A Comparative Study of the Prevalence of Bacterial Strains in Early and Late-Onset Ventilator-Associated Pneumonia in Critically Ill Patients
AbstractBackground: This study aims to determine the prevalence of early (less than 4 days of hospitalization) –and late-onset (more than 4 days after hospitalization) ventilator-associated pneumonia in the intensive care units of Al-Zahra center in Isfahan.Methods: Through a prospective study, 100 patients with ventilator-associated pneumonia who were hospitalized in the intensive care units of Al-Zahra hospital during 2015 were investigated, and early and late onset pneumonia were determined. Moreover, the etiology of bacterial strains and other clinical and demographic characteristics were compared in two groups.Results: The patients, 23 and 77 suffered from late –and early-onset pneumonia, respectively. The mean score of pneumonia in the two groups (early –and late-onset pneumonia) was 7.3± 2.1 and 7.2±1.6, respectively, which showed no significant difference (P: 0.8). The most common types of bacteria that caused pneumonia were methicillin-resistant Staphylococcus aureus (MRSA) (43% of frequency) and Acinetobacter Baumannii (34% of frequency) in early –and late-onset pneumonia, respectively. However, the frequency distribution of the type of bacteria by the type of pneumonia was not significantly different (P:0.1).Conclusion: A significant percentage of pneumonia in intensive care units are of early-onset type, which can lead to patients’ prolonged hospitalization in intensive care units and it may be lead to increased mortality rate among them. Therefore, it is recommended that the patients hospitalized in intensive care units should be carefully examined in terms of the occurrence of pneumonia symptoms.
. Fagon JY, Stephan F, Novara A. Epidemiology of acquired pneumonia in mechanically ventilated patients. In: Chastre J, Fagon JY, editors. Nosocomial pneumonia and mechanical ventilation. Paris, France: Masson; 1995. [In French].
Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med.1998; 129(6): 433-40.
Restrepo MI, Peterson J, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care. 2013; 58(7): 1220-5.
McEachern R, Campbell GD, Jr. Hospitalacquired pneumonia: epidemiology, etiology, and treatment. Infect Dis Clin North Am. 1998; 12(3): 761-79, x.
Hedrick TL, Smith RL, McElearney ST, Evans HL, Smith PW, Pruett TL, et al. Differences in early- and late-onset ventilator-associated pneumonia between surgical and trauma patients in a combined surgical or trauma intensive care unit. J Trauma. 2008; 64(3): 714-20.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999; 27(5): 887-92.
Gillespie R. Prevention and management of ventilator-associated pneumonia – the Care Bundle approach. SAJCC 2009; 25(2): 44-51.
Edwards JR, Peterson KD, Andrus ML, Tolson JS, Goulding JS, Dudeck MA, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control. 2007; 35(5): 290-301.
Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J RespirCrit Care Med 2002; 165(7): 867-903.
Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries: a systematic review. Int J Infect Dis. 2008; 12(5): 505-12.
Wagh H, Acharya D. Ventilator associated pneumonia–an overview. British Journal of Medical Practitioners. 2009; 2(2): 16-9.
Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J RespirCrit Care Med. 1996; 153(1): 343-9.
Craig CP, Connelly S. Effect of intensive care unit nosocomial pneumonia on duration of stay and mortality. Am J Infect Control. 1984; 12(4): 233-8.
Cunnion KM, Weber DJ, Broadhead WE, Hanson LC, Pieper CF, Rutala WA. Risk factors for nosocomial pneumonia: comparing adult critical-care populations. Am J RespirCrit Care Med. 1996; 153(1): 158-62.
Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med. 2003; 138(6): 494-501.
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care- -associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004; 53(RR-3): 1-36.
Bird D, Zambuto A, O'Donnell C, Silva J, Korn C, Burke R, et al. Adherence to ventilator-associated pneumonia bundle and incidence of ventilatorassociated pneumonia in the surgical intensive care unit. Arch Surg.2010; 145(5): 465-70.
Grap MJ, Munro CL, Unoki T, Hamilton VA, Ward KR. Ventilator-associated pneumonia: the potential critical role of emergency medicine in prevention. J Emerg Med. 2012; 42(3): 353-62.
Hunter JD. Ventilator associated pneumonia. Postgrad Med J. 2006; 82(965): 172-8.
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J RespirCrit Care Med. 2005; 171(4): 388-416.
Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control HospEpidemiol. 2012; 33(3): 250-6.
Dudeck MA, Horan TC, Peterson KD, AllenBridson K, Morrell G, Pollock DA, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, deviceassociated module. Am J Infect Control. 2011; 39(10): 798-816.
Azizi F, Hatami H, Janghorbani M. Epidemiology and control of common disorders in Iran. 2nd ed. Tehran, Iran: Khosravi Publications; 2004. p. 22-6. [In Persian].
Aly NY, Al-Mousa HH, Al Asar el SM. Nosocomial infections in a medical-surgical intensive care unit. Med PrincPract 2008; 17(5): 373-7.
Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries. Am J Infect Control. 2008; 36(4 Suppl): S93-100.
Ibrahim EH, Ward S, Sherman G, Kollef MH. A comparative analysis of patients with earlyonset vs late-onset nosocomial pneumonia in the ICU setting. Chest .2000; 117(5): 1434-42.
Giard M, Lepape A, Allaouchiche B, Guerin C, Lehot JJ, Robert MO, et al. Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit: com.