Retrospective Evaluation Of Patients With Ventilator Associated Pneumonia: Six Year Data

Sümeyye Kışlak Demircan; Selçuk Nazik; Selma Güler; Esma Cingöz

Article Details

Retrospective Evaluation Of Patients With Ventilator Associated Pneumonia: Six Year Data

Authors:

Sümeyye Kışlak Demircan | Selçuk Nazik | Selma Güler | Esma Cingöz

Publisher:

Kahramanmaras Sutcu Imam University

Main Topics:

Sağlık Kurumları Yönetimi

Journal:

Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi Vol.19 Issue 1, pp.8-16

Document Type:

Article

Publication Date:

3/2024

Document Language:

Turkish

Document ID (Org No.):

2001314354

pISSN:

1303-6610

Keywords:

Abstract:

 Objective: This study aimed to evaluate the demographic characteristics, ventilator-associated pneumonia VAP agents, and prognosis of VAP cases followed in the intensive care unit and to determine the relationship between these features and mortality. Materials and Methods: The study was retrospectively and single-centered between January 2012 and December 2017. 533 patients with 18 years of age and mechanical ventilation for more than 48 hours were included in the study. The data were evaluated by examining the hospital data system and patient files. Data were recorded including age, sex, clinical status, culture antibiogram results, comorbidity status, length of hospital stay, and patient status dischargedeath. Results: Of the patients included in the study, 337 63.2 were male 196 36.8 were female and the mean age was 63.8  20.4 years. Of the patients, 93.1 had Gram-negative bacteria, 6.4 had Gram-positive bacteria and 0.6 had fungal agents. The most common agents were Acinetobacter baumannii 42.2, Pseudomonas aeruginosa 19.3, and Klebsiella pneumoniae 12.2. 66.2 of VAP cases resulted in mortality. When the risk factors affecting the prognosis and the effect of accompanying diseases on mortality are examined; It was determined that the presence of cerebrovascular diseases and immunosuppression OR: 1.20, 1.67, respectively increased mortality. C-reactive protein value at the time of diagnosis was found to be effective in predicting mortality. C-reactive protein CRP AUC:0.588 p0.001, procalcitonin PCT AUC:0.658, p0.0001, neutrophil-lymphocyte ratio NLR AUC:0.598 p0.0001 and thrombocytopenia AUC:0.356 p0.0001 at the time of diagnosis was found to be effective in predicting mortality. Conclusion: Ventilator-associated pneumonia is a disease that is often associated with multidrug-resistant Gram-negative bacteria and has a high morbidity and mortality. We believe that mortality increases especially in those with comorbidities such as cerebrovascular diseases and the presence of immunosuppression, therefore it would be beneficial to follow up on the cases with these diseases more closely. We think that close monitoring of biomarkers such as PCT, CRP, and NLR in the follow-up of patients diagnosed with VAP will be beneficial in reducing morbidity and mortality.

 Objective: This study aimed to evaluate the demographic characteristics, ventilator-associated pneumonia VAP agents, and prognosis of VAP cases followed in the intensive care unit and to determine the relationship between these features and mortality. Materials and Methods: The study was retrospectively and single-centered between January 2012 and December 2017. 533 patients with 18 years of age and mechanical ventilation for more than 48 hours were included in the study. The data were evaluated by examining the hospital data system and patient files. Data were recorded including age, sex, clinical status, culture antibiogram results, comorbidity status, length of hospital stay, and patient status dischargedeath. Results: Of the patients included in the study, 337 63.2 were male 196 36.8 were female and the mean age was 63.8  20.4 years. Of the patients, 93.1 had Gram-negative bacteria, 6.4 had Gram-positive bacteria and 0.6 had fungal agents. The most common agents were Acinetobacter baumannii 42.2, Pseudomonas aeruginosa 19.3, and Klebsiella pneumoniae 12.2. 66.2 of VAP cases resulted in mortality. When the risk factors affecting the prognosis and the effect of accompanying diseases on mortality are examined; It was determined that the presence of cerebrovascular diseases and immunosuppression OR: 1.20, 1.67, respectively increased mortality. C-reactive protein value at the time of diagnosis was found to be effective in predicting mortality. C-reactive protein CRP AUC:0.588 p0.001, procalcitonin PCT AUC:0.658, p0.0001, neutrophil-lymphocyte ratio NLR AUC:0.598 p0.0001 and thrombocytopenia AUC:0.356 p0.0001 at the time of diagnosis was found to be effective in predicting mortality. Conclusion: Ventilator-associated pneumonia is a disease that is often associated with multidrug-resistant Gram-negative bacteria and has a high morbidity and mortality. We believe that mortality increases especially in those with comorbidities such as cerebrovascular diseases and the presence of immunosuppression, therefore it would be beneficial to follow up on the cases with these diseases more closely. We think that close monitoring of biomarkers such as PCT, CRP, and NLR in the follow-up of patients diagnosed with VAP will be beneficial in reducing morbidity and mortality.

 Objective: This study aimed to evaluate the demographic characteristics, ventilator-associated pneumonia VAP agents, and prognosis of VAP cases followed in the intensive care unit and to determine the relationship between these features and mortality. Materials and Methods: The study was retrospectively and single-centered between January 2012 and December 2017. 533 patients with 18 years of age and mechanical ventilation for more than 48 hours were included in the study. The data were evaluated by examining the hospital data system and patient files. Data were recorded including age, sex, clinical status, culture antibiogram results, comorbidity status, length of hospital stay, and patient status dischargedeath. Results: Of the patients included in the study, 337 63.2 were male 196 36.8 were female and the mean age was 63.8  20.4 years. Of the patients, 93.1 had Gram-negative bacteria, 6.4 had Gram-positive bacteria and 0.6 had fungal agents. The most common agents were Acinetobacter baumannii 42.2, Pseudomonas aeruginosa 19.3, and Klebsiella pneumoniae 12.2. 66.2 of VAP cases resulted in mortality. When the risk factors affecting the prognosis and the effect of accompanying diseases on mortality are examined; It was determined that the presence of cerebrovascular diseases and immunosuppression OR: 1.20, 1.67, respectively increased mortality. C-reactive protein value at the time of diagnosis was found to be effective in predicting mortality. C-reactive protein CRP AUC:0.588 p0.001, procalcitonin PCT AUC:0.658, p0.0001, neutrophil-lymphocyte ratio NLR AUC:0.598 p0.0001 and thrombocytopenia AUC:0.356 p0.0001 at the time of diagnosis was found to be effective in predicting mortality. Conclusion: Ventilator-associated pneumonia is a disease that is often associated with multidrug-resistant Gram-negative bacteria and has a high morbidity and mortality. We believe that mortality increases especially in those with comorbidities such as cerebrovascular diseases and the presence of immunosuppression, therefore it would be beneficial to follow up on the cases with these diseases more closely. We think that close monitoring of biomarkers such as PCT, CRP, and NLR in the follow-up of patients diagnosed with VAP will be beneficial in reducing morbidity and mortality.

