Incidence, Risk Factors, and Outcome of Ventilator-Associated Pneumonia in an Intensive Care Unit
-
Parisa Delkash
,
Soheila Sadeghi
,
Seyed Amir Sheikholeslami
,
Mahmoud Dehghani-Ghorbi
,
Amir Behnam Kharazmi
Abstract
Background: Ventilator-Associated Pneumonia (VAP) is one of the most common nosocomial infections that occurs after intubation in patients with mechanical ventilation.
Methods: This cross-sectional descriptive study was conducted in a group of patients admitted to the ICU with a sample size of 120 patients. patients were visited daily at the beginning of admission to the ICU and the study began by considering the entry and exit criteria. To achieve the research objectives, researchers visited the ICI department daily and identified eligible patients. Also, in this study, the demographic profile form of the patients was designed, and their information was completed by the researchers according to the information in the patients' clinical records. The questions of the demographic profile form were completed using an interview with the patient's companion and a study of the patient's hospitalization records. The data from this study were entered into SPSS version 18 and analysed using chi-square, regression, Mann-Whitney and other statistical tests.
Results: According to the findings, 120 patients admitted to the ICU were included in the study, of which 48.3% were male and 51.7% were female. The incidence of VAP in 24 patients (20%) was reported. most of the VAP Group patients were male with a rate of 70.8%, age group 70-80 years with a rate of 66.7%, a history of smoking with a rate of 100% and consciousness above 9 with a rate of 70.8%. Also, in patients with VAP, 91.7% of patients with cancer and 41.7% of patients with rheumatoid arthritis had comorbidities, which was significant compared to the No-VAP Group (P value<0.05).
Conclusion: Given the high prevalence of VAP and its role in patient mortality, preventive interventions are recommended to reduce the incidence of VAP.
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[14] Zaragoza R, Vidal-Cortés P, Aguilar G, Borges M, Diaz E, Ferrer R, et al. Update of the treatment of nosocomial pneumonia in the ICU. Crit Care. 2020; 24: 1-13.
[15] Reignier J, Darmon M, Sonneville R, Borel AL, Garrouste-Orgeas M, Ruckly S, et al. Impact of early nutrition and feeding route on outcomes of mechanically ventilated patients with shock: a post hoc marginal structural model study. Intensive Care Med. 2015; 41(5): 875-86.
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[18] Phu VD, Wertheim HF, Larsson M, Nadjm B, Dinh Q-D, Nilsson LE, et al. Burden of hospital-acquired infections and antimicrobial use in Vietnamese adult intensive care units. PLoS One. 2016; 11(1): e0147544.
[19] Murni IK, Duke T, Kinney S, Daley AJ, Soenarto Y. Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Arch Dis Child. 2015; 100(5): 454-9.
[20] Avershina E, Shapovalova V, Shipulin G. Fighting antibiotic resistance in hospital-acquired infections: current state and emerging technologies in disease prevention, diagnostics and therapy. Front Microbiol. 2021; 12: 707330.
[21] Auerbach DI, Staiger DO, Muench U, Buerhaus PI. The nursing workforce in an era of health care reform. N Engl J Med. 2013; 368(16): 1470-2.
[22] Control CfD, Prevention. Pneumonia (ventilator-associated [VAP] and non-ventilator-associated pneumonia [PNEU]) event. Device-associated Module PNEU/VAP. 2015.
[23] Becerra-Hervás J, Guitart C, Covas A, Bobillo-Pérez S, Rodríguez-Fanjul J, Carrasco-Jordan JL, et al. The Clinical Pulmonary Infection Score Combined with Procalcitonin and Lung Ultrasound (CPIS-PLUS), a good tool for ventilator-associated pneumonia early diagnosis in pediatrics. Children. 2024; 11(5): 592.
[24] Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991; 143(5 Pt 1): 1121-9.
[25] Amri Meleh P, Bayani M, Nikbakhsh N, Pourhassan A, Marzban M, Shirkhani Z, et al. Incidence, causes and outcomes of ventilator-associated pneumonia in the medical intensive care unit. Nurs Midwifery J. 2013; 11(7).
[26] Sabery M, Shiri H, Moradiance V, Taghadosi M, Gilasi H, Khamechian M. The frequency and risk factors for early-onset ventilator-associated pneumonia in intensive care units of Kashan Shahid-Beheshti Hospital during 2009-2010. Feyz J Kashan Univ Med Sci. 2013; 16(6).
[27] Chang PH, Lin TL, Chen YJ, Lai WH, Chen IL, Chang HC, et al. Risk factors, pathogens, and outcomes of ventilator-associated pneumonia in non-cardiac surgical patients: a retrospective analysis. Microorganisms. 2024; 12(7).
[28] Wu G, Fu Y, Feng W, Liu C, Li J, Gao H, et al. Prevalence and risk factors for ventilator-associated pneumonia after cardiac surgery: a systematic review and meta-analysis. J Thorac Dis. 2024; 16(9): 5946-57.
