Effect of hospital-acquired ventilator-associated pneumonia on mortality of severe community-acquired pneumonia.
OBJECTIVE
The purpose of this article is to evaluate, using two pairwise case-control studies, attributable mortality linked to hospital-acquired ventilator-associated pneumonia (HA-VAP) complicating the intensive care unit (ICU) stay of patients exhibiting severe community-acquired pneumonia (CAP).


METHODS
Over an 11-year period, 498 patients with severe CAP were collected. Among them, 43 exhibited HA-VAP. In a first case-control study, these patients were matched with control on the basis of six confounding variables known to be general ICU prognosis factors. In a second case-control study, six variables specifically linked to CAP prognosis were used for matching.


RESULTS
In the two case-control studies, each case patient was matched with one control patient. In the first analysis, success of matching was achieved in 198 of 258 (77%) variables used for matching. In the second analysis, matching was successful for 242 of 258 (94%) confounding variables used. Eighteen patients died, compared with, respectively, 6 (P = .003) and 7 (P = .01) controls. Attributable mortality of HA-VAP was similar in the two pairwise analyses, respectively, 28% (risk ratio = 3.0; 95% confidence interval, 1.32 to 6.82) and 26% (risk ratio = 2.57; 95% confidence interval, 1.2 to 5.52).


CONCLUSIONS
When confounding factors were controlled, HA-VAP appeared to increase mortality of severe CAP requiring ICU admission.
Leroy
O
O
Service de Réanimation Médicale et Maladies Infectieuses, Université de Lille, Centre Hospitalier, Tourcoing, France.
Guilley
J
J
Georges
H
H
Choisy
P
P
Guery
B
B
Alfandari
S
S
Beaucaire
G
G
D000368:Aged; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000150:complications* / Q000401:mortality / Q000628:therapy; D015986:Confounding Factors, Epidemiologic; D003422:Critical Care; D003428:Cross Infection / Q000150:complications* / Q000209:etiology / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis