VAP患者接受抗生素治疗失败的风险因素

David

Journal of Critical Care
Volume 23, Issue 1, March 2008, Pages 34-40

Theme Issue Editorial
Risk factors for treatment failure in patients with ventilator-associated pneumonia receiving appropriate antibiotic therapy
VAP患者接受抗生素治疗失败的风险因素
Gul Gursel MD, a, , Muge Aydogdu MDa, Ezgi Ozyilmaz MDa and Turkan N. Ozis MDa
aDepartment of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Besevler, Ankara, Turkey

Available online 20 March 2008.

Abstract
Purpose
The aim of this study was to investigate modifiable risk factors and predictors for treatment failure (TF) in patients with ventilator-associated pneumonia (VAP) receiving appropriate antibiotic therapy.

Materials and Methods
An observational cohort study performed in an intensive care unit (ICU) of a University hospital. Eighty-nine patients with VAP were enrolled in the study consecutively. Treatment failure was defined as lack of clinical and microbiological response to therapy within 2 weeks. Potential risk factors for TF, related with patients, microorganisms, and ICU therapies, were evaluated.

Results
Mean age was 72 ± 13 years. Fifty-three of the patients had TF. Patients with TF were older, had more comorbidities, higher admission and Acute Physiology and Chronic Health Evaluation Score (APACHE II)-VAP scores, lower daily carbohydrate intake, and lymphocyte number below 1000/mm3 than the treatment success group. Transfusions, bacteremia, infection with multidrug-resistant microorganisms, initial bacterial load (CFU/mL), and steroid therapy were similar across the groups. Comorbidity (odds ratio [OR], 4.4; 95% CI, 1.2-16.8; P = .030), VAP-APACHE II scores above 16 (OR, 6.4; 95% CI, 2.1-18.6; P = .001), daily carbohydrate intake below 190 g/d (OR, 3; 95% CI,1.1-8.6; P = .038), lymphocyte number below 1000/mm3 (OR, 4.1; 95% CI, 1.3-12.9; P = .014) were independent predictors for TF.

Conclusions
Patients with comorbidities, who are severely ill and lymphocytopenic at the time of VAP diagnosis, are at high risk for TF.