title: Ventilator-associated tracheobronchitis increases the length of intensive care unit stay.
abstract: OBJECTIVE
  To investigate prospectively the clinical course and risk factors for ventilator-associated tracheobronchitis (VAT) and the impact of VAT on intensive care unit (ICU) morbidity and mortality.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University Hospital Larissa, Larissa, Greece.
  
  
  METHODS
  Critical care patients who received mechanical ventilation for more than 48 hours were prospectively studied between 2009 and 2011.
  
  
  METHODS
  The modified Clinical Pulmonary Infection Score, white blood cell count, and C-reactive protein level were systematically assessed every 2 days for the first 2 weeks of ICU stay. Bronchial secretions were assessed daily. Quantitative cultures of endotracheal secretions were performed on the first ICU day for every patient and every 2 days thereafter for the first 2 weeks or more at the discretion of the attending physicians. Definition of VAT was based on previously published criteria.
  
  
  RESULTS
  A total of 236 patients were observed; 42 patients (18%) presented with VAT. Gram-negative pathogens, which were usually multidrug resistant, were responsible for 92.9% of cases. Patients with a neurosurgical admission presented with VAT significantly more often than did other ICU patients (28.5% vs 14.1%; . The occurrence P=.02) of VAT was a significant risk factor for increased duration of ICU stay (OR [95% CI], 3.04 [1.35–6.85]; P=.01). Age (OR [95% CI], 1.04 [1.015–1.06]; P=.02), Acute Physiology and Chronic Health Evaluation II score (OR [95% CI], 1.08 [1.015–1.16]; P=.02), and C-reactive protein level at admission (OR [95% CI], 1.05 [1.01–1.1]; P=.02) were independent factors for ICU mortality.
  
  
  CONCLUSIONS
  VAT is a nosocomial infection that might be associated with prolonged stay in the ICU, especially in neurocritical patients. VAT was not associated with increased mortality in our study.
authors.affiliation: Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece.
authors.forename: Marios
authors.initials: M
authors.lastname: Karvouniaris
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Makris
authors.forename: Efstratios
authors.initials: E
authors.lastname: Manoulakas
authors.forename: Paris
authors.initials: P
authors.lastname: Zygoulis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mantzarlis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Triantaris
authors.forename: Maria
authors.initials: M
authors.lastname: Chatzi
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Zakynthinos
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D001991:Bronchitis / Q000382:microbiology / Q000401:mortality*; D002097:C-Reactive Protein / Q000378:metabolism; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000401:mortality*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D014136:Tracheitis / Q000382:microbiology / Q000401:mortality*; D012122:Ventilators, Mechanical / Q000009:adverse effects
chemical_list: D002097:C-Reactive Protein