Exploring Ventilator-Associated Pneumonia: Microbial Clues and Biomarker Insights from a Retrospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Approval and Informed Consent
2.2. Study Design
2.3. Participants
2.4. Inclusion Criteria
2.5. Exclusion Criteria
2.6. Data Collection and Procedures
- Patients who fulfilled the criteria for inclusion in this study underwent the following procedures to determine the presence of VAP: a thorough medical history was taken from the relative(s) of the patients, a full clinical examination consisting of both general and local chest examinations was performed, and a plain chest X-ray was performed using a portable PRACTix 33 Pluse Philips (Rome, Italy) X-ray machine. The pulmonary infiltration seen on the chest X-ray served as a diagnostic indicator for the diagnosis of VAP;
- Laboratory investigations in the form of the following tests were performed. These included the measurement of complete blood count including white blood cell count, red blood cell count, hemoglobin level, and platelet count. C-reactive protein levels were measured using a Ruche Cobas800-702 auto analyzer manufactured by Ruche Diagnostic in Germany. Procalcitonin levels were measured using the BioMerieux’s VIDAS BRAHMS PCT assay manufactured by Biomerieux in Durham, NC, USA;
- Empirical antibiotic therapy was initiated according to the IDSA (Infectious Diseases Society of America) 2016 guidelines once the criteria for suspected VAP were met. This means that when there were indications that a patient might have VAP based on specific clinical criteria, antibiotic treatment was started without waiting for the confirmation of the causative organism through laboratory tests. The choice of antibiotics was guided by the guidelines provided by the IDSA in 2016, which outline recommendations for the treatment of infectious diseases [14];
- The SOFA score was calculated on admission for all included patients, which was based on clinical information and lab results for predicting ICU mortality;
- 5.
- APACHE II is a severity of illness classification system that is commonly used in critical care settings. The score was calculated based on 12 physiological variables and age, and ranges from 0 to 71, with higher scores indicating greater severity of illness. The 12 physiological variables included vital signs, blood gas measurements, electrolyte levels, and other laboratory values. Each variable was assigned a score based on the degree of abnormality, and the scores were added together to give the total APACHE II score. APACHE II scores could provide valuable prognostic information and guide clinical decision-making in critically ill patients;
- 6.
- Fiberoptic bronchoscopy with BAL under aseptic conditions was performed.
- 7.
- Microbiological analysis for the BAL: The sample was inoculated on blood agar, chocolate agar (incubated aerobically and anaerobically at 37 °C), and McConkey agar (incubated aerobically at 37 °C). Additionally, a sample was inoculated into a brain–heart infusion broth. The colony-forming units for growth-positive plates were determined [16].
2.7. Statistical Analysis
3. Results
3.1. Demography and Baseline Characteristic
3.2. Diversity of Microbial Profiles across VAP Patient Diagnosis
3.3. Microbiological Profile of VAP Patients
3.4. White Blood Cells, Platelet Count, C-Reactive Protein, Procalcitonin, SOFA, and APACHE II Scores in Died and Recovered Groups of VAP Patients
