Pathogens Identified in Patients with Ventilator Associated Pneumonia and their Impact on Outcomes
Background: Ventilator-associated pneumonia (VAP) is associated with prolonged hospitalisation, excessive antibiotic use and high mortality. The role of the various pathogens identified in patients with VAP is not well known especially in low and middle income countries (LMIC) and high income countr...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
|
| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224007604 |
| _version_ | 1826574516566884352 |
|---|---|
| author | Dr Srishti Chhabra Dr. Suchart Booraphun Dr. Andrew Yunkai Li Dr. Pornanan Domthong Dr. Gyan Kayastha Dr. Yie Hui Lau Dr. Ploenchan Chetchotisakd Professor Direk Limmathurotsakul Professor Paul Anantharajah Tambyah Professor Ben S Cooper Dr. Yin Mo |
| author_facet | Dr Srishti Chhabra Dr. Suchart Booraphun Dr. Andrew Yunkai Li Dr. Pornanan Domthong Dr. Gyan Kayastha Dr. Yie Hui Lau Dr. Ploenchan Chetchotisakd Professor Direk Limmathurotsakul Professor Paul Anantharajah Tambyah Professor Ben S Cooper Dr. Yin Mo |
| author_sort | Dr Srishti Chhabra |
| collection | DOAJ |
| description | Background: Ventilator-associated pneumonia (VAP) is associated with prolonged hospitalisation, excessive antibiotic use and high mortality. The role of the various pathogens identified in patients with VAP is not well known especially in low and middle income countries (LMIC) and high income countries (HIC) in Asia. Methods: The REGARD-VAP study was a randomised trial conducted in 39 intensive care units in Nepal, Singapore and Thailand. Adults aged ≥18 years with VAP (as defined using the US Centers for Disease Control and Prevention National Healthcare Safety Network criteria), who had been mechanically ventilated for ≥48 hours, and received culture-directed antibiotics were enrolled. In culture-negative cases, antibiotics were prescribed as per local hospital antibiograms. We analysed the effect of causative pathogens of VAP on 60-day mortality and 60-day VAP recurrence. Results: The study enrolled 460 participants and the majority (65.9%) of VAP with pathogens identified was associated with Gram-negative non-fermenters (Pseudomonas spp, Acinetobacter spp, Stenotrophomonas spp, Burkholderia spp). LMICs had significantly higher proportion of VAP associated with non-fermenters (VAPnf) (49.5% vs 30.0%, p=0.009), particularly carbapenem resistant (CR) VAPnf (28.8% vs 10.0%, p=0.005) compared to HICs. The proportion of Carbapenem sensitive VAPnf and VAP caused by CR Enterobacterales (CRE) did not differ significantly between the two income groups. Participants with VAPnf had a longer hospital stay (45 days (IQR 27–77) vs 36 days (IQR 21–73), p=0.006) and longer duration of intubation (17 days (IQR 12–26) vs 13 days (IQR 9–19), p<0.001). In a multivariable logistic regression model, VAPnf was independently associated with increased mortality (OR 2.05 (95% CI 1.32–3.17), p=0.001) after adjusting for age, gender, disease severity by qSOFA score and requirement for inotropic support, Charlson comorbidity index, and antibiotic duration. However, 60-day VAP recurrence was not associated with VAPnf (OR 1.34 (95% CI 0.76–2.38), p=0.317), but rather with comorbidities such as chronic obstructive pulmonary disease (OR 3.79 (95% CI 1.54–9.32), p=0.004) and congestive cardiac failure (OR 2.89 (95% CI 1.17–7.16), p=0.022). There was no difference in mortality amongst participants who were on empiric antibiotics to which the VAPnf was susceptible in vitro and those who were not on a susceptible regimen (OR 0.93 (95%CI 0.50 – 1.72), p=0.816) prior to switching to culture-directed antibiotics. Conclusion: In high-, middle- and low-income countries in Asia, we found high rates of Gram-negative non-fermenters isolated in patients with VAP which were associated with higher mortality and longer hospitalisation. LMICs had a higher proportion of CR VAPnf compared to HICs. There is a need for both better treatment and prevention options for these difficult to treat pathogens across the income spectrum in Asia. |
| first_indexed | 2025-03-14T13:00:03Z |
| format | Article |
| id | doaj.art-48229860f5a34a79bbef94d30cded0f5 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2025-03-14T13:00:03Z |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-48229860f5a34a79bbef94d30cded0f52025-03-02T04:33:34ZengElsevierInternational Journal of Infectious Diseases1201-97122025-03-01152107685Pathogens Identified in Patients with Ventilator Associated Pneumonia and their Impact on OutcomesDr Srishti Chhabra0Dr. Suchart Booraphun1Dr. Andrew Yunkai Li2Dr. Pornanan Domthong3Dr. Gyan Kayastha4Dr. Yie Hui Lau5Dr. Ploenchan Chetchotisakd6Professor Direk Limmathurotsakul7Professor Paul Anantharajah Tambyah8Professor Ben S Cooper9Dr. Yin Mo10Division of Infectious Diseases, Department of Medicine, National University HospitalSunpasitthiprasong HospitalDepartment of Intensive Care Medicine, Woodlands HealthKhon Kaen HospitalPatan Hospital, Patan Academy of Health SciencesAnaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng HospitalSrinagarind Hospital, Khon Kaen UniversityCentre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityDivision of Infectious Diseases, Department of Medicine, National University Hospital; Infectious Diseases Translational Research Program, National University