Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-24T21:34:20.450Z Has data issue: false hasContentIssue false

Ventilator-Associated Pneumonia in the Home Care Setting

Published online by Cambridge University Press:  02 January 2015

Carol E. Chenoweth*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Laraine L. Washer
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
Kumari Obeyesekera
Affiliation:
Australian General Practice, Sydney, Australia
Candace Friedman
Affiliation:
Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Karolyn Brewer
Affiliation:
MedEquip, Home Care Services, University of Michigan Health System, Ann Arbor, Michigan
Garrett E. Fugitt
Affiliation:
MedEquip, Home Care Services, University of Michigan Health System, Ann Arbor, Michigan
Rebecca Lark
Affiliation:
ID Consultants PA, Charlotte, North Carolina
*
Division of Infectious Diseases, University of Michigan Health System, 3116 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0378 ([email protected])

Abstract

Objective.

To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home.

Design.

Retrospective cohort study.

Setting.

University-affiliated home care service.

Patients.

Patients receiving mechanical ventilation at home from June 1995 through December 2001.

Results.

Fifty-seven patients underwent ventilation at home for a total of 50,762 ventilator-days (mean ± SD, 890.6 ± 644.43 days; range, 76-2,458 days). Seventy-nine episodes of VAP occurred in 27 patients (rate, 1.55 episodes per 1,000 ventilator-days). The first episode of VAP occurred after a mean (±SD) of 245 ± 318.07 ventilator-days. VAP was most common during the first 500 days of ventilation. Rates of VAP were higher among patients who required ventilation for longer daily durations, compared with those who required it for shorter daily durations. There was no association of VAP with age, sex, underlying disease, reason for ventilation, antacid therapy, or steroid use. Microorganisms isolated from 33 episodes of VAP with available culture results included Pseudomonas species (17 isolates), Staphylococcus aureus (11), Serratia species (7), and Stenotrophomonas species (5). Eight patients died during the study; no deaths were attributed to pneumonia.

Conclusions.

Although the organisms associated with VAP in the home setting are similar to those associated with hospital-acquired VAP, the incidence and mortality is much lower in the home care setting. Interventions to reduce the risk of VAP among patients receiving home care should be focused on patients who require ventilation for longer daily durations or who are new to receiving mechanical ventilation at home.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.Google Scholar
2. Rello, J, Sa-Borges, M, Correa, H, Leal, S, Baraibar, J. Variations in etiology of ventilator-associated pneumonia across four treatment sites. Am J Respir Crit Care Med 1999;160:608613.Google Scholar
3. Rello, J, Ollendorf, D, Oster, G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:21152121.Google Scholar
4. Bercault, N, Boulain, T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study. Crit Care Med 2001;29:23032309.Google Scholar
5. Combes, A, Figliolini, C, Trouillet, J, et al. Incidence and outcome of polymicrobial ventilator-associated pneumonia. Chest 2002;121:16181623.Google Scholar
6. Kollef, M. Ventilator-associated pneumonia: a multivariate analysis. JAMA 1993;270:19651970.Google Scholar
7. Cook, D, Walter, S, Cook, R, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433440.Google Scholar
8. Safdar, N, Dezfulian, C, Collard, H, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med 2005;33:21842193.Google Scholar
9. Garner, J, Jarvis, W, Emori, T, Horan, TC, Hughes, J. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.Google Scholar
10. Collard, H, Saint, S, Matthay, M. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 2003;138:494501.Google Scholar
11. Bertrand, P, Fehlman, E, Lizama, M, Holmgren, N, Silva, M, Sanchez, I. Home ventilatory assistance in Chilean children: 12 years experience. Arch Bronconeumol 2006;42:165170.Google Scholar
12. Joshi, N, Localio, A, Hamory, B. A predictive risk index for nosocomial pneumonia in the intensive care unit. Am J Med 1992;93:135142.Google Scholar
13. Elatrous, S, Boujdaria, R, Merghili, S. Incidence and risk factors of ventilator-associated pneumonia: a one-year prospective survey. Clin Intensive Care 1996;7:276281.Google Scholar
14. Bonten, M, Gaillard, C, deLeeuw, P, Stobberingh, E. Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia. Clin Infect Dis 1997;24:309319.Google Scholar