Risk factors for treatment failure in patients with ventilator-associated pneumonia receiving appropriate antibiotic therapy.
OBJECTIVE
The aim of this study was to investigate modifiable risk factors and predictors for treatment failure (TF) in patients with ventilator-associated pneumonia (VAP) receiving appropriate antibiotic therapy.


METHODS
An observational cohort study performed in an intensive care unit (ICU) of a University hospital. Eighty-nine patients with VAP were enrolled in the study consecutively. Treatment failure was defined as lack of clinical and microbiological response to therapy within 2 weeks. Potential risk factors for TF, related with patients, microorganisms, and ICU therapies, were evaluated.


RESULTS
Mean age was 72 +/- 13 years. Fifty-three of the patients had TF. Patients with TF were older, had more comorbidities, higher admission and Acute Physiology and Chronic Health Evaluation Score (APACHE II)-VAP scores, lower daily carbohydrate intake, and lymphocyte number below 1000/mm(3) than the treatment success group. Transfusions, bacteremia, infection with multidrug-resistant microorganisms, initial bacterial load (CFU/mL), and steroid therapy were similar across the groups. Comorbidity (odds ratio [OR], 4.4; 95% CI, 1.2-16.8; P = .030), VAP-APACHE II scores above 16 (OR, 6.4; 95% CI, 2.1-18.6; P = .001), daily carbohydrate intake below 190 g/d (OR, 3; 95% CI,1.1-8.6; P = .038), lymphocyte number below 1000/mm3 (OR, 4.1; 95% CI, 1.3-12.9; P = .014) were independent predictors for TF.


CONCLUSIONS
Patients with comorbidities, who are severely ill and lymphocytopenic at the time of VAP diagnosis, are at high risk for TF.
Gursel
Gul
G
Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Besevler, Ankara, Turkey. ggursel@gazi.edu.tr
Aydogdu
Muge
M
Ozyilmaz
Ezgi
E
Ozis
Turkan N
TN
D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D017211:Treatment Failure
D000900:Anti-Bacterial Agents