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Ventilator-Associated Pneumonia: Bacteremia and Death After Traumatic Injury
Study Question: What is the incidence of bacteremia with ventilator-associated pneumonia (VAP) and impact on patient outcomes in critically ill, trauma patients?
Study Description: This article describes a retrospective, single-center study of critically ill patients with culture-positive VAP. Secondary bacteremias were considered associated with VAP if the same organism from respiratory cultures was isolated in the blood within 24 hours of VAP diagnosis. A VAP treatment algorithm favored cephalosporins ± vancomycin, and the duration of therapy depended on the pathogen identified and the presence or absence of a secondary bacteremia.
Results: The study included 554 patients with VAP, 14% of whom had secondary bacteremias. The majority of patients had a monomicrobial infection, with the most common organisms being Staphylococcus aureus and Acinetobacter spp. Patients with VAP and an associated bacteremia experienced higher rates of morbidity and mortality (26% and 12%, respectively; p < 0.001 for the latter) than patients with isolated VAP. VAP with bacteremia was associated with an approximate 2.5-fold increase in the risk for death.
Conclusion(s): Traumatically injured patients who experience a secondary bacteremia associated with VAP have worse outcomes than those without a bacteremia.
Perspective: In general, trauma populations are often younger and otherwise healthy at the time of injury (in contrast to medical ICU patients and others) and are therefore likely to represent the lower end of the range of bacteremic incidence associated with episodes of VAP.