Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study.

OBJECTIVE: To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU). DESIGN: Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups. SETTING: Four-bed BU, in a referral University Hospital in Spain. PATIENTS: All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded. INTERVENTION: SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU. MAIN VARIABLE OF INTEREST: Incidence of HAIs during the stay in the BU. SECONDARY OUTCOMES: incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints. RESULTS: We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p=0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21-3.82) and 1.13 (0.54-1.73), respectively (p=0.029). CONCLUSIONS: SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.

Nursing care and epidemiological profile of patients with ventilator-associated pneumonia / Cuidados de enfermagem e perfil epidemiológico de pacientes com pneumonia associada à ventilação mecânica / Cuidados de enfermería y perfil epidemiológico de pacientes con neumonía asociada a ventilador

Background and Objectives: to assess the epidemiological profile of patients diagnosed with ventilator-associated pneumonia (VAP) in an Intensive Care Unit (ICU) and to investigate nursing care adequacy. Methods: a quantitative retrospective cohort study, applied in the ICU of a hospital in the countryside of Rio Grande do Sul. It involved 100% of medical records of patients over 20 years of age, in the year 2019, who developed VAP. Results: a total of 3,215 patients were on invasive mechanical ventilation (IMV), and of these 13 developed VAP (2.47%). Most were men (76.92%), with a mean age of 60.3 years, whose main causes of hospitalization were heart problems (30.77%), multiple trauma (30.77%) and stroke (15.39%). The main pathogens found in tracheal aspirates were Acinetobacter sp. (15%) and Pseudomonas aeruginosa (15%). The mean ICU stay was 30.61 days, and 61.53% died. For nursing care assessment, the mean checklist of the VAP bundle applied was calculated, according to the number of days in VMI. The result was 2.62 checklists per day, with the institution recommending four. Conclusion: the study made it possible to know the epidemiological profile of patients with VAP, in addition to observing the need for improvement in nursing care, considering that the checklist completion was below the recommended.(AU)

Justificativa e Objetivos: avaliar o perfil epidemiológico de pacientes diagnosticados com pneumonia associada à ventilação mecânica (PAVM) em Unidade de Terapia Intensiva (UTI) e investigar a adequação dos cuidados de enfermagem. Métodos: estudo quantitativo de coorte, retrospectivo, aplicado na UTI de um hospital do interior do Rio Grande do Sul. Envolveu 100% dos prontuários de pacientes com mais de 20 anos de idade, no ano de 2019, que desenvolveram PAVM. Resultados: estiveram em ventilação mecânica invasiva (VMI) 3.215 pacientes e, desses, 13 desenvolveram PAVM (2,47%). A maioria era homens (76,92%), com média de idade de 60,3 anos, cujas principais causas de internação foram problemas cardíacos (30,77%), politraumatismo (30,77%) e acidente vascular cerebral (15,39%). Os principais patógenos encontrados nos aspirados traqueais foram Acinetobacter sp (15%) e Pseudomonas aeruginosa (15%). A média de permanência na UTI foi de 30,61 dias, e foram a óbito 61,53%. Para avaliação dos cuidados de enfermagem, foi calculada a média de checklist do bundle de PAVM, aplicados, conforme a quantidade de dias em VMI. O resultado foi de 2,62 checklists por dia, sendo que a instituição preconiza quatro. Conclusão: o estudo permitiu conhecer o perfil epidemiológico dos pacientes com PAVM, além de observar a necessidade de melhora nos cuidados de enfermagem, considerando que a realização do checklist ficou abaixo do recomendado.(AU)

Justificación y Objetivos: evaluar el perfil epidemiológico de pacientes con diagnóstico de neumonía asociada a ventilación mecánica (NAVM) en una Unidad de Cuidados Intensivos (UCI) e investigar la adecuación de los cuidados de enfermería. Métodos: estudio de cohorte cuantitativo, retrospectivo, aplicado en el UCI de un hospital del interior de Rio Grande do Sul. Involucró el 100% de las historias clínicas de pacientes mayores de 20 años, en el año 2019, que desarrollaron NAVM. Resultados: un total de 3.215 pacientes estaban en ventilación mecánica invasiva (VMI), y, de estos, 13 desarrollaron NAVM (2,47%). La mayoría eran hombres (76,92%), con una edad media de 60,3 años, cuyas principales causas de hospitalización fueron problemas cardíacos (30,77%), politraumatismos (30,77%) y accidentes cerebrovasculares (15,39%). Los principales patógenos encontrados en los aspirados traqueales fueron Acinetobacter sp (15%) y Pseudomonas aeruginosa (15%). La estancia media en UCI fue de 30,61 días, y falleció el 61,53%. Para la evaluación de la atención de enfermería, se calculó el checklist promedio del bundle VAP aplicado, de acuerdo con el número de días en VMI. El resultado fue de 2,62 checklists por día, y la institución recomendó cuatro. Conclusión: el estudio posibilitó conocer el perfil epidemiológico de los pacientes con NAVM, además de observar la necesidad de mejoría en la atención de enfermería, considerando que el llenado del checklist estuvo por debajo de lo recomendado.(AU)

Stress ulcer prophylaxis for critically ill children: routine use needs to be re-examined.

INTRODUCTION: Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). Our aim was to assess the usefulness of SUP with omeprazole in critically ill children. PATIENTS AND METHODS: We conducted a randomized, controlled open-label trial, including 144 children admitted into a PICU with a paediatric Sequential Organ Failure Assessment (pSOFA) score of less than 16. We randomly allocated patients to SUP with omeprazole or no SUP. The primary outcome was development of upper gastrointestinal bleeding or nosocomial infection. RESULTS: The incidence of gastrointestinal bleeding was 27.1%, but clinically significant bleeding developed in only 5.6% of patients. We did not find a significant difference in the incidence of bleeding between the prophylaxis and control groups (27.8% vs 26.4%; P = .85). We also did not find a significant difference between the groups in the incidence of ventilator-associated pneumonia (VAP) (9.6% vs 8.3%; P = .77). The incidence of central line-associated bloodstream infection (CLABSI) was higher in the prophylaxis group compared to the control group (30.6% vs 12.5%; P = .014). None of the patients developed Clostridium difficile-associated diarrhoea. We did not find significant differences in mortality, length of PICU stay or duration of mechanical ventilation. Mechanical ventilation was an independent predictor of bleeding (OR, 6.4; 95%CI, 2.73-14.9). CONCLUSION: In PICU patients with mild to moderate organ dysfunction, omeprazole does not seem to be useful for prevention of gastrointestinal bleeding while at the same time increasing the risk of CLABSI. Thus, we recommend restricting SUP to mechanically ventilated children.

Profilaxis de las úlceras de estrés en niños críticos: necesidad de replantear su uso rutinario / Stress ulcer prophylaxis for critically ill children: Routine use needs to be re-examined

Introducción:La profilaxis de las úlceras por estrés (PUE) se utiliza comúnmente en las Unidades de Cuidados Intensivos Pediátricos (PICU). Sin embargo, no hay pruebas sólidas que apoyen esta práctica y se necesitan urgentemente ensayos clínicos controlados aleatorios (ECCA) pediátricos. Nuestro objetivo fue evaluar el valor de la PUE con omeprazol en pacientes críticos pediátricos.Pacientes y métodos:Ensayo controlado aleatorizado abierto, con inclusión de 144 niños ingresados en la UCI con una puntuación en la escala pediátrica de evaluación del fallo multiorgánico secuencial (pSOFA) inferior a 16. Los pacientes fueron asignados al azar a recibir omeprazol para el PUE o a no recibir profilaxis. La variable de resultado principal fue el desarrollo de hemorragia digestiva alta o infecciones nosocomiales.Resultados:La frecuencia de hemorragia gastrointestinal fue del 27,1%, aunque solo desarrollaron hemorragia clínicamente significativa el 5,6% de los pacientes. No se observaron diferencias significativas en la incidencia de hemorragia entre los grupos de profilaxis y de control (27,8 vs. 26,4%; p = 0,85). Tampoco surgieron diferencias significativas en la incidencia de la neumonía asociada al ventilador (NAV) entre ambos grupos (9,6 vs. 8,3%; p = 0,77). La incidencia de bacteriemia asociada a catéter venoso central (BACVC) fue mayor en el grupo de profilaxis en comparación con el grupo de control (30,6 vs. 12,5%; p = 0,014). Ningún paciente desarrolló diarrea por Clostridium difficile. No se encontraron diferencias significativas en la tasa de mortalidad, la duración de la estancia en la UCIP o la duración de la ventilación mecánica. La ventilación mecánica fue un predictor independiente de hemorragia (OR 6,4; IC 95%: 2,73-14,9). (AU)

Introduction:Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). Our aim was to assess the usefulness of SUP with omeprazole in critically ill children.Patients and methods:We conducted a randomized, controlled open-label trial, including 144 children admitted into a PICU with a paediatric Sequential Organ Failure Assessment (pSOFA) score of less than 16. We randomly allocated patients to SUP with omeprazole or no SUP. The primary outcome was development of upper gastrointestinal bleeding or nosocomial infection. Results:The incidence of gastrointestinal bleeding was 27.1%, but clinically significant bleeding developed in only 5.6% of patients. We did not find a significant difference in the incidence of bleeding between the prophylaxis and control groups (27.8 vs. 26.4%; p = 0.85). We also did not find a significant difference between the group in the incidence of ventilator-associated pneumonia (VAP) (9.6 vs. 8.3%; p = 0.77). The incidence of central line-associated bloodstream infection (CLABSI) was higher in the prophylaxis group compared to the control group (30.6% vs. 12.5%; p = 0.014). None of the patients developed Clostridium difficile-associated diarrhoea. We did not find significant differences in mortality, length of PICU stay or duration of mechanical ventilation. Mechanical ventilation was an independent predictor of bleeding (OR 6.4; 95% CI, 2.73-14.9). (AU)

Influencia de un panel molecular de reacción de polimerasa en cadena múltiple en el diagnóstico o descarte de neumonía asociada a ventilación mecánica en una cohorte chilena de pacientes críticos con COVID-19

Resumen Introducción: La neumonía asociada a ventilación mecánica (NAVM) es frecuente en pacientes críticos con COVID-19. Su diagnóstico precoz es fundamental para su pronóstico. Objetivo: Demostrar la utilidad del panel FilmArray Pneumo (PFA-P) en la confirmación o descarte de NAVM en estos pacientes. Métodos: Estudio retrospectivo de 71 pacientes críticos con COVID-19 con sospecha de NAVM en quienes se realizó cultivos y PFA-P para confirmación diagnóstica. Se describen las características clínicas, microbiología y mortalidad. Se define la validez y seguridad de PFA-P. Resultados: El uso de FAP-P y cultivos descartó NAVM en 29 pacientes (40,8%). En 41 pacientes se confirmó NAVM y la mortalidad a 30 días fue 48,8%. Se estudiaron 48 muestras, los cultivos fueron positivos en 30 (62,5%) y se detectaron 33 bacterias, PFA-P detectó 32 de estas 33 bacterias; 37 bacterias fueron detectadas exclusivamente por PFA-P. Las bacterias prevalentes fueron Klebsiella pneumoniae (31,4%) Pseudomonas aeruginosa (21,4%) y Acinetobacter calcoaceticusbaumannii (14,2%). La sensibilidad, especificidad, valor predictor positivo y valor predictor negativo de PFA-P con respecto a cultivos fue 96,9%, 92,5%, 46,4% y 99,8, respectivamente. Un paciente tuvo NAVM por Burkholderia cepacia bacteria no detectada por FAP-P. Conclusiones: La FAP-P es una técnica molecular eficaz para descartar y diagnosticar la NAVM permitiendo una suspensión rápida de los antimicrobianos o un tratamiento dirigido temprano.

