Late-onset ventilator-associated pneumonia in nontrauma intensive care unit patients.
BACKGROUND
Most studies designed to determine the factors associated with the acquisition of late-onset ventilator-associated pneumonia (VAP) were performed in critically ill trauma patients. The impact of enteral nutrition (EN) on the risk of acquiring VAP has been discussed. In this study, we assessed factors associated with late-onset VAP in nontrauma patients and determined whether nutrition provided early was associated with development of late-onset VAP in this population.


METHODS
We performed a prospective observational cohort study in a 21-bed polyvalent intensive care unit in a university hospital.


RESULTS
Three hundred sixty-one intubated adult patients with a duration of mechanical ventilation (MV) of 6 days or more were admitted over a 28-mo period. Late-onset VAP was confirmed in 76 patients (21%) by the presence of at least one microorganism at a concentration >or=10(4) colony-forming units/mL on the bronchoalveolar lavage. Gram-negative bacilli represented 75% and Staphylococcus aureus 21% of recovered organisms. Factors independently associated with late-onset VAP by multivariate analysis included a high simplified acute physiology score II score (odds ratio: 1.021; 95% confidence interval [CI]: 1.005-1.038; P = 0.01), development of acute respiratory distress syndrome during the first 5 days of MV (odds ratio: 1.98; 95% CI: 1.05-3.67; P = 0.04), and size of the endotracheal tube >or=7.5 (odds ratio: 2.06; 95% CI: 1.88-3.90; P = 0.03). EN started within 48 h of MV onset was not associated with a higher risk for late-onset VAP.


CONCLUSIONS
In our nontrauma patient population, early EN was not associated with development of late-onset VAP. In this population, severity of the disease during the first 5 days of MV seemed to be associated with late-onset VAP. In addition, our results suggest that the risk of late-onset VAP is higher in patients with a tube size >or=7.5 than in patients with a tube size <7.5.
Gacouin
Arnaud
A
Service des Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, 35033 Rennes Cedex 9, France. arnaud.gacouin@chu-rennes.f
Barbarot
Nicolas
N
Camus
Christophe
C
Salomon
Sylvain
S
Isslame
Sonia
S
Marque
Sophie
S
Lavoué
Sylvain
S
Donnio
Pierre-Yves
PY
Thomas
Rémi
R
Le Tulzo
Yves
Y
D000368:Aged; D015505:Chest Tubes; D004750:Enteral Nutrition / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006743:Hospital Bed Capacity, under 100; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology* / Q000382:microbiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000295:instrumentation; D012128:Respiratory Distress Syndrome / Q000150:complications; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors