scholarly journals Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand

2021 ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart - So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  

Abstract Background: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (16.7% VS 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95% confidence interval (CI), 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.

2021 ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart - So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  

Abstract Background: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (16.7% VS 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95% confidence interval (CI), 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  

Abstract Background Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50% EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8%) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS [median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days], hospital LOS [median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days] shorter MV days [median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days] and lower hospital mortality (16.7% vs 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 [95% confidence interval (CI), 1.08–4.54, p = 0.02]. Conclusion LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.


2020 ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart - So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  

Abstract Back ground: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 (22%) were EOVAP and 148 (78%) were LOVAP. Acinetobacter baummanii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (11.9 % VS 27.7%) than LOVAP ( p < 0.05). The factor associated with hospital mortality was having simplified acute physiology score (SAP) ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95%CI, 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.


2020 ◽  
Author(s):  
Yuichi Tamura ◽  
Hiraku Kumamaru ◽  
Kohtaro Abe ◽  
Toru Satoh ◽  
Hiroaki Miyata ◽  
...  

Abstract Back ground: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 (22%) were EOVAP and 148 (78%) were LOVAP. Acinetobacter baummanii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (11.9 % VS 27.7%) than LOVAP ( p < 0.05). The factor associated with hospital mortality was having simplified acute physiology score (SAP) ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95%CI, 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.


2020 ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart - So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  

Abstract Back ground: Ventilator-associated pneumonia (VAP) isacommon nocosomial infection inintensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patternsfor early-onset VAP (EOVAP) and late-onset VAP (LOVAP)will help to choose appropriate empiric antibiotics.Objective: To comparethe multi-drug resistant (MDR) pathogens, treatment outcomes,and factors associated with hospital mortality of VAP. Method:A cross-sectional studybetween 1 January 2015 and 31 December 2017 at Srinagarind hospital, KhonKaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed.Results:One hundred and ninety patients were enrolled; 42 (22%) were EOVAP and 148 (78%) were LOVAP. Acinetobacterbaummanii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lowerhospital mortality (11.9 % VS 27.7%) than LOVAP ( p< 0.05). The factor associated with hospital mortality washavingsimplified acute physiology score (SAP)≥ 40 with an adjustedodds ratio(aOR) of 2.22 (95%CI, 1.08-4.54,p = 0.02). Conclusion: LOVAP had significantly higherMDR pathogens, MV days, ICU LOS, hospital LOS andhospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogensshould be considered in LOVAP.The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.


2021 ◽  
pp. 105477382110401
Author(s):  
Audai A. Hayajneh ◽  
Mohammad Rababa ◽  
Sami Al-Rawashedeh

The prevalence of prehospital delay is high among older adults with acute coronary syndrome (ACS). The current study aimed to examine the associated factors of prehospital delay among patients with ACS during the COVID-19 pandemic. This cross-sectional study was conducted on a convenience sample of 300 older adults with ACS admitted to the emergency department in Jordan. Data were collected from June 1 to September 1, 2020. Bivariate and multivariate analyses were used to explore the predictors of prehospital delay. Being widowed, educational level, pain intensity, the gradual onset of ACS symptoms, symptoms lasting for more than 30 minutes, patients’ feeling anxious about their ACS symptoms, patients’ perceiving their symptoms to be particularly dangerous, history of myocardial infarction (MI), and mode of transportation were associated with the time taken before seeking emergency care. Significant predictors of time to seek help were chief complaint of chest pain or palpitations, abrupt onset of symptoms, the associated symptom of vertigo, and a higher number of chronic illnesses; they explained about 17.9% of the variance in the time to seek care. The average time to seek care among patients with ACS during the COVID-19 pandemic was found to be longer than the average time reported by studies conducted prior the pandemic. Improved understanding of the associations between prehospital delay is crucial for optimal ACS patient outcomes under the impacts of the COVID-19 pandemic.


Author(s):  
Anita Plaza ◽  
Julie Adsett ◽  
Angela Byrnes ◽  
Prue McRae

Abstract Physical activity behaviour has not been previously described in hospitalised adults with burn injuries. This prospective, cross-sectional study used a standardised behavioural mapping protocol to observe patient behaviour related to physical activity over a 12-hour period on one weekday in a quaternary referral specialist burn centre. Structured observations were recorded for each of four domains: 1) patient location, 2) position, 3) activity performed and 4) the presence of others. Observations were summarised across all participants as median (IQR) proportion of time. Participants (n=17) were predominantly male (82%) with a mean age of 44.3 (SD 15.2) years, a mean burn size of 34.9% (SD 26.7) total body surface area and a median hospital length of stay of 18 (IQR 6-49) days at time of observation. Participants spent a median of 83% (IQR 73-93) of time in their bedroom, 92% (IQR 68-97) of time in or on their bed and a median of 5% (IQR 3-13) of time mobilising. Exercise accounted for 10% (IQR 8-17) of activity related observations. A median of 68% (IQR 39-83) of time was spent alone. Results suggest time spent engaging in physical activity is low. Further studies are required to investigate motivators and barriers to performing physical activity in this population. This will consequently inform the development and implementation of appropriate strategies to improve physical activity behaviour in this cohort.


