Comparison of the Bacterial Etiology of Early-Onset and Late-Onset Ventilator-Associated Pneumonia in Subjects Enrolled in 2 Large Clinical Studies.
BACKGROUND: Ventilator-associated pneumonia (VAP) is classified as early-onset or late-onset, in part, to identify subjects at risk for infection with resistant pathogens. We assessed differences in the bacterial etiology of early-onset versus late-onset VAP. METHODS: Subjects enrolled in 2004-2006...
| Publicado en: | Respiratory Care Vol. 58; no. 7; pp. 1220 - 1226 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Jul2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104186506&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104186506 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Jul2013 vid: 58 iid: 7 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 104186506 88350396 10.4187/respcare.02173 NLM23307825 104186506 ppf: 1220 ppct: 6 formats: fmt: @attributes: type: P tig: atl: Comparison of the Bacterial Etiology of Early-Onset and Late-Onset Ventilator-Associated Pneumonia in Subjects Enrolled in 2 Large Clinical Studies. aug: au: Restrepo, Marcos I. Peterson, Janet Fernandez, Juan F. Zhihai Qin Fisher, Alan C. Nicholson, Susan C. affil: Division of Pulmonary and Critical Care, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT), Audie L Murphy Division, South Texas Veterans Health Care System, San Antonio, Texas sug: subj: Pneumonia, Ventilator-Associated Microbiology Age of Onset Evaluation Delayed Onset Evaluation Human Scales Prospective Studies Retrospective Design Male Female Adult APACHE (Acute Physiology and Chronic Health Evaluation) Middle Age Aged Fisher's Exact Test Wilcoxon Signed Rank Test Mann-Whitney U Test Descriptive Statistics Data Analysis Software Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: Ventilator-associated pneumonia (VAP) is classified as early-onset or late-onset, in part, to identify subjects at risk for infection with resistant pathogens. We assessed differences in the bacterial etiology of early-onset versus late-onset VAP. METHODS: Subjects enrolled in 2004-2006 in 2 clinical studies of doripenem versus imipenem or piperacillin/tazobactam, with a diagnosis of VAP (n 500) were included in the analysis. Subjects were classified by ventilator status: early-onset VAP (< 5 d of ventilation) or late-onset VAP (≥ 5 d of ventilation). Baseline demographics and bacterial etiology were analyzed by VAP status. RESULTS: Late-onset VAP subjects had higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores (mean 16.6 versus 15.5, P = .008). There were no significant differences in Clinical Pulmonary Infection Score, sex, age, or presence of bacteremia between the groups. A total of 496 subjects had a baseline pathogen, and 50% of subjects in each group had ≥ 2 pathogens. With the exception of Staphylococcus aureus, which was common in early-onset VAP, the pathogens (including potentially multidrug- resistant (MDR) pathogens) isolated from early-onset versus late-onset VAP were not significantly different between groups. Acinetobacter baumannii or Pseudomonas aeruginosa with decreased susceptibility to any study drug was observed in early-onset and late-onset VAP subjects. CONCLUSIONS: There were no significant differences in the prevalence of potential MDR pathogens associated with early-onset or late-onset VAP, even in subjects with prior antibiotics. Empiric therapy for early-onset VAP should also include agents likely to be effective for potential MDR pathogens. Further prospective studies should evaluate microbiology trends in subjects with VAP. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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