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

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

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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.

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

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