[29] Afkhamzadeh A, Lahoorpour F, Delpisheh A, Janmardi R. Incidence of ventilator-associated pneumonia (VAP) and bacterial resistance pattern in adult patients hospitalized at the intensive care unit of Besat Hospital in Sanandaj. Sci J Kurdistan Univ Med Sci. 2011; 16(1): 20-6.
[30] Nadi E, Nekouii B, Mobin A, Nekouii A, Moghim Beigi A. Frequency of nosocomial pneumonia in ICUs of hospitals of Hamadan University of Medical Sciences. J Isfahan Med Sch. 2011; 29(153): 1255-62.
[31] Roozegar MA, Pakzad I, Mohammadi TM, Hoshmand B. Analyzing the osteogenic stimulatory effect of the combination dexamethasone and low levelled laser irradiation (LLLI) on periodontal ligament stem cell (PDLSc). Der Pharma Chemica. 2015;7(11):226-30.
[32] Esmaeilikia M, Gholami-Parizad E, Ghazanfari Z, Abedzadeh MS. Investigation of Oral Health Status (DMFT-index) among 3–6 Years Old Children in Ilam (Western Iran), 2015. Res J Pharm Technol. 2020;13(4):1878-82.
[33] Roozegar MA, Abdi Z, Matin S, Khorshidi A, Azizian M. The effect of 1.2 mg simvastatin mouthwash on the level of interleukin-6 in patients with chronic periodontitis. Indian Journal of Forensic Medicine & Toxicology. 2019;13(3):463-7.
[34] Roozegar MA, Nourmohammadi H, Havasian M, Seidkhani H, Jamdar S. Evaluation of Oral and Dental complications caused by Cyclophosphamide in patients with breast cancer in the Shahid-Mostafa Hospital, Ilam, 2019. Res J Pharm Technol. 2022;15(12):5517-20.
[35] Abdi Z, Beigi S, Khorshidi A, Azizian M, Beigi Z. Using simvastatin mouthwash (0.6%, 1.2% and 1.8%) on the improvement of clinical parameters in patients with chronic periodontitis. Res J Pharm Technol. 2020;13(2):862-6.
[2] Mohammadi HR, Erfani A, Sadeghi S, Komlakh K, Otaghi M, Vasig A. Investigating factors affecting mortality due to spinal cord trauma in patients admitted to the intensive care unit. Bull Emerg Trauma. 2024; 12(3): 136-41.
[3] Mohammadi HR, Asadoola Y, Erfani A, Ghoreishi Amin N, Karimiyarandi H, Sadeghi S, et al. Effectiveness of pulse intravenous infusion of methylprednisolone on pain in patients with lumbar disc herniation: A randomized controlled trial. Anesth Pain Med. 2024; 14(4): e149442.
[4] Boev C, Kiss E. Hospital-acquired infections: current trends and prevention. Crit Care Nurs Clin. 2017; 29(1): 51-65.
[5] Dellinger EP. Prevention of hospital-acquired infections. Surg Infect. 2016; 17(4): 422-6.
[6] Aljamali NM, Al Najim MM. Review in hospital-acquired infection. Int J Adv Eng Res. 2020; 20(3): 7-20.
[7] Despotovic A, Milosevic B, Milosevic I, Mitrovic N, Cirkovic A, Jovanovic S, et al. Hospital-acquired infections in the adult intensive care unit—epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. Am J Infect Control. 2020; 48(10): 1211-5.
[8] Leistner R, Kohlmorgen B, Brodzinski A, Schwab F, Lemke E, Zakonsky G, et al. Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning. EClinicalMedicine. 2023; 59: 101970.
[9] Blot S, Ruppé E, Harbarth S, Asehnoune K, Poulakou G, Luyt C-E, et al. Healthcare-associated infections in adult intensive care unit patients: changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs. 2022; 70: 103227.
[10] Hashemian H, Sanati F. Comparing the mean platelet volume and the neutrophil-to-lymphocyte ratio in children with bacterial pneumonia associated with or without pleural empyema. J Guilan Univ Med Sci. 2023; 31(4): 328-37.
[11] Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: a nine months' prospective study. Ann Thorac Med. 2007; 2(2): 52-7.
[12] Edwardson S, Cairns C. Nosocomial infections in the ICU. Anaesth Intensive Care Med. 2019; 20(1): 14-8.
[13] Trubiano JA, Padiglione AA. Nosocomial infections in the intensive care unit. Anaesth Intensive Care Med. 2015; 16(12): 598-602.
[14] Zaragoza R, Vidal-Cortés P, Aguilar G, Borges M, Diaz E, Ferrer R, et al. Update of the treatment of nosocomial pneumonia in the ICU. Crit Care. 2020; 24: 1-13.
[15] Reignier J, Darmon M, Sonneville R, Borel AL, Garrouste-Orgeas M, Ruckly S, et al. Impact of early nutrition and feeding route on outcomes of mechanically ventilated patients with shock: a post hoc marginal structural model study. Intensive Care Med. 2015; 41(5): 875-86.
[16] Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002; 165(7): 867-903.
[17] Timsit JF, Esaied W, Neuville M, Bouadma L, Mourvllier B. Update on ventilator-associated pneumonia. F1000Res. 2017; 6: 2061.
