Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia

Objective: Ventilator-associated pneumonia (VAP) is the most common hospital-aquired infections in intensive care units (ICUs) and associated with prolonged hospital stay, increased mortality and cost. This study aims to analyse the epidemiology and the risk factors affecting 30 day-mortality in VAP. Method: Adult patients with VAP were included in the study. Data were obtained from infection control commitee records. Patients were followed up for mortality until 30 days after onset of VAP or until death for the patients died within 30 days. Survivor and non-survivor groups were compared as for the predictors of mortality. Results: A total of 183 VAP patients were evaluated. Early-onset VAP was observed in 16 (8.7%), and late-onset VAP in 167 (91.3%) patients. Acinetobacter baumannii was the most common cause of VAP (49.2%), followed by Pseudomonas aeruginosa (19.7%) and Klebsiella pneumoniae (13.7%). Carbapenem resistance was seen in 78 (42.6%) patients and among them, most frequently Acinetobacter baumannii (62.8%, 49/78), followed by Klebsiella pneumoniae (20.5%, 16/78), Pseudomonas aeruginosa (14.1%, 11/78) and Escherichia coli (2.6%, 2/78) were isolated. Thirty day-mortality rate was 46.4% (n=85). In univariate analysis; malignity, blood transfusion, renal replacement therapy, Higher APACHE II, SOFA and SAPS 2 scores on the day of VAP onset and Acinetobacter baumannii were found to be more common in non-survivor group. According to the Cox-regression analysis, only SOFA score on the day of VAP onset and Acinetobacter baumannii were independent predictors of mortality. Although rate of trauma patients was significantly higher in survivor group, in multivariate analysis it was not a protective factor for mortality. Conclusion: The most common cause of VAP was Acinetobacter baumannii and carbapenem resistance was seen in more than half of Acinetobacter baumannii and Klebsiella pneumoniae isolates. Higher SOFA score on the day of VAP onset and Acinetobacter baumannii infections were found to be independently associated with 30-day mortality in VAP patients.