Clinical and Economic Consequences of Ventilator-associated Pneumonia: A Systematic Review

Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, 600 Highland Avenue, Madison, WI 53792, USA.
Critical Care Medicine (Impact Factor: 6.15). 10/2005; 33(10):2184-93. DOI: 10.1097/01.CCM.0000181731.53912.D9
Source: PubMed

ABSTRACT Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in critically ill patients. The clinical and economic consequences of VAP are unclear, with a broad range of values reported in the literature
To perform a systematic review to determine the incidence of VAP and its attributable mortality rate, length of stay, and costs.
Computerized PUBMED and MEDLINE search supplemented by manual searches for relevant articles, limited to articles published after 1990.
English-language observational studies and randomized trials that provided data on the incidence of VAP were included. Matched cohort studies were included for calculation of attributable mortality rate and length of stay.
Data were extracted on patient population, diagnostic criteria for VAP, incidence, outcome, type of intensive care unit, and study design.
The cumulative incidence of VAP was calculated by combining the results of several studies using standard formulas for combining proportions, in which the weighted average and variance are calculated. Results from studies comparing intensive care unit and hospital mortality due to VAP, additional length of stay, and additional days of mechanical ventilation were pooled using a random effects model, with assessment of heterogeneity.
Our findings indicate a) between 10% and 20% of patients receiving >48 hrs of mechanical ventilation will develop VAP; b) critically ill patients who develop VAP appear to be twice as likely to die compared with similar patients without VAP (pooled odds ratio, 2.03; 95% confidence interval, 1.16-3.56); c) patients with VAP have significantly longer intensive care unit lengths of stay (mean = 6.10 days; 95% confidence interval, 5.32-6.87 days); and d) patients who develop VAP incur > or = USD $10,019 in additional hospital costs.
Ventilator-associated pneumonia occurs in a considerable proportion of patients undergoing mechanical ventilation and is associated with substantial morbidity, a two-fold mortality rate, and excess cost. Given these findings, strategies that effectively prevent VAP are urgently needed.

