Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T15:29:59.894Z Has data issue: false hasContentIssue false
  • English
  • Français

Ventilator-Associated Tracheobronchitis Increases the Length of Intensive Care Unit Stay

Published online by Cambridge University Press:  02 January 2015

Marios Karvouniaris ,
Demosthenes Makris ,
Efstratios Manoulakas ,
Paris Zygoulis ,
Konstantinos Mantzarlis ,
Apostolos Triantaris ,
Maria Chatzi  and
Epaminondas Zakynthinos
Marios Karvouniaris
Affiliation:
Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece
Demosthenes Makris*
Affiliation:
Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece
Efstratios Manoulakas
Affiliation:
Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece
Paris Zygoulis
Affiliation:
Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece
Konstantinos Mantzarlis
Affiliation:
Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece
Apostolos Triantaris
Affiliation:
Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece
Maria Chatzi
Affiliation:
Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece
Epaminondas Zakynthinos
Affiliation:
Department of Critical Care, University Hospital of Larissa, School of Medicine of the University of Thessaly, Biopolis, Larissa, Greece
*
University Hospital of Larissa, Biopolis, 41110 Larissa, Greece ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To investigate prospectively the clinical course and risk factors for ventilator-associated tracheobronchitis (VAT) and the impact of VAT on intensive care unit (ICU) morbidity and mortality.

Design.

Prospective cohort study.

Setting.

University Hospital Larissa, Larissa, Greece

Patients.

Critical care patients who received mechanical ventilation for more than 48 hours were prospectively studied between 2009 and 2011.

Methods.

The modified Clinical Pulmonary Infection Score, white blood cell count, and C-reactive protein level were systematically assessed every 2 days for the first 2 weeks of ICU stay. Bronchial secretions were assessed daily. Quantitative cultures of endotracheal secretions were performed on the first ICU day for every patient and every 2 days thereafter for the first 2 weeks or more at the discretion of the attending physicians. Definition of VAT was based on previously published criteria.

Results.

A total of 236 patients were observed; 42 patients (18%) presented with VAT. Gram-negative pathogens, which were usually multidrug resistant, were responsible for 92.9% of cases. Patients with a neurosurgical admission presented with VAT significantly more often than did other ICU patients (28.5% vs 14.1%; P = .02). The occurrence of VAT was a significant risk factor for increased duration of ICU stay (OR [95% CI], 3.04 [1.35-6.85]; P = .01). Age (OR [95% CI], 1.04 [1.015-1.06]; P = .02), Acute Physiology and Chronic Health Evaluation II score (OR [95% CI], 1.08 [1.015-1.16]; P = .02), and C-reactive protein level at admission (OR [95% CI], 1.05 [1.011.1]; P = .02) were independent factors for ICU mortality.

Conclusions.