3.5. Analysis of Antibiotic Susceptibility Patterns in Frequently Isolated Pathogens
3.6. The Correlations between SOFA and APACHE II Scores and Laboratory Values
3.7. Logistic Regression Analysis of the Measured Parameters in Relation to VAP Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Died N (%) | Recovered N (%) | p-Value | |
---|---|---|---|
Age (mean ± SD) | 58 ± 13.5 | 46 ± 16.7 | <0.0001 |
Gender (M/F) | 43 (52)/32 (68) | 40 (48)/15 (32) | 0.096 (NS) |
Days before MV (mean ± SD) | 1.52 ± 6.1 | 5.21 ± 4.4 | 0.0002 |
Ventilation Days (mean ± SD) | 17.52 ± 6.3 | 9.36 ± 3.2 | <0.0001 |
Length of ICU stay (mean ± SD) | 19.27 ± 10.22 | 18.45 ± 9.07 | 0.63 (NS) |
Chest X-ray | |||
Right | 7 | 25 | <0.0001 |
Left | 6 | 14 | |
Bilateral | 62 | 16 | |
Comorbidities | |||
AECOPD | 2 | 13 | |
ASTHMA | 0 | 2 | |
Brain abscess | 1 | 1 | |
Brain tumor | 6 | 0 | |
Burst abdomen | 15 | 3 | |
Cervical Fracture | 6 | 0 | |
colon cancer | 1 | 0 | |
Diabetic foot | 15 | 4 | |
DVT | 0 | 1 | |
Hydrocephalus | 2 | 1 | |
ICH | 1 | 1 | |
ILD | 1 | 5 | |
LL Ischemia | 6 | 0 | |
metastasis | 1 | 0 | |
OSA | 0 | 1 | |
PE | 1 | 5 | |
RTA | 12 | 16 | |
SAH | 4 | 2 | |
Stroke | 1 | 0 | |
Indication of ICU admission (Admission diagnosis) | |||
altered level of consciousness | 27 (20.7%) | 21 (16.1%) | <0.0001 |
Septic shock | 39 (30%) | 8 (6.1%) | |
Spinal shock | 5 (3.8%) | 0 (0%) | |
Type I RF | 2 (1.5%) | 9 (6.9%) | |
Type II RF | 2 (1.5%) | 17 (13%) |
Diagnosis | Pseudomonas | MRSA | Klebsiella | E. coli | Acinetobacter | Total |
---|---|---|---|---|---|---|
AECOPD | 5 | 1 | 8 | 1 | 15 | |
ASTHMA | 1 | 1 | 2 | |||
Brain abscess | 2 | 2 | ||||
Brain tumor | 2 | 4 | 6 | |||
Burst abdomen | 9 | 2 | 6 | 1 | 18 | |
Cervical Fracture | 6 | 6 | ||||
colon cancer | 1 | 1 | ||||
Diabetic foot | 8 | 2 | 8 | 1 | 19 | |
DVT | 1 | 1 | ||||
Hydrocephalus | 1 | 1 | 1 | 3 | ||
ICH | 2 | 2 | ||||
ILD | 5 | 1 | 6 | |||
LL Ischemia | 1 | 1 | 4 | 6 | ||
Metastasis | 1 | 1 | ||||
OSA | 1 | 1 | ||||
PE | 2 | 1 | 2 | 1 | 6 | |
RTA | 4 | 5 | 18 | 1 | 28 | |
SAH | 1 | 2 | 3 | 6 | ||
Stroke | 1 | 1 | ||||
Total | 36 | 15 | 66 | 5 | 8 | 130 |
Estimate | p-Value | OR | |
---|---|---|---|
CRP | −0.020 | 0.001 | 0.980 |
PCT | −0.16 | 0.423 | 0.984 |
SOFA score | −0.544 | 0.202 | 0.581 |
APACHE II | −0.180 | 0.122 | 0.835 |
Age | 0.014 | 0.627 | 1.014 |
Gender | 1.887 | 0.028 | 6.600 |
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Gouda, A.M.; Sileem, A.E.; Elnahas, H.M.; Tawfik, A.E.; Eid, R.A.; Shati, A.A.; Al-Qahtani, S.M.; Dawood, S.A.; Alshehri, M.A.; Eissa, M.; et al. Exploring Ventilator-Associated Pneumonia: Microbial Clues and Biomarker Insights from a Retrospective Study. Medicina 2024, 60, 1346. https://doi.org/10.3390/medicina60081346
Gouda AM, Sileem AE, Elnahas HM, Tawfik AE, Eid RA, Shati AA, Al-Qahtani SM, Dawood SA, Alshehri MA, Eissa M, et al. Exploring Ventilator-Associated Pneumonia: Microbial Clues and Biomarker Insights from a Retrospective Study. Medicina. 2024; 60(8):1346. https://doi.org/10.3390/medicina60081346
Chicago/Turabian StyleGouda, Ahmed M., Ashraf E. Sileem, Hanan M. Elnahas, Ahmed E. Tawfik, Refaat A. Eid, Ayed A. Shati, Saleh M. Al-Qahtani, Samy A. Dawood, Mohammed A. Alshehri, Mohamed Eissa, and et al. 2024. "Exploring Ventilator-Associated Pneumonia: Microbial Clues and Biomarker Insights from a Retrospective Study" Medicina 60, no. 8: 1346. https://doi.org/10.3390/medicina60081346