Ventilator-associated pneumonia in the home care setting

Abstract

Objective: To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home.

Design: Retrospective cohort study.

Setting: University-affiliated home care service.

Patients: Patients receiving mechanical ventilation at home from June 1995 through December 2001.

Results: Fifty-seven patients underwent ventilation at home for a total of 50,762 ventilator-days (mean +/- SD, 890.6 +/- 644.43 days; range, 76-2,458 days). Seventy-nine episodes of VAP occurred in 27 patients (rate, 1.55 episodes per 1,000 ventilator-days). The first episode of VAP occurred after a mean (+/-SD) of 245 +/- 318.07 ventilator-days. VAP was most common during the first 500 days of ventilation. Rates of VAP were higher among patients who required ventilation for longer daily durations, compared with those who required it for shorter daily durations. There was no association of VAP with age, sex, underlying disease, reason for ventilation, antacid therapy, or steroid use. Microorganisms isolated from 33 episodes of VAP with available culture results included Pseudomonas species (17 isolates), Staphylococcus aureus (11), Serratia species (7), and Stenotrophomonas species (5). Eight patients died during the study; no deaths were attributed to pneumonia.

Conclusions: Although the organisms associated with VAP in the home setting are similar to those associated with hospital-acquired VAP, the incidence and mortality is much lower in the home care setting. Interventions to reduce the risk of VAP among patients receiving home care should be focused on patients who require ventilation for longer daily durations or who are new to receiving mechanical ventilation at home.