2019 ◽  
Vol 57 (216) ◽  
Author(s):  
Anita Lamichhane ◽  
Aparna Mishra

Introduction: Ventilator-associated pneumonia is a serious problem which needs to be addressed for a better outcome of the ventilated babies. The present study is undertaken to find out the prevalence of ventilator-associated pneumonia in neonates in a tertiary care hospital in western Nepal.Methods: A descriptive cross-sectional study was carried out in a tertiary care hospital in the western region of Nepal from March 2016 to February 2019 after approval from the Institutional review committee. Sample size was calculated and convenience sampling was done to reach the sample size. Data were collected from hospital records and entered in Statistical Package for the Social Sciences, point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.Results: Out of 95 patients ventilated in neonatal intensive care unit in the last 3 years, 23 (24.01%) developed ventilator-associated pneumonia. Prevalence of ventilator-associated pneumonia is 23 (24.01%) at 95% (14%-34%). Late onset ventilator associated pneumonia was seen in 15 (15.78%) while early onset ventilator associated pneumonia was seen in 8 (8.42%). Conclusions: Prevalence of ventilator associated pneumonia in neonates in tertiary care hospital is high compared to other studies conducted in neonates.


2018 ◽  
Vol 12 (8) ◽  
pp. 2105
Author(s):  
Alexandre Lins Werneck ◽  
Ligia Marcia Contrin ◽  
Lucia Marinilza Beccaria ◽  
Gabriela Taparo De Castro ◽  
Carolina Varine Teixeira ◽  
...  

RESUMOObjetivo: associar as principais complicações com pacientes submetidos à cirurgia cardíaca e o tempo de internação. Método: estudo quantitativo, transversal, descritivo e correlacional, para identificar os registros médicos de pacientes submetidos a cirurgias cardíacas e aqueles no pós-operatório na Unidade de Terapia Intensiva. O teste de Regressão Linear Multivariada foi utilizado para a análise e a previsão de independência entre as variáveis. Resultados: dos 103 pacientes submetidos a cirurgias cardíacas, 26 apresentaram complicações pós-operatórias. As complicações mais prevalentes foram cardíacas, pulmonares e infecciosas. Nove pacientes morreram. A doença anterior mais prevalente foi hipertensão arterial sistêmica. Em relação aos dias de hospitalização, o predomínio foi de um a três dias, seguido de três a seis dias. Conclusão: a revascularização miocárdica foi a principal cirurgia realizada, seguida de endarterectomia e as complicações observadas foram cardíacas, seguidas das pulmonares. A duração hospitalar dos pacientes variou de um a três dias. Este estudo mostrou que é imprescindível o planejamento da alta do paciente o mais precocemente possível para a diminuição do tempo de internação e possíveis complicações. Descritores: Complicações; Cirurgias Cardíacas; Pacientes; Tempo de Internação; Tempo de Internação; Alta do Paciente; Unidade de Terapia Intensiva.ABSTRACT Objective: to associate the main complications experienced by patients submitted to cardiac surgery and the length of stay in a Cardiac ICU. Method: this was a quantitative, cross-sectional study using descriptive and correlation designs. We identified medical records of patients undergoing cardiac surgeries and those who were in the postoperative period in the Intensive Care Unit. Multivariate Linear Regression test was used for THE analysis and THE prediction of independence between variables. Results: twenty-six out of 103 patients submitted to cardiac surgeries presented postoperative complications. The most prevalent complications were cardiac, pulmonary, and infectious ones. Nine patients died. The most prevalent previous disease was systemic arterial hypertension. Regarding the hospital length of stay, the predominance was ONE to THREE days, followed by THREE to six days. Conclusion: The hospital length of stay ranged from ONE to THREE days long. This STUDY showed that planning is essential to set up the patient’s discharge as early as possible, as well as to reduce the hospital length of stay and potential complications. Descriptor: Complications; Thoracic Surgery; Patients; Length of Stay; Discharge Plannings; Intensive Care Unit.RESUMENObjetivo: Asociar las principales complicaciones con pacientes sometidos a la cirugía y con el tempo de internación. Método: Estudio cuantitativo, transversal, descriptivo y correlacional del banco de datos del hospital para identificar los registros médicos de pacientes sometidos a cirugías torácicas y de aquellos en el postoperatorio en la Unidad de Cuidados Intensivos. Se utilizó la prueba de Regresión Lineal Múltiple para análisis y predicción de independencia entre las variables.  Resultados: De los 103 pacientes sometidos a cirugías torácicas, 26 presentaron complicaciones postoperatorias. Las complicaciones más prevalentes fueron las cardíacas, las pulmonares y las infecciosas. Nueve pacientes murieron. La enfermedad anterior más prevalente ha sido la hipertensión arterial sistémica. Acerca de los días de hospitalización, el período predominante fue de UNO a TRES días, seguido de TRES a SEIS días. Conclusión: La cirugía de revascularización coronaria ha sido la principal cirugía, seguida de la endarterectomía, y las complicaciones observadas fueron las cardíacas, seguidas de las pulmonares. El tiempo de internación de los pacientes varió de UNO a TRES días. Eso ESTUDIO ha mostrado que es imprescindible planificar el egreso del paciente lo más temprano posible, para reducción del tiempo de internación y de las posibles complicaciones. Descriptores: Complicaciones; Cirurgía Torácica; Pacientes; Tiempo de Internación; Alta del Paciente; Unidades de Cuidados Intensivos.


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