Exogenous ventilator associated pneumonia incidence in a medical-surgical intensive care unit: a four-year surveillance
Abstract number: 1733_1417
Lecuona M., Lorente L., Miguel M., Castro B., Campos S., Pedroso Y., Sierra A.
Objective: To evaluate the ventilator associated pneumonia (VAP) incidence in an ICU, their aetiology and the exogenous VAP incidence.
Method: A 51 month duration prospective study, between July 1, 2000 to September 30, 2004 in a 24-bed medical-surgical Intensive Care Unit (ICU) of a 650-bed tertiary hospital. Patients requiring mechanical ventilation during more than 24 hours were included. The following variables were taken from each patient: sex, age, APACHE II, length of stay in ICU, days of mechanical ventilation, mortality and diagnosis group. Diagnosis of VAP was established according CDC guidelines. Throat swab and tracheal aspirate were taken at the moment of admission and twice a week until discharge for bacterial flora study and/or respiratory infection and colonisation. Respiratory infections and colonisation events were classified regarding the throat flora, in endogenous and exogenous.
Results: A total of 1434 patients were included: 65.1% male, mean age 58.1±16.9, mean length of stay 19.14±21.49 days, APACHE II 15.28±6.82, mortality 23.8%. VAP incidence (I) was 18.96% (272/1434) and VAP incidence by 1000 days of MV (DI) was 15.69 (279/18926). Exogenous pneumonia was 7.22% of total VAP (20/277), with an I of 1.39% of total patients and DI of 1.05. When we evaluated the temporal evolution of exogenous VAP, we could appreciate a decrease in I (from 3% to 1.4%) and in DI (from 2.4 to 1.05). More frequently aetiological agents were non-fermenting Gram-negative bacilli (31.3%), Staphylococcus aureus (23.6%) (48% of them were MRSA) and Enterobacteriaceae (21.1%). There were no differences in the exogenous VAP aetiology.
Conclusions: In our ICU exogenous VAP represents a little part of the total amount of VAP. The decrease in the incidence could be due to the effects that continuous surveillance makes in the staff when they manipulate the patient airway.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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