Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay

https://doi.org/10.1016/0002-9343(93)90060-3Get rights and content

Abstract

purpose: Although nosocomial pneumonia is a common problem in intubated and ventilated patients, previous studies have not clearly demonstrated that nosocomial pneumonia actually results in increased mortality or prolongs hospitalisation of these patients. In an attempt to answer these questions, we have performed a cohort study in which patients who developed nosocomial pneumonia and control subjects were carefully matched for the severity of underlying illness and other important variables.

patients and methods: Case patients were 48 ventilated patients with nosocomial pneumonia identified on the basis of results of protected specimen brush quantitative culture and identification of intracellular organisms in cells recovered by bronchoalveolar lavage. For matching cases and their respective controls, the following variables were used: age (± 5 years), Simplified Acute Physiologic Score (± 3 points), indication for ventilatory support, date of admission, and duration of exposure to risk.

results: Successful matching was achieved for 222 of 240 (92.5%) variables. The mortality rate in cases was 26 of 48 (54.2%) compared with 13 of 48 (27.1%) in controls. The attributable mortality was 27.1% (95% confidence interval [CI], 8.3% to 45.9%; p < 0.01) and the risk ratio for death was 2.0 (95% CI, 1.61 to 2.49). The mean length of stay was 34 days for cases and 21 days for controls (p < 0.02). In the case of pneumonia due to Pseudomonas or Acinetobacter species, the mortality rate was 71.4%, the attributable mortality was 42.8% (95% CI, 14.5% to 69.0%), and the risk ratio was 2.50 (95% CI, 1.31 to 4.61).

conclusion: Pneumonias occurring in ventilated patients, especially those due to Pseudomonas or Acinetobacter species, are associated with considerable mortality in excess of that resulting from the underlying disease alone, and significantly prolong the length of stay in the intensive care unit.

Reference (35)

  • PenningtonJE

    Hospital-acquired pneumonia

  • StevensRM et al.

    Pneumonia in an intensive care unit

    Arch Intern Med

    (1974)
  • HemmingVG et al.

    Nosocomial infections in a newborn intensive care unit

    N Engl J Med

    (1976)
  • CravenDE et al.

    Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation

    Am Rev Respir Dis

    (1986)
  • TorresA et al.

    Incidence risk and prognosis factor of nosocomial pneumonia in mechanically ventilated patients

    Am Rev Respir Dis

    (1990)
  • SalataRA et al.

    Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients

    Am Rev Respir Dis

    (1987)
  • FagonJY et al.

    Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques

    Am Rev Respir Dis

    (1989)
  • Cited by (0)

    This work was supported in part by a grant from the Direction Ge´ne´rale de la Sante´and the Faculte´Xavier Bichat, and was presented in part at the annual meeting of the American Thoracic Society, Boston, Massachusetts, May 1990.

    1

    From the Service de Re´animation Me´dicale, Hoˆpital Bichat, Unite´INSERM U 82, Faculte´Xavier Bichat, Paris, France.

    View full text