of this study was to identify microorganisms causing ventilator-associated pneumonia (VAP) and also study the antibiotic resistance/susceptibility.

MATERIALS AND METHODS

We retrospectively assessed microorganisms isolated from patients diagnosed with VAP in a pediatric intensive care unit between January 1, 2014, and June 30, 2016.

RESULTS

We included 44 patients diagnosed with VAP. The prevalence thereof was 8.6 patients per 1,000 ventilator days. Mechanical ventilation was required for 56.5% of patients. Thirty-three patients (75%) died. An underlying chronic disease was detected in 75% of patients (n=33). Fifty microorganisms were isolated from 44 patients. Single microorganisms were isolated from 86.4% (n=38) and two from 13.6% (n=6) of patients. Of all the isolated bacteria, 96% (n=48) were gram-negative; the most common was Pseudomonas aeruginosa (32%), followed by Klebsiella pneumoniae (24%) and Acinetobacter baumannii (22%). The isolates were most susceptible to colistin (92.6%), followed by piperacillin-tazobactam (71.4%), amikacin (65.2%), and gentamicin (52.2%). No enterobacterium or Acinetobacter strain was resistant to colistin; however, 13% of P. aeruginosa isolates were resistant.

CONCLUSION

In VAP, it is essential to catalog antibiotic resistance patterns of bacteria present in the unit to ensure that empirical antibiotic therapy is effective.

Prospective observational study to compare oral topical metronidazole versus 0.2% chlorhexidine gluconate to prevent nosocomial pneumonia

BACKGROUND

Nosocomial pneumonia is one of the most common health care-associated infections in intensive care units (ICUs) worldwide, attributing to high morbidity and mortality. Our study aim is to investigate the effectiveness of oral hygiene with 0.2% chlorhexidine gluconate (CHX) and 0.08% metronidazole (MDE) influencing the microbiologic epidemiology and incidence of nonintubation pneumonia (NIP) and ventilator-associated pneumonia (VAP).

METHODS

Patients who stayed >48 hours in the emergency ICU between 2008 and 2012 were enrolled and provided oral hygiene by swabbing with 0.08% MDE twice daily until discharge or death during the first year (period M), whereas CHX was applied during the following 3 years (period C). The incidence and microbiologic epidemiology of NIP and VAP were studied.

RESULTS

There were 873 patients enrolled. There were 44 episodes of NIP and 25 episodes of VAP that occurred among 212 patients in period M, and 84 episodes of NIP and 49 episodes of VAP occurred among 661 patients in period C. Overall, the rate of NIP and VAP decreased year by year. Acinetobacter baumannii was the most frequently identified bacteria for NIP (22.9%) and VAP (25.3%), with an annual ascent. Few changes were observed on bacteria distribution for NIP and VAP.

CONCLUSIONS

Oral hygiene with CHX, having reduced the incidence of nosocomial pneumonia among critical ill patients, suggests a benefit of oral hygiene in decreasing the incidence of nosocomial pneumonia, including VAP in ICUs, but not bacterial epidemiology.