Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology
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...
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BMC
2017-12-01
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Series: | Journal of Intensive Care |
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Online Access: | http://link.springer.com/article/10.1186/s40560-017-0266-4 |
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English |
format |
Article |
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DOAJ |
author |
Vu Dinh Phu Behzad Nadjm Nguyen Hoang Anh Duy Dao Xuan Co Nguyen Thi Hoang Mai Dao Tuyet Trinh James Campbell Dong Phu Khiem Tran Ngoc Quang Huynh Thi Loan Ha Son Binh Quynh-Dao Dinh Duong Bich Thuy Huong Nguyen Phu Lan Nguyen Hong Ha Ana Bonell Mattias Larsson Hoang Minh Hoan Đang Quoc Tuan Hakan Hanberger Hoang Nguyen Van Minh Lam Minh Yen Nguyen Van Hao Nguyen Gia Binh Nguyen Van Vinh Chau Nguyen Van Kinh Guy E. Thwaites Heiman F. Wertheim H. Rogier van Doorn C. Louise Thwaites |
spellingShingle |
Vu Dinh Phu Behzad Nadjm Nguyen Hoang Anh Duy Dao Xuan Co Nguyen Thi Hoang Mai Dao Tuyet Trinh James Campbell Dong Phu Khiem Tran Ngoc Quang Huynh Thi Loan Ha Son Binh Quynh-Dao Dinh Duong Bich Thuy Huong Nguyen Phu Lan Nguyen Hong Ha Ana Bonell Mattias Larsson Hoang Minh Hoan Đang Quoc Tuan Hakan Hanberger Hoang Nguyen Van Minh Lam Minh Yen Nguyen Van Hao Nguyen Gia Binh Nguyen Van Vinh Chau Nguyen Van Kinh Guy E. Thwaites Heiman F. Wertheim H. Rogier van Doorn C. Louise Thwaites Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology Journal of Intensive Care Ventilator-associated respiratory infection VARI Ventilator-associated pneumonia VAP Ventilator-associated tracheobronchitis Vat |
author_facet |
Vu Dinh Phu Behzad Nadjm Nguyen Hoang Anh Duy Dao Xuan Co Nguyen Thi Hoang Mai Dao Tuyet Trinh James Campbell Dong Phu Khiem Tran Ngoc Quang Huynh Thi Loan Ha Son Binh Quynh-Dao Dinh Duong Bich Thuy Huong Nguyen Phu Lan Nguyen Hong Ha Ana Bonell Mattias Larsson Hoang Minh Hoan Đang Quoc Tuan Hakan Hanberger Hoang Nguyen Van Minh Lam Minh Yen Nguyen Van Hao Nguyen Gia Binh Nguyen Van Vinh Chau Nguyen Van Kinh Guy E. Thwaites Heiman F. Wertheim H. Rogier van Doorn C. Louise Thwaites |
author_sort |
Vu Dinh Phu |
title |
Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology |
title_short |
Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology |
title_full |
Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology |
title_fullStr |
Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology |
title_full_unstemmed |
Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology |
title_sort |
ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology |
publisher |
BMC |
series |
Journal of Intensive Care |
issn |
2052-0492 |
publishDate |
2017-12-01 |
description |
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. |
topic |
Ventilator-associated respiratory infection VARI Ventilator-associated pneumonia VAP Ventilator-associated tracheobronchitis Vat |
url |
http://link.springer.com/article/10.1186/s40560-017-0266-4 |
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doaj-125696cbf33c4d8c8ef250042b6776e02020-11-25T01:02:25ZengBMCJournal of Intensive Care2052-04922017-12-01511910.1186/s40560-017-0266-4Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiologyVu Dinh Phu0Behzad Nadjm1Nguyen Hoang Anh Duy2Dao Xuan Co3Nguyen Thi Hoang Mai4Dao Tuyet Trinh5James Campbell6Dong Phu Khiem7Tran Ngoc Quang8Huynh Thi Loan9Ha Son Binh10Quynh-Dao Dinh11Duong Bich Thuy12Huong Nguyen Phu Lan13Nguyen Hong Ha14Ana Bonell15Mattias Larsson16Hoang Minh Hoan17Đang Quoc Tuan18Hakan Hanberger19Hoang Nguyen Van Minh20Lam Minh Yen21Nguyen Van Hao22Nguyen Gia Binh23Nguyen Van Vinh Chau24Nguyen Van Kinh25Guy E. Thwaites26Heiman F. Wertheim27H. Rogier van Doorn28C. Louise Thwaites29National Hospital for Tropical DiseasesOxford University Clinical Research UnitHospital for Tropical DiseasesBach Mai HospitalOxford University Clinical Research UnitNational Hospital for Tropical DiseasesOxford University Clinical Research UnitNational Hospital for Tropical DiseasesNational Hospital for Tropical DiseasesHospital for Tropical DiseasesBach Mai HospitalOxford University Clinical Research UnitOxford University Clinical Research UnitOxford University Clinical Research UnitNational Hospital for Tropical DiseasesOxford University Clinical Research UnitKarolinska InstitutetBach Mai HospitalBach Mai HospitalLinköping UniversityCentre for Tropical Medicine and Global Health, University of OxfordOxford University Clinical Research UnitHospital for Tropical DiseasesBach Mai HospitalHospital for Tropical DiseasesNational Hospital for Tropical DiseasesOxford University Clinical Research UnitDepartment of Medical Microbiology and Radboud Center for Infectious Diseases, RadboudumcOxford University Clinical Research UnitOxford University Clinical Research UnitAbstract 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.http://link.springer.com/article/10.1186/s40560-017-0266-4Ventilator-associated respiratory infectionVARIVentilator-associated pneumoniaVAPVentilator-associated tracheobronchitisVat |