Phu, Vu Dinh; Nadjm, Behzad; Duy, Nguyen Hoang Anh; Co, Dao Xuan; Mai, Nguyen Thi Hoang; Trinh, Dao Tuyet; Campbell, James; Khiem, Dong Phu; Quang, Tran Ngoc; Loan, Huynh Thi; +20 more... Binh, Ha Son; Dinh, Quynh-Dao; Thuy, Duong Bich; Lan, Huong Nguyen Phu; Ha, Nguyen Hong; Bonell, Ana; Larsson, Mattias; Hoan, Hoang Minh; Tuan, Đang Quoc; Hanberger, Hakan; Minh, Hoang Nguyen Van; Yen, Lam Minh; Van Hao, Nguyen; Binh, Nguyen Gia; Chau, Nguyen Van Vinh; Van Kinh, Nguyen; Thwaites, Guy E; Wertheim, Heiman F; van Doorn, H Rogier; Thwaites, C Louise; Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology. Journal of Intensive Care, 5 (1). 69-. ISSN 2052-0492 DOI: https://doi.org/10.1186/s40560-017-0266-4
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
Abstract
BACKGROUND: Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. METHODS: We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ≥ 16 years old and expected to be mechanically ventilated > 48 h were enrolled in the study and followed daily for 28 days following ICU admission. RESULTS: Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients' data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p < 0.01 for all). This was also true for all VARI (p < 0.01 for all) with/without tetanus. There was no increased risk of in-hospital death in patients with VARI compared to those without (VAP HR 1.58, 95% CI 0.75-3.33, p = 0.23; VARI without VAP HR 0.40, 95% CI 0.14-1.17, p = 0.09). In patients with positive endotracheal aspirate cultures, most VARI was caused by Gram-negative organisms; the most frequent were Acinetobacter baumannii (32/73, 43.8%) Klebsiella pneumoniae (26/73, 35.6%), and Pseudomonas aeruginosa (24/73, 32.9%). 40/68 (58.8%) patients with positive cultures for these had carbapenem-resistant isolates. Patients with carbapenem-resistant VARI had significantly greater ICU costs than patients with carbapenem-susceptible isolates (6053 USD (IQR 3806-7824) vs 3131 USD (IQR 2108-7551), p = 0.04) and after correction for adequacy of initial antibiotics and APACHE II score, showed a trend towards increased risk of in-hospital death (HR 2.82, 95% CI 0.75-6.75, p = 0.15). CONCLUSIONS: VARI in a resource-restricted setting has limited impact on mortality, but shows significant association with increased patient costs, length of stay, and antibiotic use, particularly when caused by carbapenem-resistant bacteria. Evidence-based interventions to reduce VARI in these settings are urgently needed.
Item Type | Article |
---|---|
Faculty and Department |
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research MRC Gambia > GM-Nutrition Theme |
PubMed ID | 29276607 |
Elements ID | 181986 |
Download
Filename: Phu_etal_2017_Ventilator-associated-respiratory-infection.pdf
Licence: Creative Commons: Attribution 4.0
Download