Abstract
Introduction: Nonventilator ICU-acquired pneumonia (NV-ICUAP), is the leading infection in critically ill patients. We evaluated retrospectively how the diagnosis of NV-ICUAP has been done in our hospital, proportion of NV-ICUAP with an etiologic diagnosis and the differences between Microbiological-Defined(MicDef) and Not Defined (MicNotDef) groups. The aim of this study was to evaluate the importance of an early microbiological definition to guide the therapy.
Methods: Data were prospectively collected in 6 ICUs (overall 45 beds) between 2007 and 2015.MicDef and MicNotDef NV-ICUAP at diagnosis were retrospectively compared according to identify: diagnostic methods, therapy, outcomes and inflammatory response.
Results: We studied 194 NV-ICUAP. Patients were clustered in two groups: MicDef 82(42%) and MicNotDef 112(58%). Both groups had similar baseline severity scores and initial systemic inflammatory response. The MicNotDef group had less Endotracheal Intubations (ETI)(54.5 vs 69,5%;p=0.034), shorter total duration of antimicrobials(ATBs) (Mean 13 days SD±6vs17 days SD±12;p=0.006) and shorter ICU stay (17.3±20.5 vs 20,9±16,3;p=0.004) than positive MicDef. The overall mortality was 42%, non significant difference was observed between groups (48% vs 38%;p=0.14) and was higher among patients with inadequate empirical treatment according with microbiologic isolation (84% vs 42%;p= 0.006).
Conclusions: Interestingly we found that MicNotDef patients had a shorter duration of ATBs treatment stayed less in the ICU and had less ETI events. Patients treated with an adequate empiric therapy (according the antibiogram) have a better survival than patients with an inadequate treatment in MicDef group.
- Copyright ©the authors 2016
