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Pathogens in Early-Onset and Late-Onset Intensive Care Unit–Acquired Pneumonia

Published online by Cambridge University Press:  02 January 2015

K. M. C. Verhamme ,
W. De Coster ,
L. De Roo ,
H. De Beenhouwer ,
G. Nollet ,
J. Verbeke ,
I. Demeyer  and
P. Jordens
K. M. C. Verhamme*
Affiliation:
Departments of Infection Control and Epidemiology, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium Pharmacoepidemiology Unit, Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
W. De Coster
Affiliation:
Departments of Infection Control and Epidemiology, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium Nutrition, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium
L. De Roo
Affiliation:
Intensive Care, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium
H. De Beenhouwer
Affiliation:
Microbiology, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium
G. Nollet
Affiliation:
Intensive Care, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium
J. Verbeke
Affiliation:
Intensive Care, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium
I. Demeyer
Affiliation:
Intensive Care, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium
P. Jordens
Affiliation:
Departments of Infection Control and Epidemiology, Onze Lieve Vrouw ziekenhuis, Aalst, Belgium
*
Onze Lieve Vrouw ziekenhuis, Department of Infection Control and Epidemiology, Moorselbaan 164, 9300 Aalst, Belgium ([email protected])
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Abstract

Objectives.

To compare the type of pathogens isolated from patients with early-onset intensive care unit (ICU)-acquired pneumonia with those isolated from patients with late-onset ICU-acquired pneumonia and to study risk factors for the isolation of pathogens that are potentially resistant to multiple drugs.

Design.

Prospective cohort study.

Setting.

Patients admitted to the ICU of a 677-bed, university-affiliated teaching hospital in Belgium during 1997-2002.

Methods.

ICU-acquired pneumonia was defined as a case of pneumonia that occurred 2 days or more after admission to the ICU in combination with a positive results of radiologic analysis, clinical signs and symptoms, and a positive culture result. All cases of pneumonia were categorized as either early onset (within 7 days after admission) and late onset (7 days or more after admission), with or without previous antibiotic treatment, and the corresponding pathogens were analyzed. Risk factors for the isolation of pathogens potentially resistant to multiple drugs (ie, Pseudomonas aeruginosa, Serratia marcescens, Enterobacter species, Morganella morganii, methicillin-resistant Stapylococcus aureus, Citrobacter species, Acinetobacter species, Burkholderia species, extended-spectrum β-lactamase–producing pathogens, and Stenotrophomonas maltophilia) were analyzed using logistic regression analysis.

Results.

A total of 4,200 patients stayed at the ICU for 2 or more days, 298 of whom developed ICU-acquired pneumonia, for an overall incidence of 13 cases (95% confidence interval [CI], 11-14 cases) per 1,000 ICU-days. Pathogens potentially resistant to multiple drugs were isolated from 52% of patients with early-onset pneumonia. Risk factors for the isolation of these pathogens were greater age and previous receipt of antibiotic prophylaxis (adjusted odds ratio [aOR], 4.6 [95% CI, 1.6-13.0]) or antibiotic therapy (aOR, 8.2 [95% CI, 2.8-23.8]). The length of ICU admission and hospital stay were weaker risk factors for the isolation of these pathogens.

Conclusions.

Pathogens potentially resistant to multiple drugs were isolated in 52% of cases of early-onset ICU-acquired pneumonia. Previous antibiotic use (both prophylactic and therapeutic) is the main risk factor for the isolation of these pathogens.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 4 , April 2007 , pp. 389 - 397
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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