of SingaporeCentre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityDivision of Infectious Diseases, Department of Medicine, National University Hospital; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University; Infectious Diseases Translational Research Program, National University of SingaporeBackground: Ventilator-associated pneumonia (VAP) is associated with prolonged hospitalisation, excessive antibiotic use and high mortality. The role of the various pathogens identified in patients with VAP is not well known especially in low and middle income countries (LMIC) and high income countries (HIC) in Asia. Methods: The REGARD-VAP study was a randomised trial conducted in 39 intensive care units in Nepal, Singapore and Thailand. Adults aged ≥18 years with VAP (as defined using the US Centers for Disease Control and Prevention National Healthcare Safety Network criteria), who had been mechanically ventilated for ≥48 hours, and received culture-directed antibiotics were enrolled. In culture-negative cases, antibiotics were prescribed as per local hospital antibiograms. We analysed the effect of causative pathogens of VAP on 60-day mortality and 60-day VAP recurrence. Results: The study enrolled 460 participants and the majority (65.9%) of VAP with pathogens identified was associated with Gram-negative non-fermenters (Pseudomonas spp, Acinetobacter spp, Stenotrophomonas spp, Burkholderia spp). LMICs had significantly higher proportion of VAP associated with non-fermenters (VAPnf) (49.5% vs 30.0%, p=0.009), particularly carbapenem resistant (CR) VAPnf (28.8% vs 10.0%, p=0.005) compared to HICs. The proportion of Carbapenem sensitive VAPnf and VAP caused by CR Enterobacterales (CRE) did not differ significantly between the two income groups. Participants with VAPnf had a longer hospital stay (45 days (IQR 27–77) vs 36 days (IQR 21–73), p=0.006) and longer duration of intubation (17 days (IQR 12–26) vs 13 days (IQR 9–19), p<0.001). In a multivariable logistic regression model, VAPnf was independently associated with increased mortality (OR 2.05 (95% CI 1.32–3.17), p=0.001) after adjusting for age, gender, disease severity by qSOFA score and requirement for inotropic support, Charlson comorbidity index, and antibiotic duration. However, 60-day VAP recurrence was not associated with VAPnf (OR 1.34 (95% CI 0.76–2.38), p=0.317), but rather with comorbidities such as chronic obstructive pulmonary disease (OR 3.79 (95% CI 1.54–9.32), p=0.004) and congestive cardiac failure (OR 2.89 (95% CI 1.17–7.16), p=0.022). There was no difference in mortality amongst participants who were on empiric antibiotics to which the VAPnf was susceptible in vitro and those who were not on a susceptible regimen (OR 0.93 (95%CI 0.50 – 1.72), p=0.816) prior to switching to culture-directed antibiotics. Conclusion: In high-, middle- and low-income countries in Asia, we found high rates of Gram-negative non-fermenters isolated in patients with VAP which were associated with higher mortality and longer hospitalisation. LMICs had a higher proportion of CR VAPnf compared to HICs. There is a need for both better treatment and prevention options for these difficult to treat pathogens across the income spectrum in Asia.http://www.sciencedirect.com/science/article/pii/S1201971224007604 |
| spellingShingle | Dr Srishti Chhabra Dr. Suchart Booraphun Dr. Andrew Yunkai Li Dr. Pornanan Domthong Dr. Gyan Kayastha Dr. Yie Hui Lau Dr. Ploenchan Chetchotisakd Professor Direk Limmathurotsakul Professor Paul Anantharajah Tambyah Professor Ben S Cooper Dr. Yin Mo Pathogens Identified in Patients with Ventilator Associated Pneumonia and their Impact on Outcomes International Journal of Infectious Diseases |
| title | Pathogens Identified in Patients with Ventilator Associated Pneumonia and their Impact on Outcomes |
| title_full | Pathogens Identified in Patients with Ventilator Associated Pneumonia and their Impact on Outcomes |
| title_fullStr | Pathogens Identified in Patients with Ventilator Associated Pneumonia and their Impact on Outcomes |
| title_full_unstemmed | Pathogens Identified in Patients with Ventilator Associated Pneumonia and their Impact on Outcomes |
| title_short | Pathogens Identified in Patients with Ventilator Associated Pneumonia and their Impact on Outcomes |
| title_sort | pathogens identified in patients with ventilator associated pneumonia and their impact on outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S1201971224007604 |
| work_keys_str_mv | AT drsrishtichhabra pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT drsuchartbooraphun pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT drandrewyunkaili pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT drpornanandomthong pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT drgyankayastha pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT dryiehuilau pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT drploenchanchetchotisakd pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT professordireklimmathurotsakul pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT professorpaulanantharajahtambyah pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT professorbenscooper pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes AT dryinmo pathogensidentifiedinpatientswithventilatorassociatedpneumoniaandtheirimpactonoutcomes |