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Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria
Patricia Cornejo-Juárez1, Ivan González-Oros2, Paola Mota-Castañeda2
1Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico. patcornejo@yahoo.com.
Background:
Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation (MV). The emergence of multidrug resistant bacteria (MDRB) has become a public health problem, creating a new burden on medical care in hospitals, particularly for patients admitted to the intensive care unit (ICU).
Aim:
To describe risk factors for ventilator-acquired pneumonia (VAP) in patients with cancer and to evaluate the impact of MDRB.
Methods:
A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City, which included all patients who were admitted to the ICU and required MV ≥ 48 h. They were classified as those who developed VAP versus those who did not; pathogens isolated, including MDRB. Clinical evolution at 60-d was assessed. Descriptive analysis was carried out; comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.
Results:
Two hundred sixty-three patients were included in the study; mean age was 51.9 years; 52.1% were male; 68.4% had solid tumors. There were 32 episodes of VAP with a rate of 12.2%; 11.5 episodes/1000 ventilation-days. The most frequent bacteria isolated were the following: Klebsiella spp. [n = 9, four were Extended-Spectrum Beta-Lactamase (ESBL) producers, one was Carbapenem-resistant (CR)]; Escherichia coli (n = 5, one was ESBL), and Pseudomonas aeruginosa (n = 8, two were CR). One Methicillin-susceptible Staphylococcus aureus was identified. In multivariate analysis, the sole risk factor associated for VAP was length of ICU stay (OR = 1.1; 95%CI: 1.03-1.17; P = 0.003). Sixty-day mortality was 53% in VAP and 43% without VAP (P = 0.342). There was not higher mortality in those patients with MDRB.
Conclusion:
This study highlights the high percentage of Gram-negative bacteria, which allows the initiation of empiric antibiotic coverage for these pathogens. In this retrospective, single center, observational study, MDRB VAP was not directly linked to increased mortality at 60 days.
Insights
In cancer patients requiring mechanical ventilation, longer ICU stays increased the risk of ventilator-acquired pneumonia (VAP). Multidrug-resistant bacteria (MDRB) VAP did not significantly increase 60-day mortality in this study.
Area of Science:
- Critical Care Medicine
- Oncology
- Infectious Diseases
Background:
- Cancer patients on mechanical ventilation (MV) face high risks of respiratory failure.
- Multidrug-resistant bacteria (MDRB) pose a significant challenge in intensive care units (ICUs).
Purpose of the Study:
- To identify risk factors for ventilator-acquired pneumonia (VAP) in cancer patients.
- To assess the impact of MDRB on VAP outcomes in this population.
Main Methods:
- Retrospective study of ICU patients requiring MV ≥ 48 hours.
- Classification based on VAP development and pathogen identification, including MDRB.
- Analysis of clinical evolution and 60-day mortality.
Main Results:
- VAP occurred in 12.2% of patients; Gram-negative bacteria were most common.
- Increased length of ICU stay was the only significant risk factor for VAP (OR = 1.1).
- No significant difference in 60-day mortality was observed between VAP and non-VAP groups, or between MDRB and non-MDRB VAP cases.
Conclusions:
- Gram-negative bacteria are prevalent in VAP, guiding empiric antibiotic therapy.
- In this cohort, MDRB VAP was not associated with increased 60-day mortality.
- Length of ICU stay is a critical factor for VAP prevention in cancer patients.
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