Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination.
OBJECTIVE
To determine the independent risk factors for late-onset ventilator-associated pneumonia (VAP) in trauma patients receiving selective digestive decontamination (SDD).


METHODS
A 4-year, prospective cohort study of trauma patients meeting the following criteria: injury severity score >15, and duration of mechanical ventilation >5 days. Predictors of late-onset VAP occurrence were assessed by logistic regression analysis.


METHODS
All patients received SDD consisting of polymixin E, gentamicin, and amphotericin B applied in nostrils, mouth, and gut with a 3-day course of parenteral cefazolin. VAP was suspected on clinical and radiological signs, and confirmed by the presence of at least one microorganism at a concentration of at least 10(4) CFU/ml on the broncho-alveolar lavage.


METHODS
Independent risk factors for late-onset VAP.


RESULTS
A late-onset VAP was diagnosed in 90 (56%) out of 159 patients. Predicting factors for late-onset VAP were: use of non-depolarizing muscle relaxant agents for intubation [3.4 (CI 1.08-10.73)], duration of intubation [1.06 (CI 1.01-1.17)], length of intensive care unit (ICU) stay [1.05 (CI 1.02-1.09)], and prior tracheal colonization [1.03 (CI 1.02-1.21)]. Exposure to prior antimicrobial treatment, except SDD, conferred protection [0.3 (0.12-0.74)].


CONCLUSIONS
This study confirms the role of duration of intubation, length of ICU stay, and prior tracheal colonization in the development of late-onset VAP. The results also highlight the importance of the initial management on the development of late-onset VAP. The type of neuromuscular blocking agents to intubate trauma patients should be evaluated in future studies.
Leone
Marc
M
Département d'Anesthésie et de Réanimation, CHU Nord, Chemin des Bourrelys, 13915 Marseille, France. marc.leone@ap-hm.fr
Delliaux
Stéphane
S
Bourgoin
Aurélie
A
Albanèse
Jacques
J
Garnier
Franck
F
Boyadjiev
Ioana
I
Antonini
Francois
F
Martin
Claude
C
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D011014:Pneumonia / Q000209:etiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications*
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000666:Amphotericin B