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. 2023 Feb 24;5(3):e0867.
doi: 10.1097/CCE.0000000000000867. eCollection 2023 Mar.

Determinants of Mortality for Ventilated Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Hayley Motowski  1 , Daniel Ilges  2 , Nicholas Hampton  3 , Marin H Kollef  4 , Scott T Micek  5   6
Affiliations

Determinants of Mortality for Ventilated Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Hayley Motowski et al. Crit Care Explor. .

Abstract

Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection, accounting for 22% of all nosocomial infections. The available studies to date have not attempted to assess whether confounding factors may account for the observed difference in mortality for the two forms of nosocomial pneumonia associated with mechanical ventilation, namely ventilated HAP (vHAP) and ventilator-associated pneumonia (VAP).

Objectives: To determine if vHAP is an independent predictor of mortality among patients with nosocomial pneumonia.

Design setting and participants: Single-center retrospective cohort study conducted at Barnes-Jewish Hospital, St. Louis, MO, between 2016 and 2019. Adult patients with a pneumonia discharge diagnosis were screened and patients diagnosed with vHAP and VAP were included. All patient data was extracted from the electronic health record.

Main outcomes and measures: The primary outcome was 30-day all-cause mortality (ACM).

Results: One thousand one-hundred twenty unique patient admissions were included (410 vHAP, 710 VAP). Thirty-day ACM was greater for patients with vHAP compared with VAP (37.1% vs 28.5%; p = 0.003). Logistic regression analysis identified vHAP (adjusted odds ratio [AOR], 1.77; 95% CI, 1.51-2.07), vasopressor use (AOR, 2.34; 95% CI, 1.94-2.82), Charlson Comorbidity Index (1-point increments) (AOR, 1.21; 95% CI, 1.18-1.24), total antibiotic treatment days (1-d increments) (AOR, 1.13; 95% CI, 1.11-1.14), and Acute Physiology and Chronic Health Evaluation II score (1-point increments) (AOR, 1.04; 95% CI, 1.03-1.06) as independent predictors of 30-day ACM. The most common bacterial pathogens identified as causes of vHAP and VAP were Staphylococcus aureus, Enterobacterales species, and Pseudomonas aeruginosa.

Conclusions and relevance: In this single-center cohort study with low rates of initial inappropriate antibiotic therapy, vHAP had greater 30-day ACM compared with VAP after adjusting for potential confounding variables including disease severity and comorbidities. This finding suggests that clinical trials enrolling patients with vHAP need to account for this outcome difference in their trial design and data interpretation.

Keywords: critical care; diagnosis; hospital-acquired pneumonia; intensive care; mortality; ventilator-associated pneumonia.

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Conflict of interest statement

Dr. Kollef’s efforts are supported by the Barnes-Jewish Hospital Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Study flow diagram. HAP = hospital-acquired pneumonia, ICD-9 = International Classification of Diseases, 9th Revision, ICD-10 = International Classification of Diseases, 10th Revision, VAP = ventilator-associated pneumonia, vHAP = ventilated hospital-acquired pneumonia.
Figure 2.
Figure 2.
Kaplan-Meier survival curves for 30-d all-cause mortality. Log-rank test: p = 0.004. VAP = ventilator-associated pneumonia, vHAP = ventilated hospital-acquired pneumonia.
See this image and copyright information in PMC

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