title: Ventilator-associated pneumonia in a neurologic intensive care unit does not lead to increased mortality.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among medical intensive care unit (ICU) patients and is associated with increased mortality and length of stay (LOS). Neurologic disease is a risk factor for VAP development, but the relationship between VAP and outcomes in patients admitted to the ICU for neurologic reasons remains largely unknown.
  
  
  METHODS
  All mechanically ventilated patients over a 2-year period with neurovascular disease were included in a retrospective study. Data collected included patient demographics, dates of admission and discharge, LOS, and ventilator hours. Comparisons between neurologic patients who did and did not develop VAP were made using univariate and multivariate analysis.
  
  
  RESULTS
  Of 585 intubated neurovascular patients, 24 (4.1%) developed VAP. Compared with those who did not develop VAP, those with VAP were younger (51.8 +/- 13.9 years vs. 58.8 +/- 15.9 years, P = 0.03), had increased LOS (32.6 +/- 29.2 days vs. 14.5 +/- 7.8 days, P < 0.001), and more ventilator hours (272 +/- 257 h vs. 85.9 +/- 140 h, P < 0.001). There was no difference in mortality between patients with and without VAP (25.0% vs. 28.3%, P = 0.72). VAP was not an independent predictor of mortality in a multivariate model (OR 1.11, 95% CI 0.37-3.30, P = 0.855).
  
  
  CONCLUSIONS
  VAP in neurocritical care patients is associated with increased LOS and ventilator hours, but is not associated with increased mortality, contrary to prior studies in medical ICU patients.
authors.affiliation: Department of Neurology, University of California San Francisco, Box 0114, 505 Parnassus Avenue M-798, San Francisco, CA 94143-0114, USA. ajosephson@memory.ucsf.edu
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Josephson
authors.forename: Asma M
authors.initials: AM
authors.lastname: Moheet
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gropper
authors.forename: Amy D
authors.initials: AD
authors.lastname: Nichols
authors.forename: Wade S
authors.initials: WS
authors.lastname: Smith
mesh_terms: D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data*; D053717:Pneumonia, Ventilator-Associated / Q000401:mortality* / Q000534:rehabilitation; D015996:Survival Rate; D016896:Treatment Outcome