Inadequate treatment of ventilator-associated and hospital-acquired pneumonia: Risk factors and impact on outcomes

Background: Initial antimicrobial therapy (AB) is an important determinant of clinical outcome in patients with severe infections as pneumonia, however well-conducted studies regarding prognostic impact of inadequate initial AB in patients who are not undergoing mechanical ventilation (MV) are lacking. In this study we aimed to identify the risk factors for inadequate initial AB and to determine its subsequent impact on outcomes in both ventilator associated pneumonia (VAP) and hospital acquired pneumonia (HAP).Methods: We retrospectively studied the accuracy of initial AB in patients with pneumonia in a university hospital in Turkey. A total of 218 patients with HAP and 130 patients with VAP were included. For each patient clinical, radiological and microbiological data were collected. Stepwise multivariate logistic regression analysis was used for risk factor analysis. Survival analysis was performed by using Kaplan-Meier method with Log-rank test.Results: Sixty six percent of patients in VAP group and 41.3% of patients in HAP group received inadequate initial AB. Multiple logistic regression analysis revealed that the risk factors for inadequate initial AB in HAP patients were; late-onset HAP (OR = 2.35 (95% CI, 1.05-5.22; p = 0.037) and APACHE II score at onset of HAP (OR = 1.06 (95% CI, 1.01-1.12); p = 0.018). In VAP patients; antibiotic usage in the previous three months (OR = 3.16 (95% CI, 1.27-7.81); p = 0.013) and admission to a surgical unit (OR = 2.9 (95% CI, 1.17-7.19); p = 0.022) were found to be independent risk factors for inadequate initial AB. No statistically significant difference in crude hospital mortality and 28-day mortality was observed between the treatment groups in both VAP and HAP. However we showed a significant increase in length of hospital stay, duration of mechanical ventilation and a prolonged clinical resolution in the inadequate AB group in both VAP and HAP.Conclusion: Our data suggests that the risk factors for inadequate initial AB are indirectly associated with the acquisition of resistant bacteria for both VAP and HAP. Although we could not find a positive correlation between adequate initial AB and survival; empirical AB with a broad spectrum should be initiated promptly to improve secondary outcomes. © 2012 Piskin et al.; licensee BioMed Central Ltd.

Yazar Piskin N.
Aydemir H.
Oztoprak N.
Akduman D.
Comert F.
Kokturk F.
Celebi G.
Yayın Türü Article
Tek Biçim Adres https://hdl.handle.net/20.500.12628/6199
Tek Biçim Adres 10.1186/1471-2334-12-268
Koleksiyonlar Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed | SOBİAD
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Dergi Adı BMC Infectious Diseases
Dergi Cilt Bilgisi 12
Sayfalar -
Yayın Yılı 2012
Eser Adı
[dc.title]
Inadequate treatment of ventilator-associated and hospital-acquired pneumonia: Risk factors and impact on outcomes
Yazar
[dc.contributor.author]
Piskin N.
Yazar
[dc.contributor.author]
Aydemir H.
Yazar
[dc.contributor.author]
Oztoprak N.
Yazar
[dc.contributor.author]
Akduman D.
Yazar
[dc.contributor.author]
Comert F.
Yazar
[dc.contributor.author]
Kokturk F.
Yazar
[dc.contributor.author]
Celebi G.
Yayın Yılı
[dc.date.issued]
2012
Yayın Türü
[dc.type]
article
Özet
[dc.description.abstract]
Background: Initial antimicrobial therapy (AB) is an important determinant of clinical outcome in patients with severe infections as pneumonia, however well-conducted studies regarding prognostic impact of inadequate initial AB in patients who are not undergoing mechanical ventilation (MV) are lacking. In this study we aimed to identify the risk factors for inadequate initial AB and to determine its subsequent impact on outcomes in both ventilator associated pneumonia (VAP) and hospital acquired pneumonia (HAP).Methods: We retrospectively studied the accuracy of initial AB in patients with pneumonia in a university hospital in Turkey. A total of 218 patients with HAP and 130 patients with VAP were included. For each patient clinical, radiological and microbiological data were collected. Stepwise multivariate logistic regression analysis was used for risk factor analysis. Survival analysis was performed by using Kaplan-Meier method with Log-rank test.Results: Sixty six percent of patients in VAP group and 41.3% of patients in HAP group received inadequate initial AB. Multiple logistic regression analysis revealed that the risk factors for inadequate initial AB in HAP patients were; late-onset HAP (OR = 2.35 (95% CI, 1.05-5.22; p = 0.037) and APACHE II score at onset of HAP (OR = 1.06 (95% CI, 1.01-1.12); p = 0.018). In VAP patients; antibiotic usage in the previous three months (OR = 3.16 (95% CI, 1.27-7.81); p = 0.013) and admission to a surgical unit (OR = 2.9 (95% CI, 1.17-7.19); p = 0.022) were found to be independent risk factors for inadequate initial AB. No statistically significant difference in crude hospital mortality and 28-day mortality was observed between the treatment groups in both VAP and HAP. However we showed a significant increase in length of hospital stay, duration of mechanical ventilation and a prolonged clinical resolution in the inadequate AB group in both VAP and HAP.Conclusion: Our data suggests that the risk factors for inadequate initial AB are indirectly associated with the acquisition of resistant bacteria for both VAP and HAP. Although we could not find a positive correlation between adequate initial AB and survival; empirical AB with a broad spectrum should be initiated promptly to improve secondary outcomes. © 2012 Piskin et al.; licensee BioMed Central Ltd.
Kayıt Giriş Tarihi
[dc.date.accessioned]
2019-12-23
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Yayın Dili
[dc.language.iso]
eng
Haklar
[dc.rights]
info:eu-repo/semantics/openAccess
ISSN
[dc.identifier.issn]
1471-2334
Dergi Adı
[dc.relation.journal]
BMC Infectious Diseases
Dergi Cilt Bilgisi
[dc.identifier.volume]
12
Tek Biçim Adres
[dc.identifier.uri]
https://dx.doi.org/10.1186/1471-2334-12-268
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/6199
Görüntülenme Sayısı ( Şehir )
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6
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1
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patients initial inadequate factors analysis hospital pneumonia clinical between regression outcomes logistic mortality significant ventilation mechanical associated impact statistically independent Background previous antibiotic months admission surgical difference improve adequate survival empirical spectrum should initiated promptly
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