title: Epidemiological and microbiological analysis of ventilator-associated pneumonia patients in a public teaching hospital.
abstract: Ventilator-associated pneumonia (VAP) is the most commonly-acquired infection in patients in intensive care units. We analyzed epidemiological and microbiological characteristics and the outcome, in a cohort of critically-ill patients with confirmed diagnosis of VAP. All patients who had been on mechanical ventilation (MV) for more than 48 hours were included in our study; material collection for microbiological analysis was done within the first 24 hours after beginning treatment or after changing antibiotics. There were 55/265 (20.7%) VAP cases diagnosed, at a rate of 21.6 episodes per 1,000 days of mechanical ventilation. Mean age of the patients was 66 years, with a mean APACHE II score of 26.7 + 7.0; male patients were more prevalent. The mortality rates in the intensive care unit (ICU) and during the hospital stay were 71% and 80%, respectively. MV duration in patients with VAP was 17 (range 3-43) days and among patients who had not developed VAP, 6 (2-32) days (p < 0.0001). 98.2% of the samples were positive, with a high prevalence of Gram-negative bacteria, mainly Acinetobacter calcoaceticus. Risk factors for death included age, MV duration and surgery. VAP incidence in this sample of critically-ill patients was high, with a high mortality rate. Control and prevention strategies based on continuing education of healthcare workers, developed by a multidisciplinary team, should be encouraged to minimize morbimortality of this infection.
authors.affiliation: Intensive Care Department, Hospital do Servidor Público Estadual de São Paulo, Rua Pedro de Toledo 1800, Vila Clementino, São Paulo, SP, Brazil. joaomanoel@sti-hspe.com.br
authors.forename: João Manoel
authors.initials: JM
authors.lastname: da Silva
authors.forename: Ederlon
authors.initials: E
authors.lastname: Rezende
authors.forename: Thaís
authors.initials: T
authors.lastname: Guimarães
authors.forename: Edvaldo V
authors.initials: EV
authors.lastname: dos Campos
authors.forename: Luiz André
authors.initials: LA
authors.lastname: Magno
authors.forename: Lívia
authors.initials: L
authors.lastname: Consorti
authors.forename: Renata Andréa Pietro
authors.initials: RA
authors.lastname: Pereira
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Nascimento
authors.forename: João Silva
authors.initials: JS
authors.lastname: de Mendonça
mesh_terms: D018806:APACHE; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000401:mortality*; D011446:Prospective Studies; D013997:Time Factors