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Updated: Mar 25, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Ventilator-associated pneumonia in critically ill patients with intensive antibiotic usage
Canan Bor1, Kubilay Demirag2, Ozlem Okcu3
1Canan Bor, Department of Anaesthesiology and Intensive Care Unit, Ege University School of Medicine Hospital, Izmir, Turkey.
Objective:
Ventilator-associated pneumonia (VAP) is an infection with high mortality and morbidity that prolongs the length of stay in the intensive care unit (ICU) and hospitalisation. VAP is one of the most common infections in critically ill patients. This study aimed to prospectively determine the VAP rate and associated factors in critically ill patients with intensive antibiotic usage during a one-year period.
Methods:
In total, 125 out of 360 patients admitted to the intensive care unit during the one-year study period (September 2010-2011) were included for follow-up for VAP diagnosis. Demographic data, APACHE II scores, diagnoses on admission, clinical pulmonary infection scores (CPIS), CRP, procalcitonin, risk factors for infection, time to VAP diagnosis, and bacteriological culture results were recorded. All data were assessed in terms of ICU, hospital and 28-day mortality.
Results:
In total, 56 (45%) out of 125 patients were diagnosed with VAP. In addition, 91% of patients diagnosed with VAP were administered antibiotics before diagnosis. In the VAP patients, the mortality rates were 48, 68 and 71% for 28-day, ICU and hospital mortality, respectively.
Conclusion:
The coexistence of clinical and microbiological parameters should not be sought when diagnosing VAP in patients who use antibiotics intensively. VAP can be diagnosed when CPIS≤6 in cases with sufficient microbiological evidence. This strategy may decrease mortality by preventing a delay in therapy.
Insights
Ventilator-associated pneumonia (VAP) affects 45% of ICU patients, with 91% receiving antibiotics prior to diagnosis. Early diagnosis using clinical and microbiological data, even with CPIS ≤6, can reduce mortality.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Ventilator-associated pneumonia (VAP) is a common and serious infection in intensive care units (ICUs).
- VAP significantly increases patient morbidity, mortality, and length of hospital stay.
- Effective diagnosis and management are crucial for improving outcomes in critically ill patients.
Purpose of the Study:
- To prospectively determine the incidence of VAP in critically ill patients.
- To identify factors associated with VAP development.
- To evaluate diagnostic strategies for VAP in patients with high antibiotic usage.
Main Methods:
- A one-year prospective study of 125 intensive care unit patients.
- Data collection included demographics, APACHE II scores, CPIS, inflammatory markers (CRP, procalcitonin), and bacteriological cultures.
- Outcomes assessed were VAP diagnosis, time to diagnosis, and ICU, hospital, and 28-day mortality.
Main Results:
- The VAP incidence was 45% (56 out of 125 patients).
- A high proportion (91%) of VAP patients received antibiotics before diagnosis.
- VAP was associated with significantly high mortality rates: 48% (28-day), 68% (ICU), and 71% (hospital).
Conclusions:
- Diagnosing VAP in patients with intensive antibiotic use may require prioritizing microbiological evidence over strict adherence to combined clinical and microbiological parameters.
- Utilizing a lower Clinical Pulmonary Infection Score (CPIS ≤6) with sufficient microbiological support can aid in timely VAP diagnosis.
- This diagnostic approach has the potential to reduce mortality by enabling earlier therapeutic interventions.
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