Related Experiment Videos
Mortality and Predictors of In-Hospital Death Among Mechanically Ventilated Adults With Gram-Negative Pneumonia
Nasar Nasrullah Khan1, Saeeda Shahid2,3, Asim Hussain Rafila4
1Medicine, Nottingham University Hospitals, Nottingham, GBR.
Abstract:
Background Critically ill adults with gram-negative pneumonia who require invasive mechanical ventilation have a high risk of adverse outcomes and in-hospital mortality. Objective The objective of this study is to determine the in-hospital mortality rate and identify predictors of mortality among intubated and mechanically ventilated adult patients with gram-negative pneumonia. Methods This retrospective cohort study included 178 adult patients with microbiologically confirmed gram-negative pneumonia requiring endotracheal intubation and invasive mechanical ventilation. Demographic characteristics, comorbidities, severity scores, microbiological profile, antimicrobial resistance patterns, laboratory parameters, and clinical outcomes were reviewed. A total of 178 gram-negative isolates were identified. Results The overall in-hospital mortality rate was 76/178 (42.7%). The most frequently isolated pathogens were Acinetobacter baumannii in 58/178 isolates (32.6%), Klebsiella pneumoniae in 47/178 isolates (26.4%), and Pseudomonas aeruginosa in 35/178 isolates (19.7%). Multidrug-resistant organisms were identified in 93/178 patients (52.2%), while carbapenem resistance was observed in 67/178 isolates (37.6%). Non-survivors were significantly older than survivors and had higher APACHE II and Sequential Organ Failure Assessment (SOFA) scores. Septic shock was present in 48/76 non-survivors (63.2%) versus 24/102 survivors (23.5%), multidrug-resistant infection in 51/76 non-survivors (67.1%) versus 42/102 survivors (41.2%), and inappropriate empirical antibiotic therapy in 36/76 non-survivors (47.4%) versus 23/102 survivors (22.5%). Conclusion In-hospital mortality among mechanically ventilated patients with gram-negative pneumonia was high. Advanced age, greater illness severity, septic shock, multidrug-resistant infection, inappropriate empirical antibiotic therapy, hypoalbuminemia, and elevated lactate levels were significant predictors of mortality.
Related Concept Videos
Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
Pneumonia I: Introduction
Pneumonia III: Complications and Assessment
Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Mechanical Ventilation I: Indication and Settings