Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals.
The purpose of this study was to assess the main clinical predictors and microbiological features of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU) environment. This work is a retrospective analysis over one year from September 2010 to September 2011. Patients' risk factors, causes of admission, comorbidities and respiratory specimens collected in six Italian ICUs were reviewed. Incidence and case fatality rate of VAP were evaluated. After stratification for VAP development, univariate and multivariate analyses were performed to assess the impact of patients' conditions on the onset of this infection. A total of 1,647 ICU patients (pts) were considered. Overall, 115 patients (6.9 %) experienced at least one episode of VAP. The incidence rate for VAP was 5.82/1,000 pts-days, with a case fatality rate of 44.3 %. Multivariate analysis showed that admission for neurological disorders (aIRR 4.12, CI 1.24-13.68, p = 0.02) and emergency referral to ICU from other hospitals (aIRR 2.11, CI 1.03-4.31, p = 0.04) were associated with higher risk of VAP, whereas a tendency to a higher risk of infection was detected for admission due to respiratory disease, cardiac disease, trauma and for having obesity or renal failure. A total of 372 microbiological isolates from respiratory specimens were collected in VAP patients. The most common species were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, showing high resistance rates to carbapenems. Neurological disorders and emergency referral at the admission into the ICU are significantly associated with the onset of VAP. A high incidence of multi-drug resistant Gram- species was detected in the respiratory specimens.
Clinical Infectious Diseases, Tor Vergata University Hospital, V. le Oxford 81, 00133, Rome, Italy. diego.dellerose82@gmail.com.
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Delle Rose
Istituto Superiore di Sanità, Rome, Italy.
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Pezzotti
Clinical Infectious Diseases, Tor Vergata University Hospital, V. le Oxford 81, 00133, Rome, Italy.
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Fortunato
Clinical Infectious Diseases, Tor Vergata University Hospital, V. le Oxford 81, 00133, Rome, Italy.
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Sordillo
Clinical Infectious Diseases, Tor Vergata University Hospital, V. le Oxford 81, 00133, Rome, Italy.
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Gini
Istituto Superiore di Sanità, Rome, Italy.
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Boros
S. Filippo Neri Hospital, Rome, Italy.
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Meledandri
San Gallicano Dermatologic Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy.
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Gallo
San Gallicano Dermatologic Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy.
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Prignano
Intensive Care Unit, S. Giovanni Hospital, Rome, Italy.
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Caccese
Intensive Care Unit, S. Giovanni Hospital, Rome, Italy.
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M
D'Ambrosio
Intensive Care Unit, La Sapienza University, Rome, Italy.
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Citterio
Intensive Care Unit, La Sapienza University, Rome, Italy.
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Rocco
Intensive Care Unit, Tor Vergata University Hospital, Rome, Italy.
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Leonardis
Intensive Care Unit, Tor Vergata University Hospital, Rome, Italy.
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Natoli
Clinical Microbiology Laboratories, Tor Vergata University Hospital, Rome, Italy.
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Fontana
Clinical Microbiology Laboratories, Tor Vergata University Hospital, Rome, Italy.
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Favaro
Clinical Pharmacy, Tor Vergata University Hospital, Rome, Italy.
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Celeste
S. Andrea Hospital, Rome, Italy.
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Franci
Clinical Infectious Diseases, Tor Vergata University Hospital, V. le Oxford 81, 00133, Rome, Italy.
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Testore
Clinical Infectious Diseases, Tor Vergata University Hospital, V. le Oxford 81, 00133, Rome, Italy.
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M
Andreoni
Clinical Infectious Diseases, Tor Vergata University Hospital, V. le Oxford 81, 00133, Rome, Italy.
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Sarmati
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification* / Q000302:isolation & purification*; D002175:Candida / Q000302:isolation & purification*; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors