title: Case fatality rate related to nosocomial and ventilator-associated pneumonia in an ICU: a single-centre retrospective cohort study.
abstract: BACKGROUND
  Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) have been associated with financially significant economic burden and increased case fatality rate in adult intensive care units (ICUs). This study was designed to evaluate case fatality rate among patients with NP and VAP in a respiratory ICU.
  
  
  METHODS
  In 2008-2013, VAP and NP in the ICUs were included in this retrospective single-centre cohort study. Data on demographics, co-morbidities, severity of illness, mechanical ventilation, empirical treatment, length of hospital stay and laboratory findings were recorded in each group, as were case fatality rate during ICU admission and after discharge including short-term (28-day) and long-term (a year) case fatality rate.
  
  
  RESULTS
  A total of 108 patients with VAP (n = 64, median (IQR) age: 70 (61-75) years, 67.2% were men) or NP (n = 44, median (IQR) age: 68 (62-74) years, 68.2% were men) were found. Appropriate empirical antibiotic therapy was identified only in 45.2 and 42.9% of patients with VAP and NP, respectively. Overall case fatality rate in VAP and NP (81.3 vs 84.1), ICU case fatality rate (42.2 vs 45.5%), short-term case fatality rate (15.6 vs 27.3%) and long-term case fatality rate (23.4 vs 11.4%) were similar between VAP and NP groups along with occurrence 50% of case fatality rate cases in the first 2 months and 90% within the first year of discharge. Multivariate analysis showed that chronic obstructive pulmonary disease (COPD) (HR: 3.15, 95% CI: 1.06-9.38; p = 0.039) and presence of septic shock (HR: 3.83, 95% CI: 1.26-11.60; p = 0.018) were independently associated with lower survival.
  
  
  CONCLUSIONS
  In conclusion, our findings in a retrospective cohort of respiratory ICU patients with VAP or NP revealed high ICU, short- and long-term case fatality rates within 1 year of diagnosis, regardless of the diagnosis of NP after 48 h of initial admission or after induction of ventilator support. COPD and presence of septic shock are associated with high fatality rate and our findings speculate that as increasing compliance with infection control programs and close monitoring especially in 2 months of discharge might reduce high-case fatality rate in patients with VAP and NP.
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey. mrtyalcinsoy@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Yalçınsoy
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Salturk
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Hurıye Berk
authors.initials: HB
authors.lastname: Takır
authors.affiliation: Infectious clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Semra Batı
authors.initials: SB
authors.lastname: Kutlu
authors.affiliation: Nurse department, Infectious clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ayşegul
authors.initials: A
authors.lastname: Oguz
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Aksoy
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Merih
authors.initials: M
authors.lastname: Balcı
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Feyza
authors.initials: F
authors.lastname: Kargın
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Ozlem Yazıcıoglu
authors.initials: OY
authors.lastname: Mocin
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Nalan
authors.initials: N
authors.lastname: Adıguzel
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Gokay
authors.initials: G
authors.lastname: Gungor
authors.affiliation: Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Karakurt
mesh_terms: D017677:Age Distribution; D000368:Aged; D001317:Austria / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000401:mortality*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012772:Shock, Septic / Q000401:mortality*; D015996:Survival Rate