Epidemiology of ICU-acquired pneumonia

Current Opinion in Critical Care - Tập 24 Số 5 - Trang 325-331 - 2018
Miquel Ferrer1,2,3, Antoní Torres1,2
1Centro de Investigaciones Biomedicas En Red-Enfermedades Respiratorias (CibeRes CB06/06/0028)-ISCIII, Barcelona, Spain
2Department of Pneumology, Respiratory Institute, Hospital Clinic – Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona
3fax: +34 93 227 55 49

Tóm tắt

Purpose of review Review of the epidemiology of ICU-acquired pneumonia, including both ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) in nonventilated ICU patients, with critical review of the most recent literature in this setting. Recent findings The incidence of ICU-acquired pneumonia, mainly VAP has decrease significantly in recent years possibly due to the generalized implementation of preventive bundles. However, the exact incidence of VAP is difficult to establish due to the diagnostic limitations and the methods employed to report rates. Incidence rates greatly vary based on the studied populations. Data in the literature strongly support the relevance of intubation, not ventilatory support, in the development of HAP in ICU patients, but also that the incidence of HAP in nonintubated patients is not negligible. Despite the fact of a high crude mortality associated with the development of VAP, the overall attributable mortality of this complication was estimated in 13%, with higher mortality rates in surgical patients and those with mid-range severity scores at admission. Mortality is consistently greatest in patients with HAP who require intubation, slightly less in VAP, and least for nonventilated HAP. The economic burden of ICU acquired pneumonia, particularly VAP, is important. The increased costs are mainly related to the longer periods of ventilatory assistance and ICU and hospital stays required by these patients. However, the different impact of VAP on economic burden among countries is largely dependent on the different costs associated with heath care. Summary VAP has significant impact on mortality mainly in surgical patients and those with mid-range severity scores at admission. The economic burden on ICU-acquired pneumonia depends mainly on the increased length of stay of these patients.

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Tài liệu tham khảo

Villar, 2011, The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation, Intensive Care Med, 37, 1932, 10.1007/s00134-011-2380-4

Magill, 2013, Developing a new, national approach to surveillance for ventilator-associated events, Crit Care Med, 41, 2467, 10.1097/CCM.0b013e3182a262db

Magill, 2014, Survey of health care-associated infections, N Engl J Med, 370, 2542, 10.1056/NEJMoa1306801

2005, Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia, Am J Respir Crit Care Med, 171, 388, 10.1164/rccm.200405-644ST

Reignier, 2013, Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial, JAMA, 309, 249, 10.1001/jama.2012.196377

Seguin, 2014, Effect of oropharyngeal povidone-iodine preventive oral care on ventilator-associated pneumonia in severely brain-injured or cerebral hemorrhage patients: a multicenter, randomized controlled trial, Crit Care Med, 42, 1, 10.1097/CCM.0b013e3182a2770f

Lorente, 2012, Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial, Eur J Clin Microbiol Infect Dis, 31, 2621, 10.1007/s10096-012-1605-y

Leblebicioglu, 2013, Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC), Infection, 41, 447, 10.1007/s15010-013-0407-1

Vincent, 2009, International study of the prevalence and outcomes of infection in intensive care units, JAMA, 302, 2323, 10.1001/jama.2009.1754

Dudeck, 2013, National Healthcare Safety Network report, data summary for 2011, device-associated module, Am J Infect Control, 41, 286, 10.1016/j.ajic.2013.01.002

Blot, 2014, Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients, Crit Care Med, 42, 601, 10.1097/01.ccm.0000435665.07446.50

Koulenti, 2009, Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units, Crit Care Med, 37, 2360, 10.1097/CCM.0b013e3181a037ac

Forel, 2012, Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy, Crit Care, 16, R65, 10.1186/cc11312

Edwards, 2007, National Healthcare Safety Network (NHSN) report, data summary for 2006, issued June 2007, Am J Infect Control, 35, 290, 10.1016/j.ajic.2007.04.001

Wang, 2014, National trends in patient safety for four common conditions, 2005–2011, N Engl J Med, 370, 341, 10.1056/NEJMsa1300991

Metersky, 2016, Trend in ventilator-associated pneumonia rates between 2005 and 2013, JAMA, 316, 2427, 10.1001/jama.2016.16226

Bougle, 2018, Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support: epidemiology and risk factors of treatment failure, PLoS One, 13, e0194976, 10.1371/journal.pone.0194976

Esperatti, 2010, Nosocomial pneumonia in the intensive care unit acquired during mechanical ventilation or not, Am J Respir Crit Care Med, 182, 1533, 10.1164/rccm.201001-0094OC

Kohlenberg, 2010, Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database, Intensive Care Med, 36, 971, 10.1007/s00134-010-1863-z

Sopena, 2005, Multicenter study of hospital-acquired pneumonia in non-ICU patients, Chest, 127, 213, 10.1378/chest.127.1.213

Kollef, 2005, Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia, Chest, 128, 3854, 10.1378/chest.128.6.3854

Melsen, 2009, Ventilator-associated pneumonia and mortality: a systematic review of observational studies, Crit Care Med, 37, 2709

Nguile-Makao, 2010, Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models, Intensive Care Med, 36, 781, 10.1007/s00134-010-1824-6

Schumacher, 2007, Attributable mortality due to nosocomial infections. A simple and useful application of multistate models, Methods Inf Med, 46, 595, 10.1160/ME9062

Melsen, 2011, Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies, Crit Care Med, 39, 2736, 10.1097/CCM.0b013e3182281f33

Melsen, 2013, Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies, Lancet Infect Dis, 13, 665, 10.1016/S1473-3099(13)70081-1

Lisboa, 2008, The ventilator-associated pneumonia PIRO score: a tool for predicting ICU mortality and health-care resources use in ventilator-associated pneumonia, Chest, 134, 1208, 10.1378/chest.08-1106

Esperatti, 2013, Validation of predictors of adverse outcomes in hospital-acquired pneumonia in the ICU, Crit Care Med, 41, 2151, 10.1097/CCM.0b013e31828a674a

Muscedere, 2010, Mortality, attributable mortality, and clinical events as end points for clinical trials of ventilator-associated pneumonia and hospital-acquired pneumonia, Clin Infect Dis, 51, S120, 10.1086/653060

Kollef, 2012, Economic impact of ventilator-associated pneumonia in a large matched cohort, Infect Control Hosp Epidemiol, 33, 250, 10.1086/664049

Warren, 2003, Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center, Crit Care Med, 31, 1312, 10.1097/01.CCM.0000063087.93157.06

Zimlichman, 2013, Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system, JAMA Intern Med, 173, 2039, 10.1001/jamainternmed.2013.9763

Rello, 2002, Epidemiology and outcomes of ventilator-associated pneumonia in a large US database, Chest, 122, 2115, 10.1378/chest.122.6.2115

Chacko, 2017, Attributable cost of a nosocomial infection in the intensive care unit: a prospective cohort study, World J Crit Care Med, 6, 79, 10.5492/wjccm.v6.i1.79

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Current Opinion in Critical Care

Tập 24 Số 5

325-331

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