Sedation, sucralfate, and antibiotic use are potential means for protection against early-onset ventilator-associated pneumonia.
To examine risk factors for early-onset ventilator-associated pneumonia (EOP) in patients requiring mechanical ventilation (MV), we performed a prospective cohort study that included 747 patients. Pneumonia was defined as a positive result for a protected quantitative distal sample. EOP was defined as pneumonia that occurred from day 3 to day 7 of MV. Eighty patients (10.7%) experienced EOP. Independent predictors of EOP were male sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.18-3.63), actual Glasgow Coma Scale value of 6-13 (OR, 1.95; 95% CI, 1.2-3.18), high Logistic Organ Dysfunction score at day 2 (OR, 1.12 per point; 95% CI, 1.02-1.23), unplanned extubation (OR, 3.19; 95% CI, 1.28-7.92), and sucralfate use (OR, 1.81; 95% CI, 1.01-3.26). Protection occurred with use of aminoglycosides (OR, 0.36; 95% CI, 0.17-0.76), beta -lactams and/or beta -lactamase inhibitors (OR, 0.47; 95% CI, 0.28-0.83), or third-generation cephalosporins (OR, 0.33; 95% CI, 0.16-0.74). Sucralfate use and unplanned extubation are independent risk factors for EOP. Use of aminoglycosides, beta-lactams/ beta-lactamase inhibitors, or third-generation cephalosporins protects against EOP.
Bornstain
C
C
Medical ICU, Saint-Louis Hospital, 75010 Paris, France.
Azoulay
E
E
De Lassence
A
A
Cohen
Y
Y
Costa
M A
MA
Mourvillier
B
B
Descorps-Declere
A
A
Garrouste-Orgeas
M
M
Thuong
M
M
Schlemmer
B
B
Timsit
J-F
JF
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D013392:Sucralfate / Q000627:therapeutic use*; D013997:Time Factors; D012122:Ventilators, Mechanical / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D013392:Sucralfate