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    • "About 40 % of the nosocomial S. aureus isolates in the USA are resistant to methicillin and in central and Southern Europe, more than 25 % of bacteraemia cases are caused by MRSA (Haddadin et al. 2002 ; Moellering 2012 ). S. aureus is the most common cause of nosocomial pneumonia and plays a prominent role in the development of VAP (American Thoracic Society 2005 ; Park 2005 ; Bahrani-Mougeot et al. 2007 ; Weber et al. 2007 ; Dickson et al. 2008 ; Hidron et al. 2008 ; Jones 2010 ; Joseph et al. 2010 ; Becker and von Eiff 2012 ; Park et al. 2012 ). S. aureus is frequently isolated from ET biofi lms by cultivation (Inglis et al. 1995 ; Adair et al. 1999 ; Feldman et al. 1999 ; Berra et al. 2012 ; Vandecandelaere et al. 2012 ; Liu et al. 2013 ) and also, the use of culture independent methods resulted in the identifi cation of S. aureus in ET biofi lms (Perkins et al. 2010 ; Cairns et al. 2011 ; Vandecandelaere et al. 2012 ). As S. aureus is part of the human nasal fl ora (Becker and von Eiff 2012 ), it can be assumed that S. aureus in ET biofi lms originate from nasopharyngeal secretions (Feldman et al. 1999 ; Safdar et al. 2005 ; Perkins et al. 2010 ). Subsequently, parts of the ET biofi lm (containing S. aureus ) can be dispersed to the lungs and this causes VAP (Otto 2013b ). "
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    ABSTRACT: In critically ill patients, breathing is impaired and mechanical ventilation, using an endotracheal tube (ET) connected to a ventilator, is necessary. Although mechanical ventilation is a life-saving procedure, it is not without risk. Because of several reasons, a biofilm often forms at the distal end of the ET and this biofilm is a persistent source of bacteria which can infect the lungs, causing ventilator-associated pneumonia (VAP). There is a link between the microbial flora of ET biofilms and the microorganisms involved in the onset of VAP. Culture dependent and independent techniques were already used to identify the microbial flora of ET biofilms and also, the antibiotic resistance of microorganisms obtained from ET biofilms was determined. The ESKAPE pathogens play a dominant role in the onset of VAP and these organisms were frequently identified in ET biofilms. Also, antibiotic resistant microorganisms were frequently present in ET biofilms. Members of the normal oral flora were also identified in ET biofilms but it is thought that these organisms initiate ET biofilm formation and are not directly involved in the development of VAP.
    Advances in Experimental Medicine and Biology 01/2015; 830:137-55. DOI:10.1007/978-3-319-11038-7_9 · 2.01 Impact Factor
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    • "The cost for each VAP is estimated at between ¤9000 and ¤31 000. (Rello et al., 2002a, 2002b; Erbay et al., 2003; Safdar et al., 2005; Cocanour et al., 2006; Keeley, 2007; Sinuff et al., 2008; Labeau et al., 2008; Stonecypher, 2010; Díaz et al., 2010). "
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    ABSTRACT: Ventilator-associated pneumonia constitutes a significant concern for ventilated patients in the intensive care unit. This study was planned to evaluate the knowledge of nurses working in general intensive care units concerning evidence-based measures for the prevention of ventilator-associated pneumonia. This study design is cross-sectional. It was carried out on nurses working in the general intensive care units of anesthiology and re-animation clinics. Collection of research data was performed by means of a Nurse Identification Form and a Form of Evidence-Based Knowledge concerning the Prevention of Ventilator-Associated Pneumonia. Characterization statistics were shown by percentage, median and interquartile range. Chi-square and Wilcoxon tests and Kruskal-Wallis tests were used as appropriate. The median value of total points scored by nurses on the questionnaire was 4.00 ± 2.00. The difference between the nurses' education levels, duration of work experience and participation in in-service training programmes on ventilator-associated pneumonia prevention and the median value of their total scores on the questionnaire was found to be statistically significant (p < 0.05). The conclusion of the study was that critical care nurses' knowledge about ventilator-associated pneumonia prevention is poor.
    Nursing in Critical Care 01/2014; 19(1):26-33. DOI:10.1111/nicc.12038 · 0.87 Impact Factor
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    • "The crude mortality of VAP ranges from 22 to 60% whereas a 6e9% attributable mortality has been estimated for this condition [12e14]. Each case of VAP causes an average increase in hospital cost of about $40.000 [15]. The hypothesis that biofilms could have a role in the pathogenesis of VAP was proposed a long time ago on the basis of the evidence that the polyvinyl-chloride (PVC) surface of the endotracheal tube (ETT) is rapidly colonized after intubation [16]. "
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    ABSTRACT: Biofilms are a key factor in the development of both acute and chronic airway infections. Their relevance is well established in ventilator associated pneumonia, one of the most severe complications in critically ill patients, and in cystic fibrosis, the most common lethal genetic disease in Caucasians. Accumulating evidence suggests that biofilms could have also a role in chronic obstructive pulmonary disease and their involvement in bronchiectais has been proposed as well. When they grow in biofilms, microorganisms become multidrug-resistant. Therefore the treatment of biofilm-dependent airway infections is problematic. Indeed, it still largely based on measures aiming to prevent the formation of biofilms or remove them once that they are formed. Here we review recent evidence suggesting that the mucokinetic drug ambroxol has specific anti-biofilm properties. We also discuss how additional pharmacological properties of this drug could be beneficial in biofilm-dependent airway infections. Specifically, we review the evidence showing that: 1-ambroxol exerts anti-inflammatory effects by inhibiting at multiple levels the acitivity of neutrophils. , and 2-it improves mucociliary clearance by interfering with the activity of airway epithelium ion channels and transporters including sodium/bicarbonate and sodium/potassium/chloride cotransporters, cystic fibrosis transmembrane conductance regulator and aquaporins. As a whole, the data that we review here suggest that ambroxol could be helpful in biofilm-dependent airway infections. However, considering the limited clinical evidence available up to date, further clinical studies are required to support the use of ambroxol in these diseases.
    Pulmonary Pharmacology &amp Therapeutics 11/2013; 28(2). DOI:10.1016/j.pupt.2013.11.002 · 2.57 Impact Factor
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