Retrospective analysis of the risk factors and pathogens associated with early-onset ventilator-associated pneumonia in surgical-ICU head-trauma patients.
BACKGROUND
Early-onset ventilator associated pneumonia (EOVAP) are frequent in head-trauma patients, but specific risk factors are poorly studied in this population.


METHODS
We conducted a retrospective cohort study in a surgical intensive care unit. Consecutive severe head-trauma patients admitted from January 2000 to December 2002 were studied. Microorganisms, and risks factors for EOVAP were analyzed.


RESULTS
During the 3-year period, 161 patients were studied; 21.1% of them developed an EOVAP. On univariate analysis 6 variables were associated with EOVAP: early enteral feeding, barbiturate use, immunosuppression, mean Simplified Acute Physiology Score 2, acute respiratory distress syndrome, and initial neurosurgery procedures. On multivariate analysis, enteral feeding >2000 Kcal before day 5 [odds ratio (OR): 0.33, 95% confidence interval (CI): 0.21-0.85] and initial neurosurgical procedure (OR: 0.36, 95% CI: 0.15-0.89) remained protective factors for EOVAP, whereas immunosuppression (OR: 7.15, 95% CI: 1.66-30.73) and barbiturate use (OR: 2.68, 95% CI: 1.06-6.80) remained risk factors for EOVAP. EOVAP was also significantly associated with a longer duration of mechanical ventilation (14.0 vs. 11.0 d, P=0.024), and a longer sedation duration (8.3 vs. 5.8 d P=0.005). Methicillin-susceptible Staphylococcus aureus was the most common pathogen involved in EOVAP (46%).


CONCLUSIONS
We demonstrate for the first time that early enteral feeding is a protective factor for EOVAP, and this result could have clinical implications for the prevention of EOVAP after traumatic brain injury. This study also confirms that barbiturate use is an important risk factor of EOVAP whereas Methicillin-susceptible S. aureus was found to be the main pathogen involved in EOVAP.
Lepelletier
Didier
D
CHU Nantes, Pôle Biologie, Service de Bactériologie-Hygiéne, Nantes, France.
Roquilly
Antoine
A
Demeure dit latte
Dominique
D
Mahe
Pierre Joachim
PJ
Loutrel
Olivier
O
Champin
Philippe
P
Corvec
Stéphane
S
Naux
Edouard
E
Pinaud
Michel
M
Lejus
Corinne
C
Asehnoune
Karim
K
D000328:Adult; D001463:Barbiturates / Q000009:adverse effects; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000150:complications*; D003422:Critical Care; D004750:Enteral Nutrition / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D016017:Odds Ratio; D053717:Pneumonia, Ventilator-Associated / Q000150:complications* / Q000382:microbiology* / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology; D013211:Staphylococcus aureus; D013997:Time Factors
D001463:Barbiturates