Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia

Yeşilbağ, Zuhal; Tekdos Seker, Yasemin

doi:10.5222/BMJ.2020.43760

Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia

Zuhal YEŞİLBAĞ, (Sağlık Bilimleri Üniversitesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye)

Yasemin TEKDÖŞ ŞEKER (Sağlık Bilimleri Üniversitesi, Bakırköy Doktor Sadi Konuk Eğitim ve Araştırma Hastanesi Anesteziyoloji ve Reanimasyon Bölümü, İstanbul, Türkiye)

Bakırköy Tıp Dergisi

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Yıl: 2020 Cilt: 16 Sayı: 3 Sayfa Aralığı: 309 - 316 Metin Dili: İngilizce DOI: 10.5222/BMJ.2020.43760 İndeks Tarihi: 15-05-2021

Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia

Öz:

Objective: Ventilator-associated pneumonia (VAP) is the most common hospital-aquired infections in intensive care units (ICUs) and associated with prolonged hospital stay, increased mortality and cost. This study aims to analyse the epidemiology and the risk factors affecting 30 day-mortality in VAP. Method: Adult patients with VAP were included in the study. Data were obtained from infection control commitee records. Patients were followed up for mortality until 30 days after onset of VAP or until death for the patients died within 30 days. Survivor and non-survivor groups were compared as for the predictors of mortality. Results: A total of 183 VAP patients were evaluated. Early-onset VAP was observed in 16 (8.7%), and late-onset VAP in 167 (91.3%) patients. Acinetobacter baumannii was the most common cause of VAP (49.2%), followed by Pseudomonas aeruginosa (19.7%) and Klebsiella pneumoniae (13.7%). Carbapenem resistance was seen in 78 (42.6%) patients and among them, most frequently Acinetobacter baumannii (62.8%, 49/78), followed by Klebsiella pneumoniae (20.5%, 16/78), Pseudomonas aeruginosa (14.1%, 11/78) and Escherichia coli (2.6%, 2/78) were isolated. Thirty day-mortality rate was 46.4% (n=85). In univariate analysis; malignity, blood transfusion, renal replacement therapy, Higher APACHE II, SOFA and SAPS 2 scores on the day of VAP onset and Acinetobacter baumannii were found to be more common in nonsurvivor group. According to the Cox-regression analysis, only SOFA score on the day of VAP onset and Acinetobacter baumannii were independent predictors of mortality. Although rate of trauma patients was significantly higher in survivor group, in multivariate analysis it was not a protective factor for mortality. Conclusion: The most common cause of VAP was Acinetobacter baumannii and carbapenem resistance was seen in more than half of Acinetobacter baumannii and Klebsiella pneumoniae isolates. Higher SOFA score on the day of VAP onset and Acinetobacter baumannii infections were found to be independently associated with 30-day mortality in VAP patients.

Anahtar Kelime:

Ventilatör ile İlişkili Pnömonide Epidemiyoloji ve Mortalite ile İlişkili Risk Faktörleri

Öz:

