Ventilator-associated pneumonia caused by multidrug resistant bacteria

cc3066 CCJ Poster presentation Ventilator-associated pneumonia caused by multidrug resistant bacteria Sartzi M Charitidou M Panagiotakopoulou A Michas C Tsidemiadou F Clouva-Molyvdas P

'THRIASSIO' Hospital of Eleusis, Attica, Greece

Critical Care 25th International Symposium on Intensive Care and Emergency Medicine Meeting abstracts 25th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium

21–25 March 2005

http://www.intensive.org/ 1364-8535 2005 9 Suppl 1 P3 10.1186/cc3066 7 3 2005 2005 BioMed Central Ltd

Introduction

The aim of the study was to investigate the epidemiology, clinical characteristics and severity of ventilator-associated pneumonia (VAP) caused by multidrug resistant bacteria (Group I) and to identify possible differences from VAP caused by sensitive pathogens (Group II).

Methods

A prospective observational 2-year study of all ICU patients who developed VAP. Age, gender, APACHE II score, underlying disease, cause of ICU admittance, length of ICU stay, duration of mechanical ventilation (MV) before the onset of VAP and total duration of MV, VAP pathogens, day of VAP onset and patient outcome were recorded. The Multi Organ Dysfunction Score (MODS) and Clinical Pulmonary Index Score (CPIS) were measured at the onset of VAP. Statistical evaluation was performed using the nonparametric Mann–Whitney test and Pearson's chi test.

Results

During this 2-year period 240 patients were admitted to the ICU. Fifty patients (20.8%) developed VAP. All VAP was late onset. VAP was caused by multidrug resistant pathogens in 23 patients (Group I) and by sensitive bacteria in 27 patients (Group II). ICU admittance (P = 0.27), underlying disease (P = 0.83) and type of isolated bacteria (P = 0.53) did not differ between the two groups. All the other results are presented in Table 1.

Table 1

Group I (n = 23)

Group II (n = 27)

P value

Men/women

17/6

21/6

0.75^c

Age

59.8 ± 18.0^a

60.7 ± 21.4^a

0.6^b

APACHE II score

20 (CI: 17.5–22.5)

21.1 (CI: 18.3–24)

0.71^b

Outcome (deaths)

8 (34.8%)

4 (14.8%)

0.09^c

CPIS

6.8 (CI: 6.6–7.0)

6.3 (CI: 6.1–6.6)

0.003^b

MODS

8.9 (CI: 7.9–9.8)

4.6 (CI: 3.9–5.2)

0.0001^b

Days of MV before VAP

16.1 ± 10.1^a

17.8 ± 10.1^a

0.11^b

Total days of MV

40.1 ± 18.1^a

36.7 ± 22.0^a

0.37^b

LOS in ICU

46 ± 21.2^a

39.9 ± 23.9^a

0.26^b

LOS, length of stay; CPIS, Clinical Pulmonary Index Score; MODS, Multi Organ Dysfunction Score; MV, mechanical ventilation; CI, 95% confidence interval. ^aData presented as mean ± standard deviation. ^bMann–Whitney test. ^cPearson's chi test.

Conclusions

Patients that developed VAP due to multiresistant bacteria did not differ in their basic characteristics (age, gender, APACHE II score, underlying disease and cause of admittance) from patients that developed VAP due to sensitive strains. However, MODS and CPIS at the onset of VAP were significantly higher in patients with VAP caused by multiresistant bacteria. The difference in outcome between the two groups, although not statistically significant, may have reached significance if our sample was larger.