The impact of antimicrobial resistance and aging in VAP outcomes: experience from a large tertiary care center

PLoS One. 2014 Feb 27;9(2):e89984. doi: 10.1371/journal.pone.0089984. eCollection 2014.

Abstract

Background: Ventilator associated pneumonia (VAP) is a serious infection among patients in the intensive care unit (ICU).

Methods: We reviewed the medical charts of all patients admitted to the adult intensive care units of the Massachusetts General Hospital that went on to develop VAP during a five year period.

Results: 200 patients were included in the study of which 50 (25%) were infected with a multidrug resistant pathogen. Increased age, dialysis and late onset (≥ 5 days from admission) VAP were associated with increased incidence of resistance. Multidrug resistant bacteria (MDRB) isolation was associated with a significant increase in median length of ICU stay (19 vs. 16 days, p=0.02) and prolonged duration of mechanical ventilation (18 vs. 14 days, p=0.03), but did not impact overall mortality (HR 1.12, 95% CI 0.51-2.46, p=0.77). However, age (HR 1.04 95% CI 1.01-1.07, p=0.003) was an independent risk factor for mortality and age ≥ 65 years was associated with increased incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections (OR 2.83, 95% CI 1.27-6.32, p=0.01).

Conclusions: MDRB-related VAP is associated with prolonged ICU stay and mechanical ventilation. Interestingly, age ≥ 65 years is associated with MRSA VAP.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Infective Agents / pharmacology*
  • Anti-Infective Agents / therapeutic use
  • Cross Infection
  • Drug Resistance, Microbial*
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Patient Outcome Assessment
  • Pneumonia, Ventilator-Associated / drug therapy
  • Pneumonia, Ventilator-Associated / epidemiology*
  • Pneumonia, Ventilator-Associated / microbiology
  • Prognosis
  • Retrospective Studies
  • Tertiary Care Centers

Substances

  • Anti-Infective Agents

Grants and funding

Part of this work was supported through a grant from Astellas, Inc. No additional funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.