title: Ventilator-associated pneumonia in critically ill patients with intensive antibiotic usage.
abstract: OBJECTIVE
  Ventilator-associated pneumonia (VAP) is an infection with high mortality and morbidity that prolongs the length of stay in the intensive care unit (ICU) and hospitalisation. VAP is one of the most common infections in critically ill patients. This study aimed to prospectively determine the VAP rate and associated factors in critically ill patients with intensive antibiotic usage during a one-year period.
  
  
  METHODS
  In total, 125 out of 360 patients admitted to the intensive care unit during the one-year study period (September 2010-2011) were included for follow-up for VAP diagnosis. Demographic data, APACHE II scores, diagnoses on admission, clinical pulmonary infection scores (CPIS), CRP, procalcitonin, risk factors for infection, time to VAP diagnosis, and bacteriological culture results were recorded. All data were assessed in terms of ICU, hospital and 28-day mortality.
  
  
  RESULTS
  In total, 56 (45%) out of 125 patients were diagnosed with VAP. In addition, 91% of patients diagnosed with VAP were administered antibiotics before diagnosis. In the VAP patients, the mortality rates were 48, 68 and 71% for 28-day, ICU and hospital mortality, respectively.
  
  
  CONCLUSIONS
  The coexistence of clinical and microbiological parameters should not be sought when diagnosing VAP in patients who use antibiotics intensively. VAP can be diagnosed when CPIS≤6 in cases with sufficient microbiological evidence. This strategy may decrease mortality by preventing a delay in therapy.
authors: Canan Bor, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.
authors: Canan
authors: C
authors: Bor
authors: Kubilay Demirag, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.
authors: Kubilay
authors: K
authors: Demirag
authors: Ozlem Okcu, Department of Radiology, Ege University School of Medicine Hospital, Izmir, Turkey.
authors: Ozlem
authors: O
authors: Okcu
authors: Ilkin Cankayali, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.
authors: Ilkin
authors: I
authors: Cankayali
authors: Mehmet Uyar, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.
authors: Mehmet
authors: M
authors: Uyar
keywords: Clinical Pulmonary Infection Scores (CPIS); Mortality; Ventilator-associated pneumonia (VAP)