Incidence, Risk, and Prognosis Factors of Nosocomial Pneumonia in Mechanically Ventilated Patients

TLDR

The study assessed the incidence, risk, and prognosis factors of nosocomial pneumonia acquired during mechanical ventilation in 322 consecutive patients. Researchers identified 78 NP episodes among these patients and analyzed risk and prognosis factors using univariate and multivariate statistical techniques. Multivariate analysis revealed that multiple intubations, prior gastric aspiration, ventilation >3 days, COPD, and PEEP increased NP risk, while underlying disease, worsening respiratory failure, septic shock, inappropriate antibiotics, and ICU type worsened prognosis; overall fatality was 23%, with NP patients experiencing higher mortality (33% vs 19%). Abstract truncated at 250 words.

Abstract

Seventy-eight (24%) episodes of nosocomial pneumonia (NP) were detected in 322 consecutive mechanically ventilated patients admitted to a 1,000-bed teaching hospital from April 1987 through May 1988 to assess the incidence, risk, and prognosis factors of NP acquired during mechanical ventilation (MV). The risk and prognosis factors for developing NP during MV were studied using both univariate and multivariate statistical techniques. Multivariate analysis selected the following variables significantly associated with a higher risk for developing ventilator-associated pneumonia: more than one intubation during MV (p = 0.000012), a prior episode of aspiration of gastric content (p = 0.00018), a MV period longer than 3 days (p = 0.015), the presence of chronic obstructive pulmonary disease (COPD) (p = 0.048), and the use of positive end-expiratory pressure (PEEP) during MV (p = 0.092). The presence of an ultimately or rapidly fatal underlying disease (p = 0.0018), worsening of acute respiratory failure caused by pneumonia (p = 0.0096), the presence of septic shock (p = 0.016), an inappropriate antibiotic treatment (p = 0.02), and the type of intensive care unit (ICU) hospitalization (noncardiac surgery and nonsurgical ICU compared with post-cardiac surgery ICU) (p = 0.08) were those factors selected by a stepwise logistic regression analysis as independently worsening the prognosis. The overall fatality rate was 23% (73 of 322). The mortality of patients with NP was higher (33%; 26 of 78; p less than 0.01) when compared with fatality rates of patients without NP (19%; 47 of 244). (ABSTRACT TRUNCATED AT 250 WORDS)