Ventilator-associated pneumonia mortality

There were, however, some convincing examples of major improvements within the run chart data collected locally some of the data capture was clearly both sustained and controlled (Box 19.4). For instance, patients received correctly timed antibiotics before surgery and the introduction of a care bundle in one site significantly reduced the incidence of ventilator associated pneumonia. In patients on mechanical ventilation, the cumulative risk of pneumonia increases with the duration of ventilation. This infection has serious potential complications and a high mortality rate, so improvement in the reliability of the care delivered has important implications. 

Since tire initial systematic review and mete-analysis that showed increased mortality with the use of tigecycline compared to comparators primarily driven by patients with ventilator-associated pneumonia (VAP), several... 

Kollef MH, Silver P, Murphy DM, Trouillion E. The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest 1995 108 1655-1662. 

Table 3 Incidence and Mortality Rate of Ventilator-Associated Pneumonia...

Epidemiological studies evaluating adverse effects of nosocomial infections indicate that pneumonia is the leading cause of death from infections acquired during the hospital stay. Table 3 summarizes six studies that have reported crude mortality rates of ventilator-associated pneumonia ranging from 33% to 71% (20). 

Kollef MH. Ventilator-associated pneumonia. JAMA 1993 270 1965-1970. Fagon J, Chastre J, Domart Y, Trouillet J, Gibert C. Mortality due to ventilator-associated pneumonia or colonization with Pseudomonas or Acinetobacter species assessment by quantitative culture of samples obtained by a protected specimen brush. Clin Infect Dis 1996 23 538-542. 

Gouin F, Bregeon F, Thirion X, Saux P, Denis JP, Papazian L. Ventilator-associated pneumonia and mortality (abstr). 35th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco 1995 1119 278. Johanson WGJ, Pierce AK, Sanford J, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli the significance of colonization of the respiratory tract. Ann Intern Med 1972 77 701-706. 

Similar to cases with P. aeruginosa, nosocomial ventilator-associated pneumonia caused by Acinetobacter is associated with a high mortality rate. In a study of 48 patients (70), pneumonia caused by these two organisms have a mortality rate of 71.4% compared to other pathogens (40.7%), with the observation that this rate was in excess of that observed for the underlying disease however, the impact of antimicrobial therapy was not discussed. 

In intensive care units (ICUs), pneumonia is the most frequent nosocomial infection (1-3) and occurs most often as ventilator-associated pneumonia (VAP) in patients on mechanical ventilation. The overall incidence of VAP in different studies varies between 10% and 85%, depending on the patient population and the criteria used to establish the diagnosis. Ventilator-associated pneumonia has been associated with an attributable mortality rate ranging from 13% to 47% (4-7), although this is not a consistent finding (8-10). 

Papazian L, Bregeon F, Thirion X, et al. Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996 154 91-97. 

A later prospective study of 490 patients with COPD who were admitted to hospital with radiologically confirmed community-acquired pneumonia, and of whom 77% were using inhaled glucocorticoids, has provided contradictory evidence [4 ]. There were no differences in any of the pneumonia severity markers between users of inhaled glucocorticoid and non-users. Multivariate analysis, after adjustment for COPD severity and pneumonia severity, showed that inhaled use of glucocorticoids was not independently associated with 30-day mortality (OR=1.7 95% CI=0.75, 3.9), 6-month mortality (OR = 1.6 95% Cl=0.82, 3.2), requirement for mechanical ventilation and/ or inotropic support (OR = 0.73 95%... 

In several studies, transfusion of older compared with fresh erythrocytes has been associated with increased mortality, prolonged hospitalization, intensive care treatment, mechanical ventilation, an increased risk of postoperative pneumonia, infection at any site, and multiorgan failure [21, 22 ]. However, most studies suffered from not adjusting the data for the number of units transfused. Patients who received old erythrocytes often received more cells on average than recipients of fresh erythrocytes. The amount of ceUs transfused reflects the severity of the illness, co-morbidity, and a poorer baseline prognosis [23 ]. A meta-analysis did not support the suspicion that old erythrocytes are associated with common adverse mor-bidity/mortality outcomes [24 ]. 

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