Risk factors for nosocomial pneumonia in intensive care units of a University Hospital

Year 2013, , 3 - 7, 01.03.2013

Yasemin Akkoyunlu Nefise Öztoprak Hande Aydemir Nihal Pişkin Güven Çelebi Handan Ankaralı Deniz Akduman

https://doi.org/10.5799/ahinjs.02.2013.01.0070

Abstract

Objective: The evaluation of risk factors in patients with Nosocomial pneumonia (NP) may provide useful guidance for patients who need intensive care. The aim of this study was to identify risk factors of NP in ICU. Methods: During the six months period of time, patients who stayed in ICUs for at least 48 hours were included in a tertiary medical center. A total of 304 patients were prospectively followed and 78 of them who developed NP made up the NP group. Patients who did not develop any infection were defined as control group. Variables which was thought or detected as a risk factor of NP in univariate analysis were analyzed with multivariate logistic regression analysis. Results: Among 304 patients, 78 (25.6%) had NP. Multivariate analysis revealed that advanced age (odds ratio [OR] 1, 95% confidence interval [CI] 1.00-1.06), length of stay (LOS) in the ICU (OR 1.3, 95% CI 1.17-1.39), prior infection on admission to ICU (OR 6.7, 95% CI 1.52-29.94), transfusion of blood and blood products (OR 4.0, 95% CI 1.43-11.46) and prior antibiotic usage within the last two weeks before admission (OR 3.3, 95% CI 1.28-8.48) were independent risk factors for NP. Additionally, the mean APACHE II score of cases with NP (16.7&plusmn;6.7) was significantly higher than that of controls (11.5&plusmn;8.1; p<0.001). Conclusion: We must be awake to make the diagnosis earlier in patients with determined risk factors: advanced age, LOS in ICU, prior infection, transfusion of blood products and prior antibiotic usage.

Keywords

Intensive care unit, nosocomial pneumonia, risk factors

Risk factors for nosocomial pneumonia in intensive care units of a University Hospital

Abstract

Amaç: Nozokomiyal pnömoni (NP) yoğun bakım ünitesi (YBÜ)’nde en sık karşılaşılan nozokomiyal enfeksiyondur. NP gelişen hastalardaki risk faktörlerinin değerlendirilmesi YBÜ ihtiyacı olan hastalar için yol gösterici olabilir. Bu çalışmanın amacı YBÜ’de gelişen NP risk faktörlerinin belirlenmesidir. Yöntemler: Altı aylık süre içerisinde, bir üniversite hastanesinin YBÜ’lerinde 48 saatten uzun kalan hastalar çalışmaya alındı. Toplam olarak 304 hasta prospektif izlenirken, bu hastaların NP gelişen 78’i NP grubunu oluşturdu. Herhangi bir enfeksiyon gelişmeyen hastalar ise kontrol grubu olarak tanımlandı. Tek değişkenli analiz ile NP risk faktörü olabileceği düşünülen veya saptanan değişkenler çok değişkenli lojistik regresyon analizi ile incelendi. Bulgular: 304 hastanın 78’inde (% 25,6) NP gelişti. Çok değişkenli analiz ile ileri yaş (odds ratio [OR] 1, %95 güven aralığı [CI] 1,00-1,06), YBÜ’de yatış süresi (OR 1,3, % 95 CI 1,17-1,39), YBÜ öncesi enfeksiyon varlığı (OR 6,7, %95 CI 1,52-29,94), kan ürünü transfüzyonu (OR 4, %95 CI 1,43-11,46) ve YBÜ yatışından önceki 2 hafta içerisinde antibiyotik kullanım öyküsü (OR 3,3, %95 CI 1,28-8,48) NP için bağımsız risk faktörleri olarak tanımlandı. Ayrıca, NP gelişen hastaların ortalama APACHE II skoru (16,7±6,7) kontrol grubundan anlamlı olarak yüksek bulundu (11,5±8,1; p<0.001).Sonuç: Nozokomiyal pnömoni özellikle YBÜ’lerde hastanede yatış süresini, maliyeti ve mortaliteyi arttıran önemli bir enfeksiyon hastalığıdır. İleri yaş, yatış öncesi enfeksiyon varlığı, YBÜ’de yatış süresinin uzunluğu, kan ürünü transfüzyonu ve önceden antibiyotik kullanımı gibi tanımlanmış risk faktörleri olan hastalarda erken tanı açısından uyanık olunmalıdır

