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Frequency and predictors of ventilator-associated pneumonia recurrence: a meta-analysis

Abstract number: P815

Siempos I., Athanassa Z., Falagas M.

Objective: Large clinical series focusing on the risk factors associated with recurrence after the onset of an initial episode of ventilator-associated pneumonia (VAP) produced inconsistent results. A meta-analysis would be helpful to shed light on the issue. To estimate the frequency of VAP recurrence and to identify risk factors associated with it.

Methods: PubMed, Scopus, Current Contents and references of retrieved articles were searched, without language restrictions. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated by using both the Mantel–Haenszel fixed-effect and the DerSimonian-Laird random effects models.

Results: The overall frequency of VAP recurrence in 1,166 patients of the nine eligible reports was 23.7%. Among the twenty evaluated risk factors, only inappropriate empirical treatment (OR=1.99; 95% CI 1.06 – 3.72), acute lung injury/acute respiratory distress syndrome (OR=1.76; 95% CI 1.12–2.75) and shock (OR=1.55; 95% CI 1.01–2.41) at the day of diagnosis of the first VAP episode were found to be associated with VAP recurrence. There was also evidence, albeit inconsistent, that severity of illness at ICU admission was associated with VAP recurrence.

Conclusion: Recurrence involves almost one in four cases of VAP and is associated with inappropriate empirical treatment, acute lung injury/acute respiratory distress syndrome and shock, but not with first-episode causative pathogens. Recognition of these predictors may permit the timely implementation of measures to prevent recurrence of VAP.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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