The value of antibody-coated bacteria in tracheal aspirates for the diagnosis of ventilator-associated pneumonia: a case-control study

Long-term assessment of functional capacity, muscle function, lung function, and quality of life in survivors of ventilator-associated pneumonia

Background and objective

The many patients who develop ventilator-associated pneumonia (VAP) have generated numerous VAP survivors who are not followed up in the long term. This study aimed, primarily, to evaluate the long-term functional capacity, as measured using the Glittre-ADL test (TGlittre), of VAP survivors and, secondarily, to calculate the correlations of TGlittre with muscle and lung function.

Methods

This cross-sectional study evaluated 30 VAP survivors 10 months after discharge from the intensive care unit. The participants underwent the following assessments: TGlittre; respiratory muscle strength; handgrip strength (HGS); spirometry; Functional Assessment of Chronic Therapy (FACIT-F); and Short Form-36 (SF-36).

Results

The median TGlittre time was 95 (81-130)% of predicted, and 30 % of the participants performed poorly on TGlittre. One-third of the participants had abnormal spirometry results. TGlittre time was correlated with weight (rs = -0.412, P = 0.023), body index mass (BMI, rs = -0.400, P = 0.029), forced vital capacity (FVC, rs = -0.401, P = 0.030), HGS (rs = -0.571, P = 0.0009), FACIT-F score (rs = -0.405, P = 0.026), and different SF-36 domain scores. Participants who returned to work had a shorter TGlittre time than those who did not (89 (69-104) vs. 129 (102-183)% predicted). Multiple linear regression indicated that FVC and BMI explained 39 % of TGlittre variability.

Conclusion

VAP survivors had suboptimal functional capacity, low lung function, and general fatigue 10 months after discharge. The longer the TGlittre time was, the worse the lung function, muscle function, general fatigue, and quality of life were and the less likely the patient was to have returned to work.

Antimicrobial resistance of Pseudomonas aeruginosa isolated from patients with pneumonia during the COVID-19 pandemic and pre-pandemic periods in Northeast Brazil

Healthcare-related infections caused by resistant microorganisms are a severe public health problem and are becoming increasingly prevalent in the hospital environment, especially Pseudomonas aeruginosa. This work aimed to evaluate the resistance profile of Pseudomonas aeruginosa to antimicrobials before the COVID-19 pandemic and during the pandemic period. Bacteria strains were obtained from tracheal aspiration, sputum, and bronchoalveolar lavage for diagnosis and phenotypic characterization. Matrix assisted laser-desorption ionization-time of flight mass spectrometry (MALD-TOF MS) was used to identify strains. Automated Phoenix and VITEK® 2 Compact system and the disc diffusion method were performed to determine the antimicrobial susceptibility profile. A total of 41,000 medical reports from adult patients with pneumonia were analyzed. Of these, 951 patients were positive for P. aeruginosa, of which 373 were related to the pre-pandemic period and 578 to the pandemic period. Older men (≥60 years) were more prevalent in both periods. P. aeruginosa strains were resistant to imipenem in both periods: 38.8 and 42.5%, respectively, followed by meropenem (34.2 and 39.2%), ciprofloxacin (33.6 and 36.7%), and levofloxacin (34.9 and 43.5%). Intensive care units had the highest percentage of affected patients (62 and 65%) compared with other sectors, with a prevalence of 71% in the public network before COVID-19 and 59% during the pandemic. Our data showed a prevalence of P. aeruginosa in elderly patients in both the pre-pandemic and pandemic periods. In addition, an increase in P. aeruginosa resistance to beta-lactams, quinolones, carbapenems, and cephalosporins was observed during the COVID-19 pandemic compared with the period before the pandemic, especially in ICUs.