Ventilator-associated pneumonia in Polish intensive care unit dedicated to COVID-19 patients.

BACKGROUND: Healthcare-Associated Infections (HAI) are most frequently associated with patients in the Intensive Care Unit (ICU). Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), led to ICU hospitalization for some patients. METHODS: The study was conducted in 2020 and 2021 at a hospital in southern Poland. The Healthcare-Associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC) was used for HAI diagnosis. The aim of this case-control study was to retrospectively assess the epidemiology of HAIs in ICU patients, distinguishing between COVID-19 and non-COVID-19 cases. RESULTS: The study included 416 ICU patients: 125 (30%) with COVID-19 and 291 (70%) without COVID-19, p < 0.05. The mortality rate was 80 (64%) for COVID-19 patients and 45 (16%) for non-COVID-19 patients, p < 0.001. Ventilator-Associated Pneumonia (VAP) occurred in 40 cases, with an incidence rate density of 6.3/1000 patient-days (pds): 14.1/1000 pds for COVID-19 patients vs. 3.6/1000 pds for non-COVID-19 patients. Odds Ratio (OR) was 2.297, p < 0.01. Acinetobacter baumannii was the most often isolated microorganism in VAP, with 25 cases (incidence rate 8.5%): 16 (18.2%) in COVID-19 patients vs. 9 (4.4%) in non-COVID-19 patients. OR was 4.814 (1.084-4.806), p < 0.001. CONCLUSIONS: Patients treated in the ICU for COVID-19 faced twice the risk of VAP compared to non-COVID-19 patients. The predominant microorganism in VAP cases was Acinetobacter baumannii.

The effect of subglottic secretion drainage on the incidence of ventilator associated pneumonia.

BACKGROUND: Ventilator-Associated Pneumonia (VAP) is an undesired side effect of mechanical ventilation in intensive care units (ICUs). AIM: We evaluated whether endotracheal tubes with subglottic secretion drainage (SSD) would reduce the incidence of VAP among patients undergoing mechanical ventilation in an ICU. METHODS: The analysis of medical records of patients undergoing mechanical ventilation exceeding 48 h who were hospitalised in ICUs between 2007 and 2014 led to separating two groups of patients: those in whom no subglottic drainage was applied (NSSD) (records dating from 2007-2010) and those whose treatment involved endotracheal tubes with subglottic secretion drainage (SSD) (records dating from 2011-2014). RESULTS: Analysis of 1807 patients hospitalised in ICUs (804 NSSD patients and 1003 SSD patients). A difference was found in the frequency of VAP incidence between the groups (P<0.001). In the NSSD group as many as 84 cases were reported (incidence: 10.7%), and in the SSD group - 43 cases (incidence: 5.2%). The odds ratio (OR) and relative risk (RR) was 2.5. The probability of VAP was significantly higher in the NSSD group. The risk factors of VAP incidence (P<0.001) included the correlation between reintubation (R=0.271), tracheostomy (R=0.309) and bronchoscopy (R=0.316). CONCLUSION: Use of endotracheal tubes with subglottic secretion drainage in patients in the ICU on mechanical ventilation significantly reduced the incidence of VAP.

The risk factors for hospital-acquired pneumonia in the Intensive Care Unit.

INTRODUCTION: Patients in the intensive care units (ICU) are exposed to many factors that may cause hospital acquired pneumonia (HAP), a particular type of which is ventilator-associated pneumonia (VAP). The specific risk factors for developing VAP affect patients already on the day of their admission to a unit and are associated with their underlying diseases and invasive medical procedures, which they undergo. The aim of this study was to evaluate the risk factors for VAP associated with a patient and the used invasive treatment. MATERIAL AND METHODS: 1227 patients were subject to the retrospective analysis. These patients were hospitalized between 2010 and 2014 in Intensive Care Unit (ICU) in the St. Luke District Hospital in Tarnów. Data about procedures used in ICU were obtained from the electronic hospital registration system and the decursus from each day when a patient stayed in the hospital, while information about hospital infections was obtained from the periodic department reports prepared by the Infection Control Team. In the diagnosis of VAP infections the definitions of nosocomial infections issued by CDC (Centers for Disease Control and Prevention) and ECDC (European Center for Disease Prevention and Control) were used. RESULTS: In the analyzed unit, 58 cases of VAP were detected in patents who underwent mechanical ventilation. Infections were more common among men (43 cases, that is 6%) than in women (15 cases, that is 3%). Mechanical ventilation longer than 20 days was a major determinant of VAP (p < 0.001). Patient's underlying diseases (which are the reason for patient's admission to a unit) had an impact on the incidence of VAP, and the most important of them are: multiple trauma (20 cases of VAP per 217 patients (9.2% incidence)), sepsis (3 cases of VAP per 31 patients (9.7% incidence)), central nervous system disease (10 cases of VAP per 124 patients (8.1% incidence)), endocrine system (1 case of VAP per 12 patients (8.3% incidence)), respiratory diseases (11 cases of VAP per 168 patients (6.5% incidence)). Invasive medical procedures performed in the patients' respiratory tract were significant risk factors (p < 0.001) for developing VAP: reintubation (R=0.271), tracheostomy (R=0.309) and bronchoscopy (R=0.316). In the period from 2010 to 2014 VAP incidence was 4.7% and incidence density per 1000 ventilation-days was 10.5 and the mortality rate with VAP was 32.8%. The most common etiological factors of VAP were Acinetobacter Baumannie (21 isolates, that is 36.4%), Pseudomonas aeruginosa (8 isolates, that is 13.8%), Escherichia coli (7 isolates, that is 12%).