Association between a silver-coated endotracheal tube and reduced mortality in patients with ventilator-associated pneumonia.
BACKGROUND
A silver-coated endotracheal tube (ETT) reduced the incidence of ventilator-associated pneumonia (VAP) compared with an uncoated ETT in the North American Silver-Coated Endotracheal Tube (NASCENT) study.


METHODS
To evaluate the effect of an ETT and risk factors on mortality, we performed a retrospective cohort analysis in patients who developed VAP in the NASCENT study. We determined causes of death and VAP due to potentially multidrug-resistant bacteria (eg, Pseudomonas, Acinetobacter) and performed stepwise multivariate logistic regression with the following predefined variables: treatment group, Acute Physiology and Chronic Health Evaluation (APACHE) II score, continuous sedation, coma, COPD, emergency surgery/trauma, immunodeficiency, potentially multidrug-resistant bacteria, and inappropriate initial antibiotics.


RESULTS
The silver-coated ETT was associated with reduced mortality in patients with VAP (silver vs control, 5/37 [14%] vs 20/56 [36%], P = .03), but not in those without VAP (228/729 [31%] vs 178/687 [26%], P = .03). The only between-group difference in leading causes of death was respiratory failure (silver vs control, 45/233 [19%] vs 22/198 [11%], P = .02). Of the VAP-related deaths, one in the silver group was caused by Acinetobacter sepsis. In the control group, six deaths were caused by sepsis and three by pneumonia; six of nine pathogens were potentially multidrug resistant. In multivariate analysis, the treatment group was a predictor of mortality (odds ratio, silver vs control, 0.28; 95% CI, 0.09-0.89; P = .03). APACHE II > or = 20 and inappropriate antibiotics also remained in the model (P < .1).


CONCLUSIONS
These findings suggest that a silver-coated ETT was associated with reduced mortality in patients who developed VAP in the NASCENT study. Studies are needed to confirm these exploratory findings.
Afessa
Bekele
B
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0001, USA. Afessa.bekele@mayo.edu
Shorr
Andrew F
AF
Anzueto
Antonio R
AR
Craven
Donald E
DE
Schinner
Regina
R
Kollef
Marin H
MH
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D009656:North America; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000401:mortality* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012834:Silver; D012122:Ventilators, Mechanical / Q000009:adverse effects* / Q000382:microbiology*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D012834:Silver