Early- and Late-Onset Ventilator-Associated Pneumonia in Emergency- and Non-emergency-Admitted Patients in the Intensive Care Units of Alzahra Hospital (Isfahan, Iran): Comparison of Bacterial Subgroups

Document Type : Original Article (s)

Authors

1 Assistant Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 General Practitioner, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: One of the most prevalent infections in intensive care units (ICUs) is ventilator-associated pneumonia that divided in two groups of early- and late-onset pneumonia. The aim of this study was determining the prevalence of early- and late-onset ventilator-associated pneumonia (VAP) in emergency- and non-emergency-admitted patients in the intensive care units.Methods: In a prospective study, 100 patients hospitalized in intensive care units of Alzahra Hospital (Isfahan, Iran) who suffered from ventilator-associated pneumonia were selected. Based on the time of pneumonia onset, the patients were divided in early- (lower than 4 days) and late-onset (4 and over days) groups. The subtype of bacteria and patients’ characteristics were compared between the two groups.Findings: The mean age of the patients was 33.85 ± 13.27 years. 58 patients were emergency- and 42 were non-emergency-admitted. 23 (23%) patients suffered from late- and 77 (77%) from early-onset pneumonia. Prevalence rate of early-onset pneumonia was 75.9% and 78.6% in emergency- and non-emergency-admitted patients (P = 0.75). The mean pneumonia score was 7.26 ± 2.07 and 7.17 ± 1.66 in late- and early-onset pneumonia, respectively (P = 0.83). The most prevalent bacterial cause was methicillin-resistant Staphylococcus aureus (MRSA) (30.4%) and Acinetobacter (33.8%) in late- and early-onset pneumonia, respectively (P = 0.10).Conclusion: A considerable part of happened ventilator-associated pneumonia in intensive care units was late-onset which my lead to increase of hospitalization time and mortality risk in these patients. In addition, antibiotic-resistant bacteria were more in late-onset pneumonia. Hence, daily visit of patients about ventilator-associated pneumonia and early treatment in suspected cases is recommended.

Keywords

References

  1. Fagon JY, Stephan F, Novara A. Epidemiology of acquired pneumonia in mechanically ventilated patients. In: Chastre J, Fagon JY, editors. Nosocomial pneumonia and mechanical ventilation. Paris, France: Masson; 1995. [In French].
  2. Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129(6): 433-40.
  3. Restrepo MI, Peterson J, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care 2013; 58(7): 1220-5.
  4. McEachern R, Campbell GD, Jr. Hospital-acquired pneumonia: epidemiology, etiology, and treatment. Infect Dis Clin North Am 1998; 12(3): 761-79, x.
  5. Hedrick TL, Smith RL, McElearney ST, Evans HL, Smith PW, Pruett TL, et al. Differences in early- and late-onset ventilator-associated pneumonia between surgical and trauma patients in a combined surgical or trauma intensive care unit. J Trauma 2008; 64(3): 714-20.
  6. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999; 27(5): 887-92.
  7. Gillespie R. Prevention and management of ventilator-associated pneumonia – the Care Bundle approach. Southern African Journal of Critical Care 2009; 25(2): 44-51.
  8. Edwards JR, Peterson KD, Andrus ML, Tolson JS, Goulding JS, Dudeck MA, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007; 35(5): 290-301.
  9. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165(7): 867-903.
  10. Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries: a systematic review. Int J Infect Dis 2008; 12(5): 505-12.
  11. Wagh H, Acharya D. Ventilator associated pneumonia–an overview. British Journal of Medical Practitioners 2009; 2(2): 16-9.
  12. Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J Respir Crit Care Med 1996; 153(1): 343-9.
  13. Craig CP, Connelly S. Effect of intensive care unit nosocomial pneumonia on duration of stay and mortality. Am J Infect Control 1984; 12(4): 233-8.
  14. Cunnion KM, Weber DJ, Broadhead WE, Hanson LC, Pieper CF, Rutala WA. Risk factors for nosocomial pneumonia: comparing adult critical-care populations. Am J Respir Crit Care Med 1996; 153(1): 158-62.
  15. Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 2003; 138(6): 494-501.
  16. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53(RR-3): 1-36.
  17. Bird D, Zambuto A, O'Donnell C, Silva J, Korn C, Burke R, et al. Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit. Arch Surg 2010; 145(5): 465-70.
  18. Grap MJ, Munro CL, Unoki T, Hamilton VA, Ward KR. Ventilator-associated pneumonia: the potential critical role of emergency medicine in prevention. J Emerg Med 2012; 42(3): 353-62.
  19. Hunter JD. Ventilator associated pneumonia. Postgrad Med J 2006; 82(965): 172-8.
  20. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171(4): 388-416.
  21. Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol 2012; 33(3): 250-6.
  22. Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Morrell G, Pollock DA, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am J Infect Control 2011; 39(10): 798-816.
  23. Azizi F, Hatami H, Janghorbani M. Epidemiology and control of common disorders in Iran. 2nd ed. Tehran, Iran: Khosravi Publications; 2004. p. 22-6. [In Persian].
  24. Aly NY, Al-Mousa HH, Al Asar el SM. Nosocomial infections in a medical-surgical intensive care unit. Med Princ Pract 2008; 17(5): 373-7.
  25. Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries. Am J Infect Control 2008; 36(4 Suppl): S93-100.
  26. Ibrahim EH, Ward S, Sherman G, Kollef MH. A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting. Chest 2000; 117(5): 1434-42.
  27. Giard M, Lepape A, Allaouchiche B, Guerin C, Lehot JJ, Robert MO, et al. Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit: Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit: comparison of risk factors: J Crit Care 2008; 23(1): 27-33.
Journal of Isfahan Medical School
Volume 33, Issue 344 - Serial Number 344
May and June 2015
Pages 1220-1232

Files

History

  • Receive Date: 26 July 2015
  • Revise Date: 02 June 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics