Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination

• Published in: Intensive care medicine 2005, Vol.31 (1), p.64-70
• Main Authors: LEONE, Marc, DELLIAUX, Stéphane, BOURGOIN, Aurélie, ALBANESE, Jacques, GARNIER, Franck, BOYADJIEV, Ioana, ANTONINI, Francois, MARTIN, Claude
• Format: Article
• Language: English
• Subjects: Adult; Amphotericin B - therapeutic use; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Artificial respiration; Bacterial pneumonia; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Care and treatment; Case studies; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency and intensive respiratory care; Female; Gentamicins - therapeutic use; Hospital Mortality; Humans; Injury Severity Score; Intensive care; Intensive care medicine; Intensive Care Units; Intubation; Logistic Models; Male; Medical sciences; Pneumonia; Pneumonia - etiology; Prospective Studies; Regression analysis; Respiration, Artificial - adverse effects; Risk Factors; Statistics; Trauma; Ulcers; Ventilators; Wounds and Injuries - classification; Wounds and Injuries - complications
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-004-2514-z

To determine the independent risk factors for late-onset ventilator-associated pneumonia (VAP) in trauma patients receiving selective digestive decontamination (SDD). A 4-year, prospective cohort study of trauma patients meeting the following criteria: injury severity score >15, and duration of mechanical ventilation >5 days. Predictors of late-onset VAP occurrence were assessed by logistic regression analysis. All patients received SDD consisting of polymixin E, gentamicin, and amphotericin B applied in nostrils, mouth, and gut with a 3-day course of parenteral cefazolin. VAP was suspected on clinical and radiological signs, and confirmed by the presence of at least one microorganism at a concentration of at least 10(4) CFU/ml on the broncho-alveolar lavage. Independent risk factors for late-onset VAP. A late-onset VAP was diagnosed in 90 (56%) out of 159 patients. Predicting factors for late-onset VAP were: use of non-depolarizing muscle relaxant agents for intubation [3.4 (CI 1.08-10.73)], duration of intubation [1.06 (CI 1.01-1.17)], length of intensive care unit (ICU) stay [1.05 (CI 1.02-1.09)], and prior tracheal colonization [1.03 (CI 1.02-1.21)]. Exposure to prior antimicrobial treatment, except SDD, conferred protection [0.3 (0.12-0.74)]. This study confirms the role of duration of intubation, length of ICU stay, and prior tracheal colonization in the development of late-onset VAP. The results also highlight the importance of the initial management on the development of late-onset VAP. The type of neuromuscular blocking agents to intubate trauma patients should be evaluated in future studies.