Keywords

yoğun bakım ünitesi, nozokomiyal pnömoni, risk faktörü

References

• Rello J, Diaz E. Pneumonia in the intensive care unit. Crit Care Med 2003; 31:2544-2551.
• Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosoco- mial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510-515.
• Akca O, Koltka K, Uzel S, et al. Risk factors for early-onset, ventilator-associated pneumonia in critical care patients: se- lected multiresistant versus nonresistant bacteria. Anesthe- siology 2000; 93:638-645.
• Vanhems P, Lepape A, Savey A, Jambou P, Fabry J. Nosoco- mial pulmonary infection by antimicrobial-resistant bacteria of patients hospitalized in intensive care units: risk factors and survival. J Hosp Infect 2000; 45:98-106.
• Boots RJ, Lipman J, Bellomo R, Stephens DP, Heller RF. Aus- tralian and New Zealand practice in intensive care (ANZPIC II): Disease risk and mortality prediction in intensive care patients with pneumonia. Anaesth Intensive Care 2005; 33:101-111.
• Hanson LC, Weber DJ, Rutala WA. Risk factors for nosoco- mial pneumonia in the elderly. Am J Med 1992;92:161-166.
• Chevret S, Hemmer M, Carlet J, Langer M. Incidence and risk factors of pneumonia acquired in intensive care units: results from a multicenter prospective study on 996 patients. Inten- sive Care Med 1993;19:256-264.
• Alp E, Guven M, Yildiz O, Aygen B, Voss A, Doganay M. Inci- dence, risk factors and mortality of nosocomial pneumonia in intensive care units: a prospective study. Ann Clin Microbiol Antimicrob 2004; 3:17-21.
• Alp E, Voss A. Ventilator associated pneumonia and infection control. Ann Clin Microbiol Antimicrob 2006;5:7.
• Yepes D, Gil B, Hernandez O, Murillo R, Gonzalez M, Valesquez JP. Ventilator associated pneumonia and trans- fusion, is there really an association? (the NAVTRA study). BMC Pulmonary Medicine 2006;6:18.
• Guidelines for prevention of nosocomial pneumonia. Centers for Disease Control and Prevention. MMWR Recomm Rep 1997;46(RR-1):1-79.
• Carrilho CM, Grion CM, Bonametti AM, Medeiros EA, Mat- suo T. Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units. Braz J Infect Dis 2007;11:339-344.
• Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a co- hort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281-288.
• 14 Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.
• Antonelli M, Conti G, Rocco M, et al. A comparison of non- invasive positive pressure ventlation and conventional me- chanican ventilation in patients with acute respiratory failure. N Engl J Med 1998;339:429-435.
• Nourdine K, Combes P, Carton MJ, Beuret P, Cannamela A, Ducreux JC. Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. In- tensive Care Med 1999;25:567-573.
• Girou E, Schortgen F, Delclaux C, et al. Association of nonin- vasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 2000;284:2361-7.
• Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneu- monia in 4 multidisciplinary intensive care units in Athens, Greece. Respir Care 2003;48:681-688.
• Agarwal R, Gupta D, Ray P, Aggarwal AN, Jindal SK. Epide- miology, risk factors and outcome of nosocomial infections in a Respiratory Intensive Care Unit in North India. J Infect 2006;53:98-105.
• Giamberardino H, Cesário E, Carmes E, Mulinari RA. Risk factors for nosocomial infection in trauma patients. Braz J Infect Dis 2007;11:285-289.
• McCusker M, Périssé A, Roghmann M. Severity-of-illness markers as predictors of nosocomial infection in adult inten- sive care unit patients. Am J Infect Control 2002;30:139-144.