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Prevalence, Risk Factors, and Mortality for Ventilator-Associated Pneumonia in Middle-Aged, Old, and Very Old Critically Ill Patients*

Blot, Stijn PhD1; Koulenti, Despoina PhD2,3; Dimopoulos, George PhD2; Martin, Claude PhD4; Komnos, Apostolos MD5; Krueger, Wolfgang A. PhD6; Spina, Giuseppe MD7; Armaganidis, Apostolos PhD2; Rello, Jordi PhD8; and the EU-VAP Study Investigators

Critical Care Medicine:
doi: 10.1097/01.ccm.0000435665.07446.50
Clinical Investigations
Abstract

Objective: We investigated the epidemiology of ventilator-associated pneumonia in elderly ICU patients. More precisely, we assessed prevalence, risk factors, signs and symptoms, causative bacterial pathogens, and associated outcomes.

Design: Secondary analysis of a multicenter prospective cohort (EU-VAP project).

Setting: Twenty-seven European ICUs.

Patients: Patients who were mechanically ventilated for greater than or equal to 48 hours. We compared middle-aged (45–64 yr; n = 670), old (65–74 yr; n = 549), and very old patients (≥ 75 yr; n= 516).

Measurements and Main Results: Ventilator-associated pneumonia occurred in 103 middle-aged (14.6%), 104 old (17.0%), and 73 very old patients (12.8%). The prevalence (n ventilator-associated pneumonia/1,000 ventilation days) was 13.7 in middle-aged patients, 16.6 in old patients, and 13.0 in very old patients. Logistic regression analysis could not demonstrate older age as a risk factor for ventilator-associated pneumonia. Ventilator-associated pneumonia in elderly patients was more frequently caused by Enterobacteriaceae (24% in middle-aged, 32% in old, and 43% in very old patients; p = 0.042). Regarding clinical signs and symptoms at ventilator-associated pneumonia onset, new temperature rise was less frequent among very old patients (59% vs 76% and 74% for middle-aged and old patients, respectively; p = 0.035). Mortality among patients with ventilator-associated pneumonia was higher among elderly patients: 35% in middle-aged patients versus 51% in old and very old patients (p = 0.036). Logistic regression analysis confirmed the importance of older age in the risk of death (adjusted odds ratio for old age, 2.1; 95% CI, 1.2–3.9 and adjusted odds ratio for very old age, 2.3; 95% CI, 1.2–4.4). Other risk factors for mortality in ventilator-associated pneumonia were diabetes mellitus, septic shock, and a high-risk pathogen as causative agent.

Conclusions: In this multicenter cohort study, ventilator-associated pneumonia did not occur more frequently among elderly, but the associated mortality in these patients was higher. New temperature rise was less common in elderly patients with ventilator-associated pneumonia, whereas more episodes among elderly patients were caused by Enterobacteriaceae.

Author Information

1Department of Internal Medicine, Ghent University, Ghent, Belgium.

2Attikon University Hospital, Athens, Greece.

3Critical Care Department, The Burns, Trauma, and Critical Care Research Center, The University of Queensland, Brisbane, QLD, Australia.

4Critical Care Department, Nord University Hospital, Marseille, France.

5Critical Care Department, General Hospital of Larisa, Larisa, Greece.

6Critical Care Department, Clinics of Constance, Constance, Germany.

7Department of Intensive Care, Mauriziano Hospital, Turin, Italy.

8Critical Care Department, Vall d’Hebron University Hospital, CIBERES, Universitat Autonoma de Barcelona, Barcelona, Spain.

* See also p. 742.

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Supported, in part, by Generalitat de Catalunya grant (SGR 05/920), CIBER Enfermedades Respiratorias, and Carlos III Health Institute grants (PI05/2410 and AI/07/90031).

Dr. Blot is an associate board member for the prevention of postoperative pulmonary complications. Dr. Blot received grant support from Ghent University (Special Research Fund) and received support for educational development of slide kit on endotracheal tube management. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: stijn.blot@ugent.be

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins