title: Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates.
abstract: Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14-70%).
  
  
  OBJECTIVE
  This study evaluated factors influencing mortality of patients with Ventilator-associated pneumonia (VAP), including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy.
  
  
  METHODS
  This retrospective study included 120 cases of Ventilator-associated pneumonia admitted to the adult adult intensive care unit of the Federal University of Uberlândia. The chi-square test was used to compare qualitative variables. Student's t-test was used for quantitative variables and multiple logistic regression analysis to identify independent predictors of mortality.
  
  
  RESULTS
  De-escalation of antibiotic therapy and resistant bacteria did not influence mortality. Mortality was 4 times and 3 times higher, respectively, in patients who received an inappropriate antibiotic loading dose and in patients whose antibiotic dose was not adjusted for renal function. Multiple logistic regression analysis revealed the incorrect adjustment for renal function was the only independent factor associated with increased mortality.
  
  
  CONCLUSIONS
  Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.
authors.affiliation: Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Programa de Pós Graduação em Ciências da Saúde, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Hospital de Clínicas, Uberlândia, MG, Brazil. Electronic address: acsouzao@yahoo.com.br.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Souza-Oliveira
authors.affiliation: Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Programa de Pós Graduação em Ciências da Saúde, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Hospital de Clínicas, Uberlândia, MG, Brazil.
authors.forename: Thúlio Marquez
authors.initials: TM
authors.lastname: Cunha
authors.affiliation: Universidade Federal de Uberlândia (UFU), Hospital de Clínicas, Uberlândia, MG, Brazil.
authors.forename: Liliane Barbosa da Silva
authors.initials: LB
authors.lastname: Passos
authors.affiliation: Universidade Federal de Uberlândia (UFU), Hospital de Clínicas, Uberlândia, MG, Brazil.
authors.forename: Gustavo Camargo
authors.initials: GC
authors.lastname: Lopes
authors.affiliation: Universidade Federal de Uberlândia (UFU), Hospital de Clínicas, Uberlândia, MG, Brazil.
authors.forename: Fabiola Alves
authors.initials: FA
authors.lastname: Gomes
authors.affiliation: Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Programa de Pós Graduação em Ciências da Saúde, Uberlândia, MG, Brazil; Instituto de Ciências Biomédicas, Uberlândia, MG, Brazil.
authors.forename: Denise Von Dolinger de Brito
authors.initials: DV
authors.lastname: Röder
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001938:Brazil; D016009:Chi-Square Distribution; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008508:Medication Errors / Q000009:adverse effects*; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacterial resistance; De-escalation of antibiotic therapy; Prescription errors; Ventilator-associated pneumonia