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Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients

Stijn Blot UGent, Despoina Koulenti, George Dimopoulos, Claude Martin, Apostolos Komnos, Wolfgang A Krueger, Giuseppe Spina, Apostolos Armaganidis and Jordi Rello (2014) CRITICAL CARE MEDICINE. 42(3). p.601-609
abstract
Objective: We investigated the epidemiology of ventilator-associated pneumonia in elderly ICU patients. More precisely, we assessed prevalence, risk factors, signs and symptoms, causative bacterial pathogens, and associated outcomes. Design: Secondary analysis of a multicenter prospective cohort (EU-VAP project). Setting: Twenty-seven European ICUs. Patients: Patients who were mechanically ventilated for greater than or equal to 48 hours. We compared middle-aged (45-64 yr; n = 670), old (65-74 yr; n = 549), and very old patients ( 75 yr; n= 516). Measurements and Main Results: Ventilator-associated pneumonia occurred in 103 middle-aged (14.6%), 104 old (17.0%), and 73 very old patients (12.8%). The prevalence (n ventilator-associated pneumonia/1,000 ventilation days) was 13.7 in middle-aged patients, 16.6 in old patients, and 13.0 in very old patients. Logistic regression analysis could not demonstrate older age as a risk factor for ventilator-associated pneumonia. Ventilator-associated pneumonia in elderly patients was more frequently caused by Enterobacteriaceae (24% in middle-aged, 32% in old, and 43% in very old patients; p = 0.042). Regarding clinical signs and symptoms at ventilator-associated pneumonia onset, new temperature rise was less frequent among very old patients (59% vs 76% and 74% for middle-aged and old patients, respectively; p = 0.035). Mortality among patients with ventilator-associated pneumonia was higher among elderly patients: 35% in middle-aged patients versus 51% in old and very old patients (p = 0.036). Logistic regression analysis confirmed the importance of older age in the risk of death (adjusted odds ratio for old age, 2.1; 95% CI, 1.2-3.9 and adjusted odds ratio for very old age, 2.3; 95% CI, 1.2-4.4). Other risk factors for mortality in ventilator-associated pneumonia were diabetes mellitus, septic shock, and a high-risk pathogen as causative agent. Conclusions: In this multicenter cohort study, ventilator-associated pneumonia did not occur more frequently among elderly, but the associated mortality in these patients was higher. New temperature rise was less common in elderly patients with ventilator-associated pneumonia, whereas more episodes among elderly patients were caused by Enterobacteriaceae.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
geriatric, elderly, infection, intensive care, mortality, outcome, pneumonia, risk factors, ESCHERICHIA-COLI PNEUMONIA, BLOOD-STREAM INFECTIONS, ELDERLY-PATIENTS, INTENSIVE-CARE, ATTRIBUTABLE MORTALITY, ORGAN FAILURE, HEALTH-CARE, EPIDEMIOLOGY, PREVENTION, SEPSIS
journal title
CRITICAL CARE MEDICINE
Crit. Care Med.
volume
42
issue
3
pages
601 - 609
Web of Science type
Article
Web of Science id
000331387200041
JCR category
CRITICAL CARE MEDICINE
JCR impact factor
6.312 (2014)
JCR rank
4/27 (2014)
JCR quartile
1 (2014)
ISSN
0090-3493
DOI
10.1097/01.ccm.0000435665.07446.50
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
4239070
handle
http://hdl.handle.net/1854/LU-4239070
date created
2014-01-21 10:15:58
date last changed
2016-12-19 15:45:44
@article{4239070,
  abstract     = {Objective: We investigated the epidemiology of ventilator-associated pneumonia in elderly ICU patients. More precisely, we assessed prevalence, risk factors, signs and symptoms, causative bacterial pathogens, and associated outcomes. 
Design: Secondary analysis of a multicenter prospective cohort (EU-VAP project). 
Setting: Twenty-seven European ICUs. 
Patients: Patients who were mechanically ventilated for greater than or equal to 48 hours. We compared middle-aged (45-64 yr; n = 670), old (65-74 yr; n = 549), and very old patients ( 75 yr; n= 516). 
Measurements and Main Results: Ventilator-associated pneumonia occurred in 103 middle-aged (14.6\%), 104 old (17.0\%), and 73 very old patients (12.8\%). The prevalence (n ventilator-associated pneumonia/1,000 ventilation days) was 13.7 in middle-aged patients, 16.6 in old patients, and 13.0 in very old patients. Logistic regression analysis could not demonstrate older age as a risk factor for ventilator-associated pneumonia. Ventilator-associated pneumonia in elderly patients was more frequently caused by Enterobacteriaceae (24\% in middle-aged, 32\% in old, and 43\% in very old patients; p = 0.042). Regarding clinical signs and symptoms at ventilator-associated pneumonia onset, new temperature rise was less frequent among very old patients (59\% vs 76\% and 74\% for middle-aged and old patients, respectively; p = 0.035). Mortality among patients with ventilator-associated pneumonia was higher among elderly patients: 35\% in middle-aged patients versus 51\% in old and very old patients (p = 0.036). Logistic regression analysis confirmed the importance of older age in the risk of death (adjusted odds ratio for old age, 2.1; 95\% CI, 1.2-3.9 and adjusted odds ratio for very old age, 2.3; 95\% CI, 1.2-4.4). Other risk factors for mortality in ventilator-associated pneumonia were diabetes mellitus, septic shock, and a high-risk pathogen as causative agent. 
Conclusions: In this multicenter cohort study, ventilator-associated pneumonia did not occur more frequently among elderly, but the associated mortality in these patients was higher. New temperature rise was less common in elderly patients with ventilator-associated pneumonia, whereas more episodes among elderly patients were caused by Enterobacteriaceae.},
  author       = {Blot, Stijn and Koulenti, Despoina and  Dimopoulos, George and Martin, Claude and Komnos, Apostolos and Krueger, Wolfgang A and Spina, Giuseppe and Armaganidis, Apostolos and Rello, Jordi},
  issn         = {0090-3493},
  journal      = {CRITICAL CARE MEDICINE},
  keyword      = {geriatric,elderly,infection,intensive care,mortality,outcome,pneumonia,risk factors,ESCHERICHIA-COLI PNEUMONIA,BLOOD-STREAM INFECTIONS,ELDERLY-PATIENTS,INTENSIVE-CARE,ATTRIBUTABLE MORTALITY,ORGAN FAILURE,HEALTH-CARE,EPIDEMIOLOGY,PREVENTION,SEPSIS},
  language     = {eng},
  number       = {3},
  pages        = {601--609},
  title        = {Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients},
  url          = {http://dx.doi.org/10.1097/01.ccm.0000435665.07446.50},
  volume       = {42},
  year         = {2014},
}

Chicago
Blot, Stijn, Despoina Koulenti, George Dimopoulos, Claude Martin, Apostolos Komnos, Wolfgang A Krueger, Giuseppe Spina, Apostolos Armaganidis, and Jordi Rello. 2014. “Prevalence, Risk Factors, and Mortality for Ventilator-associated Pneumonia in Middle-aged, Old, and Very Old Critically Ill Patients.” Critical Care Medicine 42 (3): 601–609.
APA
Blot, S., Koulenti, D., Dimopoulos, G., Martin, C., Komnos, A., Krueger, W. A., Spina, G., et al. (2014). Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. CRITICAL CARE MEDICINE, 42(3), 601–609.
Vancouver
1.
Blot S, Koulenti D, Dimopoulos G, Martin C, Komnos A, Krueger WA, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. CRITICAL CARE MEDICINE. 2014;42(3):601–9.
MLA
Blot, Stijn, Despoina Koulenti, George Dimopoulos, et al. “Prevalence, Risk Factors, and Mortality for Ventilator-associated Pneumonia in Middle-aged, Old, and Very Old Critically Ill Patients.” CRITICAL CARE MEDICINE 42.3 (2014): 601–609. Print.