Abstract
Background Ventilator-associated pneumonia (VAP) is a leading infectious cause of morbidity in critically ill patients, yet current guidelines offer no indications for follow-up cultures. We aimed to evaluate the role of follow-up cultures and microbiological response 3 days after diagnosing VAP as predictors of short- and long-term outcomes.
Methods We performed a retrospective analysis of a cohort prospectively collected from 2004 to 2017. VAP was diagnosed based on clinical, radiographical and microbiological criteria. For microbiological identification, a tracheobronchial aspirate was performed at diagnosis and repeated after 72 h. We defined three groups when comparing the two tracheobronchial aspirate results: persistence, superinfection and eradication of causative pathogens.
Results 157 patients were enrolled in the study, among whom microbiological persistence, superinfection or eradication was present in 67 (48%), 25 (16%) and 65 (41%), respectively, after 72 h. Those with superinfection had the highest mortalities in the intensive care unit (p=0.015) and at 90 days (p=0.036), while also having the fewest ventilator-free days (p=0.019). Multivariable analysis revealed shock at VAP diagnosis (OR 3.43, 95% CI 1.25–9.40), Staphylococcus aureus isolation at VAP diagnosis (OR 2.87, 95% CI 1.06–7.75) and hypothermia at VAP diagnosis (OR 0.67, 95% CI 0.48–0.95, per +1°C) to be associated with superinfection.
Conclusions Our retrospective analysis suggests that VAP short- and long-term outcomes may be associated with superinfection in follow-up cultures. Follow-up cultures may help guide antibiotic therapy and its duration. Further prospective studies are necessary to verify our findings.
Abstract
Follow-up cultures on day 3 after a VAP diagnosis can help the clinician stratify patients. Those patients who present early with superinfection have worse ICU mortality, worse 90-day mortality and require more days of mechanical ventilation. https://bit.ly/2W5wFLk
Footnotes
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Author contributions: C. Dominedò, A. Ceccato, M. Ferrer, I. Martin-Loeches and A. Torres: conception and design. E. Barbeta, C. Cilloniz and O. Ranzani: acquisition, analysis or interpretation of data. A. Ceccato, C. Dominedò, I. Martin-Loeches, G. De Pascale, S. Nogas, P. Di Giannatale, M. Antonelli and A. Torres: drafting the manuscript for important intellectual content. A. Gabarrús: statistical analysis. A. Ceccato: administrative, technical or material support. A. Torres: study supervision. All authors reviewed, revised and approved the manuscript for submission.
Conflict of interest: A. Ceccato has nothing to disclose.
Conflict of interest: C. Dominedò has nothing to disclose.
Conflict of interest: M. Ferrer has nothing to disclose.
Conflict of interest: I. Martin-Loeches has nothing to disclose.
Conflict of interest: E. Barbeta has nothing to disclose.
Conflict of interest: A Gabarrús has nothing to disclose.
Conflict of interest: C. Cilloniz has nothing to disclose.
Conflict of interest: O. Ranzani has nothing to disclose.
Conflict of interest: G. De Pascale has nothing to disclose.
Conflict of interest: S. Nogas has nothing to disclose.
Conflict of interest: P. Di Giannatale has nothing to disclose.
Conflict of interest: M. Antonelli has nothing to disclose.
Conflict of interest: A. Torres has nothing to disclose.
Support statement: This study was supported by Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) and August Pi i Sunyer Biomedical Research Institute (IDIBAPS). The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and in the decision to submit the manuscript for publication. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received March 1, 2021.
- Accepted August 12, 2021.
- Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
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