[18] Phu VD, Wertheim HF, Larsson M, Nadjm B, Dinh Q-D, Nilsson LE, et al. Burden of hospital-acquired infections and antimicrobial use in Vietnamese adult intensive care units. PLoS One. 2016; 11(1): e0147544.
[19] Murni IK, Duke T, Kinney S, Daley AJ, Soenarto Y. Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Arch Dis Child. 2015; 100(5): 454-9.
[20] Avershina E, Shapovalova V, Shipulin G. Fighting antibiotic resistance in hospital-acquired infections: current state and emerging technologies in disease prevention, diagnostics and therapy. Front Microbiol. 2021; 12: 707330.
[21] Auerbach DI, Staiger DO, Muench U, Buerhaus PI. The nursing workforce in an era of health care reform. N Engl J Med. 2013; 368(16): 1470-2.
[22] Control CfD, Prevention. Pneumonia (ventilator-associated [VAP] and non-ventilator-associated pneumonia [PNEU]) event. Device-associated Module PNEU/VAP. 2015.
[23] Becerra-Hervás J, Guitart C, Covas A, Bobillo-Pérez S, Rodríguez-Fanjul J, Carrasco-Jordan JL, et al. The Clinical Pulmonary Infection Score Combined with Procalcitonin and Lung Ultrasound (CPIS-PLUS), a good tool for ventilator-associated pneumonia early diagnosis in pediatrics. Children. 2024; 11(5): 592.
[24] Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991; 143(5 Pt 1): 1121-9.
[25] Amri Meleh P, Bayani M, Nikbakhsh N, Pourhassan A, Marzban M, Shirkhani Z, et al. Incidence, causes and outcomes of ventilator-associated pneumonia in the medical intensive care unit. Nurs Midwifery J. 2013; 11(7).
[26] Sabery M, Shiri H, Moradiance V, Taghadosi M, Gilasi H, Khamechian M. The frequency and risk factors for early-onset ventilator-associated pneumonia in intensive care units of Kashan Shahid-Beheshti Hospital during 2009-2010. Feyz J Kashan Univ Med Sci. 2013; 16(6).
[27] Chang PH, Lin TL, Chen YJ, Lai WH, Chen IL, Chang HC, et al. Risk factors, pathogens, and outcomes of ventilator-associated pneumonia in non-cardiac surgical patients: a retrospective analysis. Microorganisms. 2024; 12(7).
[28] Wu G, Fu Y, Feng W, Liu C, Li J, Gao H, et al. Prevalence and risk factors for ventilator-associated pneumonia after cardiac surgery: a systematic review and meta-analysis. J Thorac Dis. 2024; 16(9): 5946-57.
[29] Afkhamzadeh A, Lahoorpour F, Delpisheh A, Janmardi R. Incidence of ventilator-associated pneumonia (VAP) and bacterial resistance pattern in adult patients hospitalized at the intensive care unit of Besat Hospital in Sanandaj. Sci J Kurdistan Univ Med Sci. 2011; 16(1): 20-6.
[30] Nadi E, Nekouii B, Mobin A, Nekouii A, Moghim Beigi A. Frequency of nosocomial pneumonia in ICUs of hospitals of Hamadan University of Medical Sciences. J Isfahan Med Sch. 2011; 29(153): 1255-62.
[31] Roozegar MA, Pakzad I, Mohammadi TM, Hoshmand B. Analyzing the osteogenic stimulatory effect of the combination dexamethasone and low levelled laser irradiation (LLLI) on periodontal ligament stem cell (PDLSc). Der Pharma Chemica. 2015;7(11):226-30.
[32] Esmaeilikia M, Gholami-Parizad E, Ghazanfari Z, Abedzadeh MS. Investigation of Oral Health Status (DMFT-index) among 3–6 Years Old Children in Ilam (Western Iran), 2015. Res J Pharm Technol. 2020;13(4):1878-82.
[33] Roozegar MA, Abdi Z, Matin S, Khorshidi A, Azizian M. The effect of 1.2 mg simvastatin mouthwash on the level of interleukin-6 in patients with chronic periodontitis. Indian Journal of Forensic Medicine & Toxicology. 2019;13(3):463-7.
[34] Roozegar MA, Nourmohammadi H, Havasian M, Seidkhani H, Jamdar S. Evaluation of Oral and Dental complications caused by Cyclophosphamide in patients with breast cancer in the Shahid-Mostafa Hospital, Ilam, 2019. Res J Pharm Technol. 2022;15(12):5517-20.
[35] Abdi Z, Beigi S, Khorshidi A, Azizian M, Beigi Z. Using simvastatin mouthwash (0.6%, 1.2% and 1.8%) on the improvement of clinical parameters in patients with chronic periodontitis. Res J Pharm Technol. 2020;13(2):862-6.
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How to Cite
1.
Delkash P, Sadeghi S, Sheikholeslami SA, Dehghani-Ghorbi M, Kharazmi AB. Incidence, Risk Factors, and Outcome of Ventilator-Associated Pneumonia in an Intensive Care Unit. Arch Anesth & Crit Care. 2025;.
