Inadequate treatment of ventilator-associated and hospital-acquired pneumonia: Risk factors and impact on outcomesReportar como inadecuado




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BMC Infectious Diseases

, 12:268

Bacterial and fungal diseases

Abstract

BackgroundInitial antimicrobial therapy AB is an important determinant of clinical outcome in patients with severe infections as pneumonia, however well-conducted studies regarding prognostic impact of inadequate initial AB in patients who are not undergoing mechanical ventilation MV are lacking. In this study we aimed to identify the risk factors for inadequate initial AB and to determine its subsequent impact on outcomes in both ventilator associated pneumonia VAP and hospital acquired pneumonia HAP.

MethodsWe retrospectively studied the accuracy of initial AB in patients with pneumonia in a university hospital in Turkey. A total of 218 patients with HAP and 130 patients with VAP were included. For each patient clinical, radiological and microbiological data were collected. Stepwise multivariate logistic regression analysis was used for risk factor analysis. Survival analysis was performed by using Kaplan-Meier method with Log-rank test.

ResultsSixty six percent of patients in VAP group and 41.3% of patients in HAP group received inadequate initial AB. Multiple logistic regression analysis revealed that the risk factors for inadequate initial AB in HAP patients were; late-onset HAP OR = 2.35 95% CI, 1.05-5.22; p = 0.037 and APACHE II score at onset of HAP OR = 1.06 95% CI, 1.01-1.12; p = 0.018. In VAP patients; antibiotic usage in the previous three months OR = 3.16 95% CI, 1.27-7.81; p = 0.013 and admission to a surgical unit OR = 2.9 95% CI, 1.17-7.19; p = 0.022 were found to be independent risk factors for inadequate initial AB. No statistically significant difference in crude hospital mortality and 28-day mortality was observed between the treatment groups in both VAP and HAP. However we showed a significant increase in length of hospital stay, duration of mechanical ventilation and a prolonged clinical resolution in the inadequate AB group in both VAP and HAP.

ConclusionOur data suggests that the risk factors for inadequate initial AB are indirectly associated with the acquisition of resistant bacteria for both VAP and HAP. Although we could not find a positive correlation between adequate initial AB and survival; empirical AB with a broad spectrum should be initiated promptly to improve secondary outcomes.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-12-268 contains supplementary material, which is available to authorized users.

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Autor: Nihal Piskin - Hande Aydemir - Nefise Oztoprak - Deniz Akduman - Fusun Comert - Furuzan Kokturk - Guven Celebi

Fuente: https://link.springer.com/







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