Ventilator-associated pneumonia in long-term ventilator-assisted individuals.
BACKGROUND
Information on the characteristics of pneumonia in long-term ventilator-assisted individuals is scarce. We evaluate the incidence, risk factors and outcome of ventilator-associated pneumonia (VAP) in a large series of chronically ventilated patients.


METHODS
All patients assisted in a chronic ventilator-dependent unit were prospectively followed up for the development of VAP. Patients with a new and persistent lung infiltrate and a purulent tracheal aspirate were suspected to have VAP. Pneumonia was considered microbiologically confirmed in the presence of (1) a positive blood culture and/or (2) ≥10⁵ CFU ml⁻¹ in quantitative bacterial culture of tracheal aspirates or ≥10³ CFU ml⁻¹ in quantitative mini-bronchoalveolar lavage cultures.


RESULTS
In total, 100 consecutive long-term ventilated individuals with spinal cord injury (mean age 49 years) were prospectively followed up. The length of mechanical ventilation before admission in the unit was 54±37 days, and the follow-up after admission was 119±127 days. There were 32 episodes of VAP in 27 patients (1.74 episodes per 1000 days of mechanical ventilation). By logistic regression analysis, hypoalbuminaemia (P=0.03), administration of antacids (P=0.002) and length of mechanical ventilation (P=0.05) were independent risk factors for VAP. The most frequently isolated organisms were Pseudomonas aeruginosa (62%), methicillin-resistant Staphylococcus aureus (25%) and Acinetobacter baumannii (15%); 9 (28%) episodes were polymicrobial. Antimicrobial treatment, including monotherapy in 66%, was successful in most patients. Only three patients (11%) died in relation to VAP.


CONCLUSIONS
Patients on long-term ventilation are at significant risk for the development of VAP, but the mortality is low.
García-Leoni
M E
ME
Infectious Disease Unit, Department of Internal Medicine, Hospital Nacional de Parapléjicos, Toledo, Spain. eugega@yahoo.com
Moreno
S
S
García-Garrote
F
F
Cercenado
E
E
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology
D000900:Anti-Bacterial Agents