title: Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia.
abstract: BACKGROUND
  Prolonged intubation with mechanical ventilation carries a risk for ventilator-associated respiratory infections manifest as tracheobronchitis or pneumonia. This study analyzed natural history, incidence, and outcomes of patients developing ventilator-associated tracheobronchitis and pneumonia.
  
  
  METHODS
  We studied 188 mixed intensive care unit (ICU) patients intubated ≥48 hours for the development of tracheobronchitis defined as quantitative endotracheal aspirate ≥10(5) cfu/mL plus at least 2 clinical criteria (fever, leukocytosis, or purulent sputum). Pneumonia was defined as microbiologic criteria for tracheobronchitis and a new and persistent infiltrate on chest radiograph.
  
  
  RESULTS
  Airways of 41 (22%) patients became heavily colonized with a bacterial pathogen(s) at a concentration of ≥10(5) cfu/mL. Tracheobronchitis developed in 21 (11%) study patients, of which 6 (29%) later progressed to pneumonia. Including these 6 patients, 28 (15%) study patients developed pneumonia. Multidrug-resistant pathogens were isolated in 39% of pneumonia patients. Patients with tracheobronchitis and pneumonia had significantly more ventilator days and longer stays in the ICU (P ≤.02).
  
  
  CONCLUSIONS
  Approximately one third of tracheobronchitis patients later developed pneumonia. Patients with tracheobronchitis or pneumonia experienced significantly more ventilator days and longer ICU stays, but had no difference in mortality. Better patient outcomes and reduced health care costs may be achieved by earlier treatment of ventilator-associated respiratory infections, manifest as tracheobronchitis or pneumonia.
authors.affiliation: Center for Infectious Diseases & Prevention, Lahey Clinic Medical Center, Burlington, MA 01805, USA. donald.e.craven@lahey.org
authors.forename: Donald E
authors.initials: DE
authors.lastname: Craven
authors.forename: Yuxiu
authors.initials: Y
authors.lastname: Lei
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: Akmal
authors.initials: A
authors.lastname: Sarwar
authors.forename: Jana
authors.initials: J
authors.lastname: Hudcova
mesh_terms: D018806:APACHE; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001991:Bronchitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014136:Tracheitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents