Ventilator-Associated Pneumonia: Overdiagnosis and Treatment Are Common in Medical and Surgical Intensive Care Units

2014 ◽  
Vol 35 (3) ◽  
pp. 278-284 ◽  
Author(s):  
Veronique Nussenblatt ◽  
Edina Avdic ◽  
Sean Berenholtz ◽  
Elizabeth Daugherty ◽  
Eric Hadhazy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Culture Collection ◽  
Antimicrobial Use ◽  
Health Evaluation ◽  
Ventilator Associated Pneumonia ◽  
Surgical Intensive Care ◽  
Radiographic Data ◽  
Adjudication Committee

Objective.Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days.Methods.Patients suspected of having VAP were identified in 6 adult intensive care units (ICUs) over 1 year. A multidisciplinary adjudication committee determined whether the ICU team's VAP diagnosis and therapy were justified, using clinical, microbiologic, and radiographic data at diagnosis and on day 3. Outcomes included the proportion of VAP events misdiagnosed as and treated for VAP on days 1 and 3 and risk factors for the continuation of antibiotics in patients without VAP after day 3.Results.Two hundred thirty-one events were identified as possible VAP by the ICUs. On day 1, 135 (58.4%) of them were determined to not have VAP by the committee. Antibiotics were continued for 120 (76%) of 158 events without VAP on day 3. After adjusting for acute physiology and chronic health evaluation II score and requiring vasopressors on day 1, sputum culture collection on day 3 was significantly associated with antibiotic continuation in patients without VAP. Patients without VAP or other infection received 1,183 excess days of antibiotics during the study.Conclusions.Overdiagnosis and treatment of VAP was common in this study and led to 1,183 excess days of antibiotics in patients with no indication for antibiotics. Clinical differences between non-VAP patients who had antibiotics continued or discontinued were minimal, suggesting that clinician preferences and behaviors contribute to unnecessary prescribing.

scholarly journals Development of an Algorithm for Surveillance of Ventilator-Associated Pneumonia With Electronic Data and Comparison of Algorithm Results With Clinician Diagnoses

2008 ◽  
Vol 29 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Michael Klompas ◽  
Ken Kleinman ◽  
Richard Platt
Keyword(s):  
Intensive Care ◽  
Positive Predictive Value ◽  
Intensive Care Units ◽  
Predictive Value ◽  
Ventilator Associated Pneumonia ◽  
Surgical Intensive Care ◽  
Electronic Data ◽  
Prospective Comparison ◽  
Control And Prevention ◽  
High Positive Predictive Value

Objective.Surveillance for ventilator-associated pneumonia (VAP) using standard Centers for Disease Control and Prevention (CDC) criteria is labor intensive and involves many subjective assessments. We sought to improve the efficiency and objectivity of VAP surveillance by adapting the CDC criteria to make them amenable to evaluation with electronic data.Design.Prospective comparison of the accuracy of VAP surveillance by use of an algorithm with responses to prospective queries made to intensive care physicians. CDC criteria for VAP were used as a reference standard to evaluate the algorithm and clinicians' reports.Setting.Three surgical intensive care units and 2 medical intensive care units at an academic hospital.Methods.A total of 459 consecutive patients who received mechanical ventilation for a total of 2,540 days underwent surveillance by both methods during consecutive 3-month periods. Electronic surveillance criteria were chosen to mirror the CDC definition. Quantitative thresholds were substituted for qualitative criteria. Purely subjective criteria were eliminated. Increases in ventilator-control settings were taken to indicate worsening oxygenation. Semiquantitative Gram stain of pulmonary secretion samples was used to assess whether there was sputum purulence.Results.The algorithm applied to electronic data detected 20 patients with possible VAP. All cases of VAP were confirmed in accordance with standard CDC criteria (100% positive predictive value). Prospective survey of clinicians detected 33 patients with possible VAP. Seventeen of the 33 possible cases were confirmed (52% positive predictive value). Overall, 21 cases of confirmed VAP were identified by either method. The algorithm identified 20 (95%) of 21 known cases, whereas the survey of clinicians identified 17 (81%) of 21 cases.Conclusions.Surveillance for VAP using electronic data is feasible and has high positive predictive value for cases that meet CDC criteria. Further validation of this method is warranted.

scholarly journals Incidence and risk factors of delirium in multi-center Thai surgical intensive care units: a prospective cohort study

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Tanyong Pipanmekaporn ◽  
◽  
Kaweesak Chittawatanarat ◽  
Onuma Chaiwat ◽  
Thammasak Thawitsri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Surgical Intensive Care

scholarly journals Exploring Risk Factors with Ventilator Associated Pneumonia among Infants in Intensive Care Units

2018 ◽  
Vol 86 (December) ◽  
pp. 3505-3518
Author(s):  
FATMA E. DAGHER, M.Sc.; AZZA A. ATTIA, M.D. ◽  
NAGLAA F. MAHMOUD, M.D.; AHMED M. BADR, M.D.
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Ventilator Associated Pneumonia

scholarly journals Candida tropicalis: insight into the characteristics and outcome of adult patients admitted in medical and surgical intensive care units

2019 ◽  
Vol 7 (4) ◽  
pp. 1184
Author(s):  
Raminder Sandhu ◽  
Ramnika Aggarwal ◽  
Surinder Kumar ◽  
Diksha Budhani
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Candida Tropicalis ◽  
Clinical Samples ◽  
Surgical Intensive Care ◽  
Prolonged Duration ◽  
One Year ◽  
Systemic Infections ◽  
Culture Positive

Background: Non albicans species are emerging increasingly as significant ICU pathogens.  The increasing incidence of C. tropicalis infections is a significant problem because of its ability to develop rapid resistance to fluconazole.Methods: The study was designed to isolate, evaluate the risk factors and outcome of C. tropicalis infection from intensive care units. Identification was done by the biochemical methods. A total of 89 patients culture positive for C. tropicalis were selected for retrospective analysis over a period of one year. We collected various data about risk factors and outcome from the medical records.Results: A total of 89 patients culture positive for Candida tropicalis were analysed. Majority of these culture isolates were obtained from their blood (59.55%) followed by urine samples (31.46%). The indwelling devices (93.2%) remained a highest risk followed by prolonged administration of antibiotic therapy (92.1%) and admission in ICU for more than a week (88.8%). Overall mortality rate was 31.5%. Mortality was higher in patients with longer total length of stay in hospital (89.3%; p 1.000), indwelling devices (85.7%; p 0.5663) and in whom the antimicrobial therapy was administered for prolonged duration (82.1%; p 0.7581), although these factors remained statistically insignificant. 92.1% of isolates were sensitive to amphotericin B and showed 52.8%; 9.0% sensitivity to itraconazole and fluconazole respectively.Conclusions: C. tropicalis is now classified as the third or fourth NAC species being commonly isolated from clinical samples and associated with persistent systemic infections leading to a longer stay in the hospital. Several virulence factors seem to be responsible for high dissemination and mortality.

Risk Factors for Ventilator-Associated Pneumonia in Surgical Intensive-Care-Unit Patients

1996 ◽  
Vol 17 (6) ◽  
pp. 374-376 ◽  
Author(s):  
Consuelo M. Beck-Sague ◽  
Ronda L. Sinkowitz ◽  
Raymond Y. Chinn ◽  
Judy Vargo ◽  
Wendy Kaler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Surgical Intensive Care

scholarly journals Criteria for the administration of systemic antimicotic therapy in surgical intensive care units (literature review)

2019 ◽  
Vol 9 (4) ◽  
pp. 11-20
Author(s):  
B. Z. Belotserkovskiy ◽  
E. B. Gelfand ◽  
A. O. Bykov ◽  
O. A. Mamontova ◽  
D. N. Protsenko
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Invasive Candidiasis ◽  
Fungal Infections ◽  
Laboratory Data ◽  
Diagnostic Methods ◽  
Critical Conditions ◽  
Surgical Intensive Care ◽  
Timely Initiation

This review focuses on the practical aspects of prevention and treatment of fungal infections in surgical patients. It covers epidemiology and risk factors for invasive candidiasis, updates on the etiological structure of fungal infections in patients in critical conditions, and provides the information on drug sensitivity of Candida species. The authors discuss the limitations of cultural and non-cultural diagnostic methods used in invasive candidiasis, emphasizing the importance of analyzing the existing risk factors in combination with a comprehensive assessment of clinical and laboratory data for timely initiation of adequate antifungal therapy. The review provides a brief description of currently available antimicotics, including polyenes, triazoles, and echinocandins. It also describes the benefits of anidulafungin, which does not interact with other drugs and has no negative effect on the liver and kidney. The article also covers indications for antifungal agents in surgical intensive care units in accordance with international and Russian guidelines. A cohort of patients with abdominal diseases requiring preventive and empirical treatment with antimicotics is described. In additions to that, the manuscript contains a rationale for the use of echinocandins in targeted therapy of invasive candidiasis.

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