Microbial Etiology and Prognostic Factors of Ventilator-associated Pneumonia: A Multicenter Retrospective Study in Shanghai.

Abstract

Background:

The microbial etiology and mortality risk factors of ventilator-associated pneumonia (VAP) have not been investigated extensively in Shanghai.

Methods:

VAP cases were identified from the patients hospitalized during the period from 1 January 2013 to 30 December 2017 in Shanghai. The relevant data were reviewed and analyzed retrospectively.

Results:

One hundred ninety-four VAP cases were included in this analysis. The overall mortality rate was 32.47%. The respiratory pathogens isolated from these patients included 212 bacterial strains and 54 fungal strains. The leading pathogens were Acinetobacter baumannii (33.96%), Klebsiella pneumoniae (23.58%), Pseudomonas aeruginosa (19.81%), and Staphylococcus aureus (7.08%). Candida colonization was associated with higher mortality of VAP patients compared to those without Candida colonization (45.45% vs 28.67%, P < .05). The VAP patients with Candida colonization also showed higher prevalence of P. aeruginosa, carbapenem-resistant P. aeruginosa (CRPA), K. pneumoniae, carbapenem-resistant K. pneumoniae (CRKP), A. baumannii, and carbapenem-resistant A. baumannii (CRAB) (P < .05). VAP nonsurvivors had higher prevalence of CRPA, K. pneumoniae, CRAB, and Candida than VAP survivors (P < .05). Multivariate analysis showed that prior antibiotic use was a significant risk factor for Candida colonization, while hypertension and length of hospital stay were significant risk factors of VAP mortality (P < .05).

Conclusions:

The top pathogens of VAP patients in Shanghai tertiary teaching hospitals are A. baumannii, K. pneumoniae, and P. aeruginosa, with high prevalence of carbapenem resistance. Carbapenem-resistant bacterial pathogens and Candida may predict poor outcome.

• Authors: Yi Huang, Yang Jiao, Jing Zhang, Jinfu Xu, Qijian Cheng, Yi Li, Shuo Liang, Huayin Li, Jin Gong, Yinggang Zhu, Lin Song, Zhaohui Rong, Bin Liu, Zhijun Jie, Shuo Sun, Ping Li, Guifang Wang, Jieming Qu, Infection Assembly of Shanghai Respiratory Society
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 67 Issue suppl_2 Pg. S146-S152 (11 13 2018) ISSN: 1537-6591 [Electronic] United States
• PMID: 30423049 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents

Topics

• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Bacteria (drug effects, isolation & purification)
• Candida (drug effects, isolation & purification)
• China (epidemiology)
• Drug Resistance, Multiple, Bacterial
• Female
• Hospitals, Teaching
• Humans
• Hypertension (complications)
• Length of Stay
• Male
• Middle Aged
• Pneumonia, Ventilator-Associated (diagnosis, microbiology, mortality)
• Prognosis
• Retrospective Studies
• Risk Factors