[Impact clinically related factors on the outcomes of ventilator-associated pneumonia].
OBJECTIVE
To define the influence clinically related factors in the prognosis of ventilated pneumonia (VAP).


METHODS
A prospective clinical study involving 120 patients with VAP was carried ont. Etiologic diagnosis was established under quantitative culture of endotracheal aspiration, a protected specimen brush and bronchoalveolar lavage. Prognostic using a statistical software package (SPSS) factors were examined for univariate and multivariate analyses.


RESULTS
Case fatality directly related to the infection was 14 percent. From univariate analysis, variables that significantly associated with attributable mortality were age older than 45 years, use of corticosteroids, presence of shock, in-hospital days of VAP over as follows 9, antecedent chronic obstructive pulmonary disease, and a prior antibiotic use. Through step-forward logistic regression analysis, only prior antibiotic use (P < 0.000 1, OR = 9.2) was defined as a significant factor influencing the risk of death from VAP. The same result was obtained when severity was included in the model. However, prior antibiotic use entirely dropped out as a significant risk factor when the etiologic agent was included in the regression equation.


CONCLUSIONS
Distribution of microorganisms that responsible for VAP shown different in patients who had received prior antimicrobial therapy, and this factor caused higher mortality rate. We suggested a restrictive antibiotic use strategy among mechanically ventilated patients to reduce the risk of death from VAP.
Zhou
Pan
P
Department of Pulmonary, Sir Run Run Shaw Hospital, Zhejiang, Hangzhou 310016, China.
He
Hong
H
Liu
Jing-dong
JD
Wu
Xiao-hong
XH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D002681:China / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors
D000900:Anti-Bacterial Agents