Microbial Etiology and Prognostic Factors of Ventilator-associated Pneumonia: A Multicenter Retrospective Study in Shanghai. (13th November 2018)

• Record Type: Journal Article
• Authors: Huang, Yi; Jiao, Yang; Zhang, Jing; Xu, Jinfu; Cheng, Qijian; Li, Yi; Liang, Shuo; Li, Huayin; Gong, Jin; Zhu, Yinggang; Song, Lin; Rong, Zhaohui; Liu, Bin; Jie, Zhijun; Sun, Shuo; Li, Ping; Wang, Guifang; Qu, Jieming
• Is Part Of: Clinical infectious diseases. Volume 67(2018)Supplement 2
• Page Start: S146
• Page End: S152
• Publication Date: 2018-11-13
• Subjects: ventilator-associated pneumonia -- pathogen -- antibiotic resistance -- outcome -- Candida; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciy686
• Languages: English
• ISSNs: 1058-4838

Abstract

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.