VAT is a nosocomial infection that might be associated with prolonged stay in the ICU, especially in neurocritical patients. VAT was not associated with increased mortality in our study.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 8 , August 2013 , pp. 800 - 808
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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.Chastre, J, Fagon, JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.Google Scholar
2.Rello, J, Ollendorf, DA, Oster, G, et al; VAP Outcomes Scientific Advisory Group. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122: 2115–2121.Google Scholar
3.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: 2303–2309.Google Scholar
4.Warren, DK, Shukla, SJ, Olsen, MA, et al.Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31:1312–1317.CrossRefGoogle Scholar
5.Heyland, DK, Cook, DJ, Griffin, L, Keenan, SP, Brun-Buisson, C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999;159:1249–1256.Google Scholar
6.Nseir, S, Di Pompeo, C, Pronnier, P, et al.Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome. Eur Respir J 2002;20:1483–1489.Google Scholar
7.Agrafiotis, M, Siempos, II, Falagas, ME. Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: systematic review and meta-analysis. Respir Med 2010; 104:325–336.Google Scholar
8.Craven, DE, Chroneou, A, Zias, N, Hjalmarson, KI. Ventilator-associated tracheobronchitis (VAT): the impact of targeted antibiotic therapy on patient outcomes. Chest 2008;135:521–528.Google Scholar
9.Palmer, LBVentilator-associated infection. Curr Opin Pulm Med 2009;15:230–235.Google Scholar
10.Nseir, S, Di Pompeo, C, Soubrier, S, et al.Effect of ventilator-associated tracheobronchitis on outcome in patients without chronic respiratory failure: a case-control study. Crit Care 2005; 9:R238–R245.Google Scholar
11.Nseir, S, Favory, R, Jozefowicz, E, et al; VAT Study Group. Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized controlled multicenter study. Crit Care 2008; 12:R62.Google Scholar
12.Palmer, LB, Smaldone, GC, Chen, JJ, et al.Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 2008;36:2008–2013.Google Scholar
13.Dallas, J, Skrupky, Lee, Abebe, N, Boyle, WA 3rd, Kollef, MH. Ventilator-associated tracheobronchitis in a mixed surgical and medical ICU population. Chest 2011;139:513–518.Google Scholar
14.Craven, DE, Hjalmarson, KI. Ventilator-associated tracheobronchitis and pneumonia: thinking outside the box. Clin Infect Dis 2010;51(S1):S59–S66.Google Scholar
15.American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005: 171:388–416.Google Scholar
16.Torres, A, Valencia, M. Does ventilator-associated tracheobronchitis need antibiotic treatment? Crit Care 2005;9:255–256.Google Scholar
17.Wunderink, RG. Ventilator-associated tracheobronchitis: public-reporting scam or important clinical infection? Chest 2011; 139: 485–488.Google Scholar
18. WHONET Greece. Cumulative results of January-June 2010. http://www.mednet.gr/whonet. Accessed July 21, 2012.Google Scholar
19.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818–829.Google Scholar
20.Vincent, JL, de Mendonca, A, Cantraine, F, et al.Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med 1998;26:1793–1800.Google Scholar
21.Cohen, J. Weighed kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychological Bulletin 1968; 70(4):213–220.Google Scholar
22.Singh, N, Rogers, P, Atwood, CW, Wagener, MM, Yu, VL. Short course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000;162:505–511.Google Scholar
23.Rea-Neto, A, Youssef, NCM, Tuche, F, et al.Diagnosis of ventilator-associated pneumonia: a systematic review of the literature. Crit Care 2008;12:R56.Google Scholar
24.Mermel, LA, Allon, M, Bouza, E, et al.Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Disease Society of America. Clin Infect Dis 2009;49:1–45.Google Scholar
25. Institute for Healthcare Improvement. Bundle up for safety. http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Changes/ImplementtheVentilatorBundle.htm. Accessed March 10, 2009.Google Scholar
26.Makris, D, Moschandreas, J, Damianaki, A, et al.Exacerbations and lung function decline in COPD: new insights in current and ex-smokers. Respir Med 2007;101:1305–1312.Google Scholar
27.Rodríguez-Baño, J, Millán, AB, Domínguez, MA, et al; GEIH/ GEMARA/REIPI. Impact of inappropriate empirical therapy for sepsis due to health care-associated methicillin-resistant Staphylococcus aureus. J Infect 2009;58:131–137.CrossRefGoogle ScholarPubMed
28.Bouderka, MA, Fakhir, B, Bouaggad, A, Hmamouchi, B, Hamoudi, D, Harti, A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma 2004;57:251–254.Google Scholar
29.Lambert, M-L, Suetens, C, Savey, A, et al.Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. Lancet Infect Dis 2011;11:30–38.Google Scholar
30.Grundmann, H, Livermore, DM, Giske, CG, et al; CNSE Working Group. Carbapenem-non-susceptible enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Sur-veill 2010;15(46):pii19711.Google Scholar
31.Ho, J, Tambyah, PA, Paterson, DL. Multiresistant gram-negative infections: a global perspective. Curr Opin Infect Dis 2010;23: 546–553.Google Scholar
32.Hayon, J, Figliolini, C, Combes, A, et al.Role of serial routine microbiologic culture results in the initial management of ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165:41–46.Google Scholar
33.Depuydt, P, Benoit, D, Vogelaers, D, et al.Systematic surveillance cultures as a tool to predict involvement of multidrug antibiotic resistant bacteria in ventilator-associated pneumonia. Intensive Care Med 2008;34:675–682.Google Scholar
34.Michel, F, Franceschini, B, Berger, P, et al.Early antibiotic treatment for BAL-confirmed ventilator-associated pneumonia: a role for routine endotracheal aspirate cultures. Chest 2005; 127: 589–597.Google Scholar
35.Schetz, MR, Van den Berghe, G. Do we have reliable biochemical markers to predict the outcome of critical illness? Int J Artif Organs 2005;28:1197–1210.Google Scholar
36.Gartman, EJ, Casserly, BP, Martin, D, Ward, NS. Using serial severity scores to predict death in ICU patients: a validation study and review of the literature. Curr Opin Crit Care 2009;15:578–582.CrossRefGoogle ScholarPubMed
37.Minne, L, Abu-Hanna, A, de Jonge, E. Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review. Crit Care 2008;12(6):R161.Google Scholar