 Amaç: Bu çalışmada yoğun bakım ünitesinde takip edilen ventilatör ilişkili pnömoni VİP olgularının demografik özelliklerinin, VİP etkenlerinin ve prognozunun değerlendirilmesi ve bu özelliklerin mortalite ile olan ilişkisinin ortaya konulması amaçlanmıştır. Gereç ve Yöntemler: Çalışma retrospektif ve tek merkezli olarak Ocak 2012-Aralık 2017 tarihleri arasında yapılmıştır. Hastanemizde VİP tanısı ile yatan 18 yaş hastalar ve 48 saatten uzun süre mekanik ventilasyon altında olan 533 hasta çalışmaya dahil edilmiştir. Veriler, hastane veri sistemi ve hasta dosyaları incelenerek değerlendirildi. Hastalara ait yaş, cinsiyet, yattığı klinik, kültür antibiyogram sonuçları, komorbidite durumu, hastanede kalış süresi ve hastanın son durumu taburcueksitus gibi veriler kaydedildi. Bulgular: Çalışmaya dahil edilen olguların 337si 63.2 erkek, 196sı 36.8 kadın cinsiyette olup yaş ortalaması 63.820.4 yıldı. Hastaların 93.1 inde Gram negatif bakteri, 6.4ünde Gram pozitif bakteri ve 0.6sında mantar üremesi saptandı. En sık saptanan etkenler Acinetobacter baumannii 42.2, Pseudomonas aeruginosa 19.3, Klebsiella pneumoniae 12.2 idi. VİP olgularının  66.2si mortalite ile sonuçlandı. Prognozu etkileyen risk faktörleri ve eşlik eden hastalıkların mortalite üzerindeki etkisi incelendiğinde; serebrovasküler hastalıklar ve immünsupresyon varlığının sırasıyla OR:1.20, 1.67 mortaliteyi arttırdığı saptanmıştır. Hastaların tanı anındaki C-reaktif protein CRP AUC:0.588 p0,001, prokalsitonin PCT AUC:0.658 p0.0001, nötrofil lenfosit oranı NLO AUC:0.598 p0.0001 ve platelet düşüklüğünün AUC:0.356 p0.0001 mortaliteyi öngörmede etkili olduğu bulunmuştur. Sonuçlar: Ventilatör ilişkili pnömoni sıklıkla çok ilaca dirençli Gram negatif bakterilere bağlı gelişen mortalitesi ve morbiditesi yüksek bir hastalıktır. Özellikle serebrovasküler hastalıklar ve immünsupresyon varlığı gibi komorbiditesi olanlarda mortalitenin arttığı bu nedenle bu hastalıklara sahip olguların daha yakından takip edilmesinin faydalı olacağı kanaatindeyiz. VİP tanısı alan hastaların takibinde özellikle PCT, CRP ve NLO gibi biyobelirteçlerin yakından takip edilmesinin morbidite ve mortalitenin azaltılmasında faydalı olacağını düşünmekteyiz.

Article Details

Retrospective Evaluation Of Patients With Ventilator Associated Pneumonia: Six Year Data

Authors:

Sümeyye Kışlak Demircan | Selçuk Nazik | Selma Güler | Esma Cingöz

Publisher:

Kahramanmaras Sutcu Imam University

Main Topics:

Sağlık Kurumları Yönetimi

Journal:

Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi Vol.19 Issue 1, pp.8-16

Document Type:

Article

Publication Date:

3/2024

Document Language:

Turkish

Document ID (Org No.):

2001314354

pISSN:

1303-6610

Hospital-acquired Infection

Ventilator-associated pneumonia

Mortality

Intesive Care UnitMortalite

Ventilatör İlişkili Pnömoni

Yoğun Bakım Ünitesi

Hastane enfeksiyonu

Issues

Article Details

Authors: Sümeyye Kışlak Demircan | Selçuk Nazik | Selma Güler | Esma Cingöz

Publisher: Kahramanmaras Sutcu Imam University

Main Topics: Sağlık Kurumları Yönetimi

Journal: Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi Vol.19 Issue 1, pp.8-16

Document Type: Article

Publication Date: 3/2024

Document Language: Turkish

Document ID (Org No.): 2001314354

pISSN: 1303-6610

Issues

Authors:

Sümeyye Kışlak Demircan | Selçuk Nazik | Selma Güler | Esma Cingöz

Publisher:

Kahramanmaras Sutcu Imam University

Main Topics:

Sağlık Kurumları Yönetimi

Journal:

Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi Vol.19 Issue 1, pp.8-16

Document Type:

Article

Publication Date:

3/2024

Document Language:

Turkish

Document ID (Org No.):

2001314354

pISSN:

1303-6610