Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World Data
<b>Background/Objectives</b>: Ventilator-associated pneumonia (VAP) is the main nosocomial infection in intensive care units (ICUs) that causes the highest morbidity and mortality. The aim of our study is to investigate variations in crude ICU mortality among patients with VAP over the p...
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2025-02-01
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| author | Alejandro Rodríguez Julen Berrueta Carolina Páez Ronny Huertas Marco Marotta Laura Claverias Josep Gómez Sandra Trefler Frederic F. Gómez Bertomeu María Dolores Guerrero-Torres Sergio Pardo-Granell Ester Picó-Plana Alicia Selles-Sánchez Francisco Javier Candel Ignacio Martín-Loeches María Bodí |
| author_facet | Alejandro Rodríguez Julen Berrueta Carolina Páez Ronny Huertas Marco Marotta Laura Claverias Josep Gómez Sandra Trefler Frederic F. Gómez Bertomeu María Dolores Guerrero-Torres Sergio Pardo-Granell Ester Picó-Plana Alicia Selles-Sánchez Francisco Javier Candel Ignacio Martín-Loeches María Bodí |
| author_sort | Alejandro Rodríguez |
| collection | DOAJ |
| description | <b>Background/Objectives</b>: Ventilator-associated pneumonia (VAP) is the main nosocomial infection in intensive care units (ICUs) that causes the highest morbidity and mortality. The aim of our study is to investigate variations in crude ICU mortality among patients with VAP over the past decade. We also wish to identify associated risk factors, evaluate changes in the etiology, and assess the incidence and impact of inappropriate empirical antibiotic treatment (IEAT). <b>Methods</b>: We conducted a retrospective, observational, single-center study over a 10-year period (2014–2024), including critically ill patients who developed VAP. The population was divided into three periods: (P1) from 2014 to 2018 (pre-COVID-19); (P2) from 2019 to 2021 (COVID-19); and (P3) from 2022 to 2024 (post-COVID-19). Binary logistic regression was used to identify which variables were independently associated with ICU mortality. <b>Results</b>: A total of 220 patients were included in the study (P1 = 47, P2 = 96, and P3 = 77 patients). The most prevalent microorganisms identified were <i>P. aeruginosa</i>, <i>Klebsiella</i> spp., and <i>S. aureus</i>. Significant variations in etiology were not observed over the years. The incidence of IEAT was 4.5%, with no observed differences between the study periods. Crude ICU mortality was 33.6%, with higher rates observed in IEAT (40% vs. 33.3%, <i>p</i> = 0.73). In patients with appropriate empiric antibiotic treatment (AEAT), there was a significant decrease in crude mortality over the years from 42.2% in P1 to 22.2% in P3 (<i>p</i> < 0.001). Age (OR = 1.04; 95% CI = 1.01–1.08) and P2 (OR = 2.8; 95% CI = 1.1–7.4) were found to be independently associated with an increased risk of mortality. Conversely, a lower risk of death was associated with mean arterial pressure (OR = 0.94; 95% CI = 0.69–0.99) and the use of syndromic respiratory panel (OR = 0.23; 95% CI = 0.07–0.68). <b>Conclusions</b>: A reduction in crude VAP mortality over the years was observed, with no change in the etiology or rate of IEAT. The implementation of protocols using respiratory syndromic panels could be a measure to implement to reduce VAP mortality. |
| format | Article |
| id | doaj-art-024e2517dc264c14823fa95dbbdc2245 |
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| issn | 2227-9059 |
| language | English |
| publishDate | 2025-02-01 |
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| series | Biomedicines |
| spelling | doaj-art-024e2517dc264c14823fa95dbbdc22452025-08-20T03:12:16ZengMDPI AGBiomedicines2227-90592025-02-0113236010.3390/biomedicines13020360Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World DataAlejandro Rodríguez0Julen Berrueta1Carolina Páez2Ronny Huertas3Marco Marotta4Laura Claverias5Josep Gómez6Sandra Trefler7Frederic F. Gómez Bertomeu8María Dolores Guerrero-Torres9Sergio Pardo-Granell10Ester Picó-Plana11Alicia Selles-Sánchez12Francisco Javier Candel13Ignacio Martín-Loeches14María Bodí15Intensive Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainIntensive Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainPostgrado Medicina Crítica y Cuidado Intensivo, Facultad de Medicina, Fundación Universitari Ciencias de la Salud, Distrito Especial, Cra. 54 No. 67A-80, Bogotá 111221, ColombiaTarragona Health Data Research Working Group (THeDaR), 43005 Tarragona, SpainIntensive Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainIntensive Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainTechnical Secretary’s Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainIntensive Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainIISPV (Instituto de Investigación Sanitaria Pere Virgili), 43005 Tarragona, SpainMicrobiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragon, SpainMicrobiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragon, SpainMicrobiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragon, SpainMicrobiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragon, SpainClinical Microbiology & Infectious Diseases Department, Hospital Clínico Universitario San Carlos, 28040 Madrid, SpainDepartment of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James’ Hospital, D08 NHY1 Dublin, IrelandIntensive Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain<b>Background/Objectives</b>: Ventilator-associated pneumonia (VAP) is the main nosocomial infection in intensive care units (ICUs) that causes the highest morbidity and mortality. The aim of our study is to investigate variations in crude ICU mortality among patients with VAP over the past decade. We also wish to identify associated risk factors, evaluate changes in the etiology, and assess the incidence and impact of inappropriate empirical antibiotic treatment (IEAT). <b>Methods</b>: We conducted a retrospective, observational, single-center study over a 10-year period (2014–2024), including critically ill patients who developed VAP. The population was divided into three periods: (P1) from 2014 to 2018 (pre-COVID-19); (P2) from 2019 to 2021 (COVID-19); and (P3) from 2022 to 2024 (post-COVID-19). Binary logistic regression was used to identify which variables were independently associated with ICU mortality. <b>Results</b>: A total of 220 patients were included in the study (P1 = 47, P2 = 96, and P3 = 77 patients). The most prevalent microorganisms identified were <i>P. aeruginosa</i>, <i>Klebsiella</i> spp., and <i>S. aureus</i>. Significant variations in etiology were not observed over the years. The incidence of IEAT was 4.5%, with no observed differences between the study periods. Crude ICU mortality was 33.6%, with higher rates observed in IEAT (40% vs. 33.3%, <i>p</i> = 0.73). In patients with appropriate empiric antibiotic treatment (AEAT), there was a significant decrease in crude mortality over the years from 42.2% in P1 to 22.2% in P3 (<i>p</i> < 0.001). Age (OR = 1.04; 95% CI = 1.01–1.08) and P2 (OR = 2.8; 95% CI = 1.1–7.4) were found to be independently associated with an increased risk of mortality. Conversely, a lower risk of death was associated with mean arterial pressure (OR = 0.94; 95% CI = 0.69–0.99) and the use of syndromic respiratory panel (OR = 0.23; 95% CI = 0.07–0.68). <b>Conclusions</b>: A reduction in crude VAP mortality over the years was observed, with no change in the etiology or rate of IEAT. The implementation of protocols using respiratory syndromic panels could be a measure to implement to reduce VAP mortality.https://www.mdpi.com/2227-9059/13/2/360ventilator-associated pneumoniaempiric antibiotic treatmentoutcomeepidemiologysyndromic respiratory panel |
| spellingShingle | Alejandro Rodríguez Julen Berrueta Carolina Páez Ronny Huertas Marco Marotta Laura Claverias Josep Gómez Sandra Trefler Frederic F. Gómez Bertomeu María Dolores Guerrero-Torres Sergio Pardo-Granell Ester Picó-Plana Alicia Selles-Sánchez Francisco Javier Candel Ignacio Martín-Loeches María Bodí Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World Data Biomedicines ventilator-associated pneumonia empiric antibiotic treatment outcome epidemiology syndromic respiratory panel |
| title | Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World Data |
| title_full | Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World Data |
| title_fullStr | Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World Data |
| title_full_unstemmed | Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World Data |
| title_short | Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World Data |
| title_sort | ten year evaluation of ventilator associated pneumonia vap according to initial empiric treatment a retrospective analysis using real world data |
| topic | ventilator-associated pneumonia empiric antibiotic treatment outcome epidemiology syndromic respiratory panel |
| url | https://www.mdpi.com/2227-9059/13/2/360 |
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