Abstract Background: Ventilator-associated pneumonia (VAP) is frequent in critical COVID-19 patients. Its early diagnosis is essential for its prognosis. Aim: To demonstrate the usefulness of the FilmArray Pneumo panel (FAP-P) in confirming or ruling out VAP in these patients. Methods: Retrospective study of 71 critical COVID-19 patients with suspected VAP in whom cultures and FAP-P were performed for diagnostic confirmation. Clinical characteristics, microbiology and mortality are described. The validity and safety of FAP-P is defined. Results: The use of FAP-P and cultures ruled out VAP in 29 patients (40.8%). In 41 patients, VAP was confirmed and the 30-day mortality was 48.8%. Forty-eight samples were studied, the cultures were positive in 30 (62.5%) and 33 bacteria were detected, FAP-P detected 32 of these 33 bacteria; 37 bacteria were exclusively detected by PFA-P. The most prevalent bacteria were Klebsiella pneumoniae (31.4%), Pseudomonas aeruginosa (21.4%) and Acinetobacter calcoaceticus-baumannii (14.2%). The sensitivity, specificity, positive predictive value and negative predictive value of FAP-P with respect to cultures were 96.9%, 92.5%, 46.4% and 99.8%, respectively. One patient had VAP due to Burkholderia cepacia bacteria not detected by FAP-P. Conclusions: FAP-P is an effective molecular technique to rule out and diagnose VAP, allowing rapid suspension of antibiotics or early targeted treatment.

Relação entre pneumonia associada à ventilação mecânica e a permanência em unidade de terapia intensiva / Relación entre neumonía asociada a ventilación mecánica y permanencia en una unidad de cuidados intensivos / Relationship between ventilator-associated pneumonia and permanence in an intensive care unit

Objetivo: Analisar a relação de incidência de Pneumonia associada à ventilação mecânica (PAV) com o aumento da média de permanência em pacientes de terapia intensiva. Método: Pesquisa quantitativa, retrospectiva, descritiva e documental. Realizada em duas UTIs de um Hospital Universitário no Estado do Paraná. A amostra foi composta por 2503 pacientes, no período de janeiro de 2017 a junho de 2019. Resultados: A maioria dos pacientes era do sexo masculino 58,7% (n=1471). Verificou-se forte poder estatístico, p valor de 0,0001, evidenciando que a PAV aumentou o tempo de internação, ou seja, o desenvolvimento de PAV gera uma permanência maior na UTI. O desfecho, 74,19% receberam alta e 25,81% evoluíram para óbito. Conclusão: Os dados apontaram para uma relação estatisticamente comprovada entre a PAV e o acréscimo do tempo de internação nas UTIs, o que acarreta o aumento dos riscos de morbimortalidade e altos custos na hospitalização.(AU)

Objective: To analyze the relationship between the incidence of Ventilator-associated pneumonia (VAP) and the increase in the average length of stay in intensive care patients. Method: Quantitative, retrospective, descriptive and documentary research. Carried out in two ICUs of a University Hospital in the State of Paraná. The sample consisted of 2503 patients, from January 2017 to June 2019. Results: Most patients were male 58.7% (n=1471). There was a strong statistical power, p value of 0.0001, showing that the VAP increased the length of stay, that is, the development of VAP generates a longer stay in the ICU. The outcome, 74.19% were discharged and 25.81% evolved to death. Conclusion: The data pointed to a statistically proven relationship between VAP and increased length of stay in the ICUs, which leads to increased risks of morbidity and mortality and high hospitalization costs.(AU)

Objetivo: Analizar la relación entre la incidencia de neumonía asociada a ventilador (NAV) y el aumento de la estancia media en pacientes de cuidados intensivos. Método: Investigación cuantitativa, retrospectiva, descriptiva y documental. Realizado en dos UCI de un Hospital Universitario del Estado de Paraná. La muestra estuvo constituida por 2503 pacientes, de enero de 2017 a junio de 2019. Resultados: La mayoría de los pacientes fueron hombres 58,7% (n = 1471). Hubo un fuerte poder estadístico, valor de p de 0,0001, mostrando que la NAV aumentó la estancia, es decir, el desarrollo de NAV genera una estancia más prolongada en la UCI. El resultado, 74,19% fueron dados de alta y 25,81% evolucionaron a muerte. Conclusión: Los datos apuntan a una relación estadísticamente probada entre NAV y mayor tiempo de estancia en UCI, lo que conduce a mayores riesgos de morbilidad y mortalidad y altos costos de hospitalización.(AU)

[Stress ulcer prophylaxis for critically ill children: Routine use needs to be re-examined]. / Profilaxis de las úlceras de estrés en niños críticos: necesidad de replantear su uso rutinario.

INTRODUCTION: Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). Our aim was to assess the usefulness of SUP with omeprazole in critically ill children. PATIENTS AND METHODS: We conducted a randomized, controlled open-label trial, including 144 children admitted into a PICU with a paediatric Sequential Organ Failure Assessment (pSOFA) score of less than 16. We randomly allocated patients to SUP with omeprazole or no SUP. The primary outcome was development of upper gastrointestinal bleeding or nosocomial infection. RESULTS: The incidence of gastrointestinal bleeding was 27.1%, but clinically significant bleeding developed in only 5.6% of patients. We did not find a significant difference in the incidence of bleeding between the prophylaxis and control groups (27.8 vs. 26.4%; p = 0.85). We also did not find a significant difference between the group in the incidence of ventilator-associated pneumonia (VAP) (9.6 vs. 8.3%; p = 0.77). The incidence of central line-associated bloodstream infection (CLABSI) was higher in the prophylaxis group compared to the control group (30.6% vs. 12.5%; p = 0.014). None of the patients developed Clostridium difficile-associated diarrhoea. We did not find significant differences in mortality, length of PICU stay or duration of mechanical ventilation. Mechanical ventilation was an independent predictor of bleeding (OR 6.4; 95% CI, 2.73-14.9). CONCLUSION: In PICU patients with mild to moderate organ dysfunction, omeprazole does not seem to be useful for prevention of gastrointestinal bleeding while at the same time increasing the risk of CLABSI. Thus, we recommend restricting SUP to mechanically ventilated children.

Factores de riesgo para infección por pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica de la unidad de cuidados intensivos. Estudio multicéntrico / Risk factors for multi-resistant aeruginous pseudomonas infection in patients with pneumonia associated with mechanical ventilation of the intensive care unit. Multicentric study

Objetivo:Determinar los factores de riesgo de infección para Pseudomonas aeruginosa multirresistente en pacientes con Neumonía asociada a ventilación de la unidad de cuidados intensivos.:Serealizóunestudioobservacional,analítico, MaterialyMétodosretrospectivo, de casos y controles en el cual se seleccionaron mediante aleatorización simple 84 historias clínicas de pacientes con edad ≥ 18 años, con diagnóstico de neumonía asociada a ventilación mecánica en el Hospital Alta Complejidad Virgen de la Puerta (HACVP) y Hospital Belén de Trujillo (HBT) durante el periodo de enero-2014 a diciembre-2019. En el análisis de datos se utilizó la prueba Chi-cuadrado para determinar la significancia estadística de asociación en las variables de estudio. :La edad, uso de antibioticoterapia previa Resultadosde amplio espectro, uso de sonda vesical, tiempo de uso de sonda vesical y postoperado de cirugía abdominal, se asociaron significativamente (P<0,05) a infección por Pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica de la unidad de cuidados intensivos. El tiempo de exposición de sonda vesical es factor de riesgo para infección por Pseudomonas aeruginosa multirresistente (p<0.001). : El Conclusionestiempo de uso de sonda vesical por más de 7 días sin recambio de sonda es un factor de riesgo para infección por Pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica.

Objective:Determine the risk factors for multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with mechanical ventilation in the intensive care unit. :An observational, analytical, retrospective, case-control Material and Methodsstudy was carried out in which 84 medical records of patients aged ≥ 18 years with a diagnosis of ventilator-associatedpneumoniawereselectedbysimplerandomizationattheAlta Complejidad Hospital Virgen de la Puerta (HACVP) and Hospital Belén de Trujillo (HBT) during the period from January-2014 to December-2019. In the data analysis, the Chi-square test was used to determine the statistical significance of association in the study variables. :ResultsAge, use of prior broad-spectrum antibiotic therapy, use of urinary catheter, time of urinary catheter use, and postoperative abdominal surgery were significantly associated (P<0,05) with multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with intensive care unit mechanical ventilation. Urinary catheter exposure time is a risk factor for multidrug-resistant Pseudomonas aeruginosa infection (p <0.001). :The time Conclusionsof use of the urinary catheter for more than 7 days without change the catheter is a risk factor for infection by multidrug-resistant Pseudomonas aeruginosa in patients with pneumonia associated with mechanical ventilation.

Factores de riesgo para infección por pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica de la unidad de cuidados intensivos. Estudio multicéntrico / Risk factors for multi-resistant aeruginous pseudomonas infection in patients with pneumonia associated with mechanical ventilation of the intensive care unit. Multicentric study

RESUMEN Objetivo: Determinar los factores de riesgo de infección para Pseudomonas aeruginosa multirresistente en pacientes con Neumonía asociada a ventilación de la unidad de cuidados intensivos. Material y Métodos: Se realizó un estudio observacional, analítico, retrospectivo, de casos y controles en el cual se seleccionaron mediante aleatorización simple 84 historias clínicas de pacientes con edad ≥ 18 años, con diagnóstico de neumonía asociada a ventilación mecánica en el Hospital Alta Complejidad Virgen de la Puerta (HACVP) y Hospital Belén de Trujillo (HBT) durante el periodo de enero-2014 a diciembre-2019. En el análisis de datos se utilizó la prueba Chi-cuadrado para determinar la significancia estadística de asociación en las variables de estudio. Resultados: La edad, uso de antibioticoterapia previa de amplio espectro, uso de sonda vesical, tiempo de uso de sonda vesical y postoperado de cirugía abdominal, se asociaron significativamente (P<0,05) a infección por Pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica de la unidad de cuidados intensivos. El tiempo de exposición de sonda vesical es factor de riesgo para infección por Pseudomonas aeruginosa multirresistente (p<0.001). Conclusiones: El tiempo de uso de sonda vesical por más de 7 días sin recambio de sonda es un factor de riesgo para infección por Pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica.

ABSTRACT Objective: Determine the risk factors for multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with mechanical ventilation in the intensive care unit. Material and Methods: An observational, analytical, retrospective, case-control study was carried out in which 84 medical records of patients aged ≥ 18 years with a diagnosis of ventilator-associated pneumonia were selected by simple randomization at the Alta Complejidad Hospital Virgen de la Puerta (HACVP) and Hospital Belén de Trujillo (HBT) during the period from January-2014 to December-2019. In the data analysis, the Chi-square test was used to determine the statistical significance of association in the study variables. Results: Age, use of prior broad-spectrum antibiotic therapy, use of urinary catheter, time of urinary catheter use, and postoperative abdominal surgery were significantly associated (P <0,05) with multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with intensive care unit mechanical ventilation. Urinary catheter exposure time is a risk factor for multidrug-resistant Pseudomonas aeruginosa infection (p <0.001). Conclusions: The time of use of the urinary catheter for more than 7 days without change the catheter is a risk factor for infection by multidrug-resistant Pseudomonas aeruginosa in patients with pneumonia associated with mechanical ventilation.

Factores predisponentes que conllevan a los pacientes a una neumonía asociada ventilación mecánica de la unidad de cuidados intensivos del hospital Teodoro Maldonado Carbo. Periodo 2018 ­ 2019 / Predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado carbo hospital's intensive care unit. period 2018 ­ 2019

Hay varios factores de riesgo que pueden conllevar a una neumonía asociada a ventilación mecánica, tanto intrínseco como extrínseco, y el porcentaje de la neumonía asociada a ventilación mecánica va en aumento, por lo que el personal médico tiene una dura lucha para tratar de disminuir esta problemática. Objetivo: Determinar los factores predisponentes que conllevan a los pacientes a una neumonía asociada a la ventilación mecánica en la Unidad de Cuidados Intensivos del Hospital Teodoro Maldonado Carbo durante el periodo 2018 ­ 2019. Materiales y Métodos: paradigma positivista, enfoque cuantitativo; de modalidad de campo, no experimental. De tipo descriptivo y transversal. La población fue 285 pacientes y la muestra de 60, seleccionado de manera probabilística y sistemático. La técnica fue la encuesta y el instrumento el cuestionario con 15 ítems, revisados y validados por juicios de expertos en el tema, que dieron una confiabilidad de 95%. Resultados: Se evidenció que los factores predominantes, que aumentan los riesgos de padecer una NAVM son elementos de tipo Extrínseco, entre ellos los más comunes son: intubación prolongada, re intubaciones, aspiraciones de secreciones y el traslado del paciente. Mientras que los del factor intrínseco son: desnutrición, edad y etnia. Conclusión: se evidenció la importancia de un diagnóstico oportuno y seguir las normas de bioseguridad establecidas antes, durante y después del proceso de entubación como mecanismo de disminución de probabilidad de que el paciente desarrolle un NAVM(au)

There are several risk factors can lead to pneumonia associated with mechanical ventilation both, intrinsic and extrinsic, and the percentage of pneumonia associated with mechanical ventilation is increasing, which is why medical personnel have a tough fight to try to reduce this problem. Objective: To determine the predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado Carbo Hospital's Intensive Care Unit during the period 2018 - 2019. Materials and Methods: positivist paradigm, quantitative approach; field modality, not experimental. Descriptive and transversal. The population was 285 patients and the sample of 60, selected in a probabilistic and systematic way. The technique was the survey and the instrument was the questionnaire with 15 items, reviewed and validated by expert judgments on the subject, which gave a reliability of 95%. Results: It was evident that the predominant factors that increase the risks of suffering from AVM are extrinsic elements, among them the most common are prolonged intubation, re-intubations, aspiration of secretions and the transfer of the patient. While those of the intrinsic factor are malnutrition, age and ethnicity. Conclusion: the importance of a timely diagnosis and following the biosafety standards established before, during and after the intubation process was evidenced as a mechanism to decrease the probability that the patient develops a VAP(AU)

Adesão ao bundle para prevenção de pneumonia associada à ventilação mecânica em terapia intensiva / Adherence to the bundle for prevention of pneumonia associated with mechanical ventilation in intensive care / Adhesión del paquete de atención para prevenir la neumonía asociada al ventilador en la unidad de cuidados intensivos

Introdução: Pacientes internados em ambientes de terapia intensiva podem vir a apresentar pneumonia associada à ventilação mecânica e com expressivas taxas de morbimortalidade. Pacotes de cuidados ou bundles atualmente estão sendo utilizados como estratégia terapêutica no tratamento. Objetivo: Verificar adesão ao bundle de pneumonia associada à ventilação mecânica em terapia intensiva. Método: Transversal com delineamento descritivo, abordagem quantitativa, do tipo analítico e correlação entre variáveis, realizado em duas unidades de terapia intensiva adulto de um hospital de ensino, por meio de checklist elaborado pelo serviço de controle de infecção hospitalar. A amostragem foi não probabilística em sequência, no período de abril a novembro de 2019. Resultados: A maior faixa etária foi de 61 a 80 anos. Os pacientes que ficaram internados até 10 dias, em terapia intensiva, foram 50% e 31% ficaram entre 11 a 20 dias. O tempo de ventilação mecânica foi de até 10 dias em 66%. De 400 pacientes, 54% morreram e 46% receberam alta para a unidade de internação. Nos meses de março e abril, a porcentagem de não conformidades na variável "Cabeceira Elevada" e "Higiene Oral" foi maior em relação aos demais meses, e o período da noite foi o que teve maior adesão ao checklist. A variável "Oportunidades de Verificação do Cuff" foi uma não conformidade que se manteve alta durante todo o período estudado. A "Interrupção de Sedação diária" apresentou baixas não conformidades e depois caiu para zero. Conclusão: Não houve adesão total ao bundle de pneumonia associada à ventilação mecânica, sendo que o período que mais estava em conformidade foi o noturno, entretanto, em todos os turnos houve não conformidades, indicando a necessidade de intervenção do gestor de enfermagem e serviço de educação permanente para melhorar a adesão dos profissionais envolvidos.(AU)

Introduction: Patients hospitalized in intensive care environments may present pneumonia associated with mechanical ventilation and with expressive morbidity and mortality rates. Care packages or bundles are currently being used as a therapeutic strategy in treatment. Objective: To verify adherence to pneumonia blister associated with mechanical ventilation in intensive care. Method: Cross-sectional with descriptive design, quantitative approach, analytical type and correlation between variables, performed in two adult intensive care units of a teaching hospital, by means of checklist elaborated by the hospital infection control service. The sampling was non-probabilistic in sequence, from April to November 2019. Results: The largest age group was 61 to 80 years. The patients who remained hospitalized for up to 10 days in intensive care were 50% and 31% were between 11 and 20 days. Mechanical ventilation time was up to 10 days in 66%. Of 400 patients, 54% died and 46% were discharged to the hospital. In the months of March and April, the percentage of non-conformities in the variable "High Head" and "Oral Hygiene" was higher in relation to the other months, and the period of the night was the one that had greater adherence to checklist. The variable "Cuff Verification Opportunities" was a non-conformity that remained high throughout the study period. The "Daily Interruption of Sedation" showed low non-conformities and then dropped to zero. Conclusion: There was no total adhesion to pneumonia bundle associated with mechanical ventilation, and the period that was most in accordance was the night, however, in all shifts there were nonconformities, indicating the need for intervention of the nursing manager and permanent education service to improve the adherence of the professionals involved.(AU)

Introducción: Los pacientes hospitalizados en cuidados intensivos pueden experimentar neumonía asociada con la ventilación mecânica, con tasas significativas de morbilidad y mortalidad. Los paquetes o paquetes de ayuda se utilizan actualmente como estrategia terapéutica en el tratamiento. Objetivo: Verificar la adherencia al paquete de neumonía asociada a la ventilación mecánica en cuidados intensivos. Método: Transversal con diseño descriptivo, abordaje cuantitativo, tipo analítico y correlación entre variables, realizado en dos unidades de cuidados intensivos de adultos de un hospital docente, mediante un checklist elaborado por el servicio de control de infecciones del hospital. El muestreo fue secuencial no probabilístico, de abril a noviembre.(AU)

Ventilator-associated pneumonia in patients with cerebral hemorrhage: Impact on mortality and microbiological characterization.

Ventilator-associated pneumonia (VAP) is a major complication among critically ill patients who depend on mechanical ventilation. Few reports have focused on intracerebral hemorrhage patients with VAP. Our main objective was to investigate the bacteria distribution characteristics and the impact of ventilator-associated pneumonia mortality in critical cerebral hemorrhage patients. This retrospective study included 89 cases of cerebral hemorrhage patients with VAP admitted to the ICU of Huashan Hospital. We used the chi-square test to compare qualitative variables and Student's t-test to compare means between groups of normally distributed quantitative variables. Multiple logistic regression analysis was used to assess mortality-independent predictors in the ICU. A total of 42% patients with cerebral hemorrhage were diagnosed with VAP in the ICU during the study period, and the mortality rate was 18%. Acinetobacter baumannii (n=58), Klebsiella pneumoniae (n=52), and Pseudomonas aeruginosa (n=21) were the most common pathogenic bacteria. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were independent factors associated with increased mortality. Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the time from bleeding to intubation were other potentially important factors. While the number of infecting bacteria may not be directly related to death, it can increase antibiotic consumption and length of intensive care unit (ICU) stays. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were directly related to the death of critical cerebral hemorrhage patients with ventilator-associated pneumonia.

Comportamiento de neumonía asociada a ventilación mecánica en cuidados intensivos de adultos / Behavior of mechanic ventilator-associated pneumonia in adult at intensive care

Introducción: las neumonías asociadas a la ventilación causan grandes inquietudes a los médicos que plantean serias dificultades diagnósticas las que a su vez motivan a menudo la toma de decisiones terapéuticas desproporcionadas que favorecen la génesis de la resistencia antimicrobiana. Objetivo: valorar el comportamiento de la neumonía asociada a la ventilación mecánica como indicador de calidad asistencial en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente Octavio de la Concepción y de la Pedraja de Baracoa entre enero-diciembre de 2015. Método: se realizó un estudio descriptivo transversal. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. Resultados: las enfermedades de base que más incidieron fueron las enfermedades cerebrovasculares seguidas por distrés respiratorio y sepsis severa. En los primeros nueve días fue que aparecieron los síntomas. Se obtuvo mayor aislamiento de gérmenes Gram negativo. Conclusiones: el comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcus epidermidis y la Klebsiellap neumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes(AU)

Introduction: pneumonias associated with ventilation cause great concern to physicians who pose serious diagnostic difficulties which in turn often motivate the making of disproportionate therapeutic decisions that favor the genesis of antimicrobial resistance. Objective: assess the behavior of pneumonia associated with mechanical ventilation as an indicator of quality of care in the Unit of Intensive Adult Therapy of the General Teaching Hospital Octavio de la Concepción y de la Pedraja of Baracoa between January-December 2015. Method: a cross-sectional descriptive study was carried out. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. Results: the underlying diseases that most affected were cerebrovascular diseases followed by respiratory distress and severe sepsis. In the first nine days, the symptoms appeared. Greater isolation of Gram negative germs was obtained. Conclusions: the behavior of the pneumonias associated to ventilation was given in the male sex, older than 60 years, they were associated with a greater frequency to the cerebrovascular diseases, in the majority the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellap pneumoniae were the germs that were most frequently isolated in these patients(AU)

Introdução: as pneumonias associadas à ventilação são motivo de grande preocupação para os médicos que apresentam sérias dificuldades diagnósticas, que por sua vez, muitas vezes motivam a tomada de decisões terapêuticas desproporcionais que favorecem a gênese da resistência antimicrobiana. Objetivo: avaliar o comportamento da pneumonia associada à ventilação mecânica como um indicador de qualidade de atendimento na Unidade de Terapia Intensiva de Adultos do Hospital Geral de Ensino Octavio de la Concepción y de la Pedraja de Baracoa entre janeiro-dezembro de 2015. Método: foi realizado um estudo descritivo transversal. De um universo de 67 pacientes, uma amostra de 27 pacientes foi tomada pelo método aleatório simples, que desenvolveu essa doença associada à ventilação de acordo com as faixas etárias, sexo, condições que levaram ao seu uso, tempo de início dos sintomas e resultados microbiológicos. Resultados: as doenças de base que mais afetaram foram as doenças cerebrovasculares, seguidas de desconforto respiratório e sepse grave. Nos primeiros nove dias, os sintomas apareceram. Maior isolamento de germes Gram negativos foi obtido. Conclusões: o comportamento das pneumonias associadas à ventilação foi dado no sexo masculino, com idade superior a 60 anos, foram associadas com maior frequência às doenças cerebrovasculares, na maioria os sintomas apareceram entre 4 e 6 dias; Staphylococcus epidermidis e Klebsiellap pneumoniae foram os germes mais freqüentemente isolados nesses pacientes(AU)

Impacto de las Neumonías Asociadas a la Ventilación Mecánica en la Mortalidad en una Unidad de Cuidados Intensivos Adultos

RESUMEN Introducción: La neumonía asociada a la ventilación mecánica (NAVM)representa la infección hospitalaria más frecuente, asociándose con una elevada tasa de mortalidad, morbilidad y costos. El objetivo del estudio fue determinar la incidencia, los microorganismos aislados y la mortalidad en pacientes que presentaron neumonía asociada a Ventilación mecánica (NAVM). Métodos: Estudio descriptivo, retrospectivo con enfoque cuantitativo de pacientes internados en la Unidad de Cuidados Intensivos de Adultos (UCIA), del hospital de Clínicas en los años 2015-2016. Fueron incluidos todos los pacientes con criterios de neumonía asociada a la ventilación mecánica (NAVM). Los datos se obtuvieron de la vigilancia activa y selectiva. Resultados: Durante el periodo de estudio 877 pacientes ingresaron a la UCIA y requirieron Asistencia Respiratoria Mecánica 809 (92.2%). La tasa de incidencia de NAVM fue de 16,7/ 1.000 días de Ventilación Mecánica. Los microorganismos más frecuentes aislados en NAVM, fueron A. baumannii complex 30% (35/113), P. aeruginosa 29% (33/113) y K. pneumoniae 23% (15/113). El 91% (32/35) de Acinetobacter spp, el 87% (29/33) de P. aeruginosa y el 58% (15/26) de las K. pneumoniae fueron multirresistentes. La mortalidad fue significativamente más elevada en los pacientes que desarrollaron NACM (52,3% vs 31,3%, p<0,0002; OR=2,5 (1,5 - 4,1). Conclusiones: La tasa de incidencia de NAVM fue elevada. Los microorganismos causantes de las neumonías asociadas a la ventilación mecánica fueron los bacilos Gram negativos, con una elevada frecuencia de gérmenes multi-resistentes. La mortalidad asociada a NAVM fue significativamente superior que en aquellos pacientes que no desarrollaron NAVM.

ABSTRACT Introduction: Pneumonia associated with mechanical ventilation (VAP) represents the most common hospital infection, associated with a high mortality, morbidity and costs. The objective of the study was to determine the incidence, isolated microorganisms and the mortality in pneumonia associated with mechanical ventilation (VAP). Methods: A descriptive with analytical component, retrospective study with a quantitative approach of patients admitted to the Adult Intensive Care Unit (AICU) of the Hospital de Clínicas in the years 2015-2016. All patients were included with criteria of pneumonia associated with mechanical ventilation (VAP). The data was obtained from active and selective surveillance. Results: During the study period, 877 patients were admitted at the AICU, of which 809 patients required 809 (92,2%) Mechanical Respiratory Assistance. The VAP was 16,7 / 1,000 days of Mechanical Ventilation. The most frequent microorganisms isolated were A. baumannii complex 30% (35/113),P. aeruginosa 29% (33/113) and K. pneumoniae 23% (15/113), and 91% (32/35) of Acinetobacter spp, 87% (29/33) of P. aeruginosa and 58% (15/26) of K. pneumoniae were multiresistant. The mortality was significantly higher in the patients with NAVM (52,3% vs 31,3%) (p<0,0002; OR=2,5 (1,5 - 4,1). Conclusions: The incidence rate of VAP was high. The Gram-negative bacilli were the most frequent microorganisms isolated. The study determined a high frequency of multi-resistant microorganism. The mortality associated with VAP was significantly higher than in those patients who did not develop VAP.

Comportamiento de neumonía asociada a ventilación mecánica en cuidados intensivos de adultos / Comportamento de pneumonia associado à ventilação mecãnica em terapia intensiva de adultos / Behavior of mechanic ventilator-associated pneumonia in adult at intensive care

Introducción: las neumonías asociadas a la ventilación causan grandes inquietudes a los médicos que plantean serias dificultades diagnósticas las que a su vez motivan a menudo la toma de decisiones terapéuticas desproporcionadas que favorecen la génesis de la resistencia antimicrobiana. Objetivo: valorar el comportamiento de la neumonía asociada a la ventilación mecánica como indicador de calidad asistencial en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente Octavio de la Concepción y de la Pedraja de Baracoa entre enero-diciembre de 2015. Método: se realizó un estudio descriptivo transversal. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. Resultados: las enfermedades de base que más incidieron fueron las enfermedades cerebrovasculares seguidas por distrés respiratorio y sepsis severa. En los primeros nueve días fue que aparecieron los síntomas. Se obtuvo mayor aislamiento de gérmenes Gram negativo. Conclusiones: el comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcus epidermidis y la Klebsiellap neumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes(AU)

Introduction: pneumonias associated with ventilation cause great concern to physicians who pose serious diagnostic difficulties which in turn often motivate the making of disproportionate therapeutic decisions that favor the genesis of antimicrobial resistance. Objective: assess the behavior of pneumonia associated with mechanical ventilation as an indicator of quality of care in the Unit of Intensive Adult Therapy of the General Teaching Hospital "Octavio de la Concepción y de la Pedraja" of Baracoa between January-December 2015. Method: a cross-sectional descriptive study was carried out. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. Results: the underlying diseases that most affected were cerebrovascular diseases followed by respiratory distress and severe sepsis. In the first nine days, the symptoms appeared. Greater isolation of Gram negative germs was obtained. Conclusions: the behavior of the pneumonias associated to ventilation was given in the male sex, older than 60 years, they were associated with a greater frequency to the cerebrovascular diseases, in the majority the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellap pneumoniae were the germs that were most frequently isolated in these patients(AU)

Introdução: as pneumonias associadas à ventilação são motivo de grande preocupação para os médicos que apresentam sérias dificuldades diagnósticas, que por sua vez, muitas vezes motivam a tomada de decisões terapêuticas desproporcionais que favorecem a gênese da resistência antimicrobiana. Objetivo: avaliar o comportamento da pneumonia associada à ventilação mecânica como um indicador de qualidade de atendimento na Unidade de Terapia Intensiva de Adultos do Hospital Geral de Ensino "Octavio de la Concepción y de la Pedraja" de Baracoa entre janeiro-dezembro de 2015. Método: foi realizado um estudo descritivo transversal. De um universo de 67 pacientes, uma amostra de 27 pacientes foi tomada pelo método aleatório simples, que desenvolveu essa doença associada à ventilação de acordo com as faixas etárias, sexo, condições que levaram ao seu uso, tempo de início dos sintomas e resultados microbiológicos. Resultados: as doenças de base que mais afetaram foram as doenças cerebrovasculares, seguidas de desconforto respiratório e sepse grave. Nos primeiros nove dias, os sintomas apareceram. Maior isolamento de germes Gram negativos foi obtido. Conclusões: o comportamento das pneumonias associadas à ventilação foi dado no sexo masculino, com idade superior a 60 anos, foram associadas com maior frequência às doenças cerebrovasculares, na maioria os sintomas apareceram entre 4 e 6 dias; Staphylococcus epidermidis e Klebsiellap pneumoniae foram os germes mais freqüentemente isolados nesses pacientes(AU)

Nursing workload and adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia. A pilot study. / Carga de trabajo y cumplimiento por parte de las enfermeras de las medidas no farmacológicas para la prevención de la neumonía asociada a la ventilación mecánica. Estudio piloto.

OBJECTIVE: To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. METHODS: A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. VARIABLES: knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. RESULTS: Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures. CONCLUSIONS: Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors.

Time of elevation of head of bed for patients receiving mechanical ventilation and its related factors. / Tiempo de elevación del cabezal de la cama del paciente con ventilación mecánica y factores relacionados.

INTRODUCTION: The semirecumbent position is a widespread recommendation for the prevention of pneumonia associated with mechanical ventilation. AIMS: To identify the time of elevation of head of bed for patients under mechanical ventilation and the factors related to such elevation in an intensive care unit. MATERIALS AND METHODS: An observational, descriptive cross-sectional study. Conducted in an intensive care unit of a tertiary hospital from April to June 2015. The studied population were mechanically ventilated patients. Daily hours in which patients remained with the head of the bed elevated (≥30°), socio-demographic data and clinical variables were recorded. RESULTS: 261 head elevation measurements were collected. The average daily hours that patients remained at ≥30° was 16h28' (SD ±5h38'), equivalent to 68.6% (SD ±23.5%) of the day. Factors related to elevations ≥30° for longer were: enteral nutrition, levels of deep sedation, cardiac and neurocritical diagnostics. Factors that hindered the position were: sedation levels for agitation and abdominal pathologies. Sex, age and ventilation mode did not show a significant relationship with bed head elevation. CONCLUSIONS: Although raising the head of the bed is an easy to perform, economical and measurable preventive measure, its compliance is low due to specific factors specific related o the patient's clinical condition. Using innovations such as continuous measurement of the head position helps to evaluate clinical practice and allows to carry out improvement actions whose impact is beneficial to the patient.

Tracheo-bronchitis and pneumonia associated with mechanical ventilation by Chryseobacterium indologenes. / Traqueobronquitis y neumonía asociada a ventilación mecánica por Chryseobacterium indologenes.

The development of nosocomial infections by germs resistant to carbapenems inherently increases mortality, and causes an increase in health spending. The knowledge and study of these infections is important in improving epidemiological and therapeutic performance protocols. We present a descriptive study of eight patients diagnosed with tracheobronchitis (TAVM) and pneumonia (NAVM) associated with mechanical ventilation Chryseobacterium indologenes (CBI), over a period of five years. CBI isolation occurred at 11 days on average (rank 7-18) of remaining patients connected to mechanical ventilation. The average length of patients on mechanical ventilation was 36 days (range 10-140). The average ICU stay was 49 days (range 14-180). There was no death at 28 days, but the intra-hospital mortality was 2 cases (25%). Nosocomial respiratory infection secondary to CBI in mechanically ventilated patients has increased in recent years, so that should be included in the differential diagnostic of NAMV.

Enteral nutrition volume is not correlated with lower respiratory tract infection in patients on mechanical ventilation.

OBJECTIVE: To evaluate the effect of enteral nutrition volume, gastrointestinal function and the type of acid suppressive drug upon the incidence of lower respiratory tract infections in critically ill patients on mechanical ventilation (MV). DESIGN: A retrospective secondary analysis was carried out. SETTING: The Intensive Care Unit of a University Hospital. PATIENTS OR PARTICIPANTS: Patients≥18-years-old expected to need MV for more than four days, and receiving enteral nutrition by nasogastric tube within 24h of starting MV. INTERVENTIONS: We correlated enteral nutrition volume administered during the first 10 days, gastrointestinal function and the type of acid suppressive therapy with the episodes of lower respiratory tract infection up until day 28. Cox proportional hazards ratios in univariate and adjusted multivariate models were used. Statistical significance was considered for p<0.05. MAIN VARIABLES OF INTEREST: Lower respiratory tract infection episodes. RESULTS: Sixty-six out of 185 patients (35.7%) had infection; 27 patients had ventilator-associated pneumonia; and 39 presented ventilator-associated tracheobronchitis. Uninfected and infected groups were similar in terms of enteral nutrition volume (54±12 and 54±9mL/h; p=0.94) and caloric intake (19.4±4.9 and 19.6±5.2kcal/kg/d; p=0.81). The Cox proportional hazards model showed neurological indication of MV to be the only independent variable related to infection (p=0.001). Enteral nutrition volume, the type of acid suppressive therapy, and the use of prokinetic agents were not significantly correlated to infection. CONCLUSIONS: Enteral nutrition volume and caloric intake, gastrointestinal dysfunction and the type of acid suppressive therapy used were not associated to lower respiratory tract infection in patients on MV.

Quality of the aetiological diagnosis of ventilator-associated pneumonia in Spain in the opinion of intensive care specialists and microbiologists.

INTRODUCTION: Current guidelines for the microbiological diagnosis of ventilator-associated pneumonia (VAP) are imprecise. Based on data provided by intensive care specialists (ICS) and microbiologists, this study defines the clinical practices and microbiological techniques currently used for an aetiological diagnosis of VAP and pinpoints deficiencies. METHODS: Eighty hospitals in the national health network with intensive care and microbiology departments were sent two questionnaires, one for each department, in order to collect data on VAP diagnosis for the previous year. RESULTS: Out of the 80 hospitals, 35 (43.8%) hospitals participated. These included 673 ICU beds, 32,020 ICU admissions, 173,820 ICU days stay, and generated 27,048 lower respiratory tract specimens in the year. A third of the hospitals (35%) had a microbiology department available 24/7. Most samples (83%) were tracheal aspirates. Gram stain results were immediately reported in around half (47%) of the hospitals. Quantification was made in 75% of hospitals. Molecular techniques and direct susceptibility testing were performed in 12% and one institution, respectively. Mean turnaround time for a microbiological report was 1.7 (SD; 0.7), and 2.2 (SD; 0.6) days for a negative and positive result, respectively. Telephone/in-person information was offered by 65% of the hospitals. Most (89%) ICS considered microbiological information as very useful. No written procedures were available in half the ICUs. CONCLUSIONS: Both ICS and microbiologists agreed that present guidelines for the diagnosis of VAP could be much improved, and that a new set of consensus guidelines is urgently required. A need for guidelines to be more effectively implemented was also identified in order to improve outcomes in patients with VAP.