title: Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis.
abstract: BACKGROUND
  Despite the significant impact of nosocomial infections on the morbidity and mortality of patients staying in the intensive care unit (ICU), no study over the past 20 years has focused specifically on VAP following secondary peritonitis. The objective of the present study was to determine in-hospital mortality and epidemiological features attributed to ventilator-associated pneumonia (VAP) following secondary peritonitis.
  
  
  METHODS
  Prospective observational study involved 418 consecutive patients admitted in the ICU. Univariate and multivariate analyses were performed to identify risk factors associated with mortality and development of VAP.
  
  
  RESULTS
  The incidence of VAP following secondary peritonitis was 9.6 %. Risk factors associated with the development of VAP were hospital-acquired peritonitis, requiring >48 h of mechanical ventilation, and SOFA score. The onset of VAP was late in majority of patients. VAP was developed about 16.8 days after the initiation of the peritonitis. Etiological microorganisms responsible for the peritonitis were different than for VAP. The 90-day in-hospital mortality rate was 47.5 % of VAP patients. Independent factors associated with 30- to 90-day in-hospital mortality were VAP and SOFA.
  
  
  CONCLUSIONS
  In light of the impact on morbidity and mortality in the ICU, more attention should be given to the concurrent features among VAP and secondary peritonitis.
authors.affiliation: Anaesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005, Valladolid, Spain. maria_her_05@hotmail.com.|Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain. maria_her_05@hotmail.com.
authors.forename: María
authors.initials: M
authors.lastname: Heredia-Rodríguez
authors.affiliation: Anaesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005, Valladolid, Spain. mteresapelaez@gmail.com.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Peláez
authors.affiliation: Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Fierro
authors.affiliation: Anaesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005, Valladolid, Spain.|Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Gómez-Sánchez
authors.affiliation: Anaesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005, Valladolid, Spain.|Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Estefanía
authors.initials: E
authors.lastname: Gómez-Pesquera
authors.affiliation: Anaesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005, Valladolid, Spain.|Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Lorenzo
authors.affiliation: Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Álvarez-González
authors.affiliation: Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Bustamante-Munguira
authors.affiliation: Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.|Department of Microbiology, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Eiros
authors.affiliation: Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.|Investigación Médica en Infección e Inmunidad (IMI), Hospital Clínico Universitario de Valladolid-IECSCYL, Valladolid, Spain.
authors.forename: Jesús F
authors.initials: JF
authors.lastname: Bermejo-Martin
authors.affiliation: Anaesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005, Valladolid, Spain.|Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: José I
authors.initials: JI
authors.lastname: Gómez-Herreras
authors.affiliation: Anaesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005, Valladolid, Spain.|Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo