Factors associated with death in intensive care unit patients with ventilator-associated pneumonia

Abstract

Background: The incidence of ventilator-associated pneumonia (VAP) among patients on mechanical ventilation ranges from 15% to 25%, and mortality ranges from 33% to 38%. Aim: The aim of our study was to analyse the importance of previously uninvestigated potential risk factors for death in intensive care unit (ICU) patients with VAP. Methods: A case-control design was chosen for this study. The study population consisted of all patients who developed ventilator-associated pneumonia in the central ICU of a tertiary care hospital (n = 65) during a period of 6 months. Cases (n=45) included patients who died during their treatments in the ICU, if their primary cause of death was ventilator-VAP. Controls (n=20) included patients with VAP who survived their treatments in the ICU and who subsequently were subsequently transferred to other hospital wards. Results: Significant associations were found between death and age over 65 (ORadjusted = 10.66; CI: 1.22, 93.12; p = 0.032), death and infection upon admission to the ICU (ORadjusted = 434.39; CI: 3.07, 61449.65; p = 0.016), and death and administration of ceftriaxone prior to VAP (ORadjusted = 69.32; CI: 1.74, 2768.92; p = 0.024). A synergistic effect on death was found only for age over 65 and infection upon admission to the ICU. Conclusions: ICU patients with VAP experience have increased risk of mortality if they receive ceftriaxone prophylactically, if they have an infection upon admission to the ICU and if their age is advanced.