Amaç: Ventilatörle ilişkili pnömoni (VİP), yoğun bakım üniteleri (YBÜ)’de en sık hastane kaynaklı infeksiyonlardan biridir ve uzun süreli hastane yatışı, artan ölüm oranı ve maliyet ile ilişkilidir. Bu çalışma, YBÜ’de VİP tanılı hastalarda epidemiyoloji ve 30 günlük mortaliteyi etkileyen risk faktörlerini irdelemeyi amaçlamaktadır. Yöntem: Erişkin VİP hastaları çalışmaya dahil edildi. Hasta verileri enfeksiyon kontrol komitesi kayıtlarından elde edildi. Hastalar VİP başlangıcından 30 gün sonrasına kadar veya 30 gün içinde öldüyse ölene kadar mortalite açısından takip edildi. Yaşayan ve ölen hastalar risk faktöreri açısından karşılaştırıldı. Bulgular: Çalışmaya toplam 183 VİP hastası dahil edildi. Erken başlangıçlı VİP 16 (%8,7) hastada, geç başlangıçlı VİP 167 (%91,3) hastada görüldü. En sık VİP etkeni Acinetobacter baumannii idi (%49,2), bunu Pseudomonas aeruginosa (%19,7) ve Klebsiella pneumoniae (%13,7) izledi. 78 (%42.6) hastada karbapeneme direnç görüldü. Bu hastalarda sıklık sırasına göre Acinetobacter baumannii (% 62.8, 49/78), Klebsiella pneumoniae (%20.5, 16/78), Pseudomonas aeruginosa (%14.1, 11/78) ve Escherichia coli (%2.6, 2/78) izole edildi. Çalışmada otuz günlük mortalite oranı %46,4 (n=85) olarak bulundu. Tek değişkenli analizde; ölen grupta malignite, kan transfüzyonu, renal replasman tedavisi, APACHE II, SOFA ve SAPS II skorları ve Acinetobacter baumannii sıklığının daha fazla olduğu görüldü. Cox-regresyon analizine göre, sadece VİP geliştiği andaki SOFA skoru ve Acinetobacter baumannii mortalitenin için bağımsız risk faktörü olarak bulundu. Yaşayan grupta travma hastalarının oranı anlamlı olarak daha yüksek olmasına rağmen, travma çok değişkenli analizde mortalite için koruyucu bir faktör değildi. Sonuç: VİP hastalarında en sık etken Acinetobacter baumannii idi ve karbapenem direnci Acinetobacter baumannii ve Klebsiella pneumoniae izolatlarının yarısından fazlasında görüldü.VIP geliştiği andaki SOFA skoru yüksekliği ve Acinetobacter baumannii infeksiyonu VIP hastalarında 30 günlük mortalite ile bağımsız olarak ilişkili bulundu.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Yeşilbağ Z, Tekdos Seker Y (2020). Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. , 309 - 316. 10.5222/BMJ.2020.43760
Chicago	Yeşilbağ Zuhal,Tekdos Seker Yasemin Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. (2020): 309 - 316. 10.5222/BMJ.2020.43760
MLA	Yeşilbağ Zuhal,Tekdos Seker Yasemin Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. , 2020, ss.309 - 316. 10.5222/BMJ.2020.43760
AMA	Yeşilbağ Z,Tekdos Seker Y Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. . 2020; 309 - 316. 10.5222/BMJ.2020.43760
Vancouver	Yeşilbağ Z,Tekdos Seker Y Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. . 2020; 309 - 316. 10.5222/BMJ.2020.43760
IEEE	Yeşilbağ Z,Tekdos Seker Y "Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia." , ss.309 - 316, 2020. 10.5222/BMJ.2020.43760
ISNAD	Yeşilbağ, Zuhal - Tekdos Seker, Yasemin. "Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia". (2020), 309-316. https://doi.org/10.5222/BMJ.2020.43760

APA	Yeşilbağ Z, Tekdos Seker Y (2020). Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. Bakırköy Tıp Dergisi, 16(3), 309 - 316. 10.5222/BMJ.2020.43760
Chicago	Yeşilbağ Zuhal,Tekdos Seker Yasemin Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. Bakırköy Tıp Dergisi 16, no.3 (2020): 309 - 316. 10.5222/BMJ.2020.43760
MLA	Yeşilbağ Zuhal,Tekdos Seker Yasemin Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. Bakırköy Tıp Dergisi, vol.16, no.3, 2020, ss.309 - 316. 10.5222/BMJ.2020.43760
AMA	Yeşilbağ Z,Tekdos Seker Y Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. Bakırköy Tıp Dergisi. 2020; 16(3): 309 - 316. 10.5222/BMJ.2020.43760
Vancouver	Yeşilbağ Z,Tekdos Seker Y Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia. Bakırköy Tıp Dergisi. 2020; 16(3): 309 - 316. 10.5222/BMJ.2020.43760
IEEE	Yeşilbağ Z,Tekdos Seker Y "Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia." Bakırköy Tıp Dergisi, 16, ss.309 - 316, 2020. 10.5222/BMJ.2020.43760
ISNAD	Yeşilbağ, Zuhal - Tekdos Seker, Yasemin. "Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia". Bakırköy Tıp Dergisi 16/3 (2020), 309-316. https://doi.org/10.5222/BMJ.2020.43760