Effect of hospital-acquired ventilator-associated pneumonia on mortality of severe community-acquired pneumonia

J Crit Care. 1999 Mar;14(1):12-9. doi: 10.1016/s0883-9441(99)90003-5.

Abstract

Purpose: The purpose of this article is to evaluate, using two pairwise case-control studies, attributable mortality linked to hospital-acquired ventilator-associated pneumonia (HA-VAP) complicating the intensive care unit (ICU) stay of patients exhibiting severe community-acquired pneumonia (CAP).

Materials and methods: Over an 11-year period, 498 patients with severe CAP were collected. Among them, 43 exhibited HA-VAP. In a first case-control study, these patients were matched with control on the basis of six confounding variables known to be general ICU prognosis factors. In a second case-control study, six variables specifically linked to CAP prognosis were used for matching.

Results: In the two case-control studies, each case patient was matched with one control patient. In the first analysis, success of matching was achieved in 198 of 258 (77%) variables used for matching. In the second analysis, matching was successful for 242 of 258 (94%) confounding variables used. Eighteen patients died, compared with, respectively, 6 (P = .003) and 7 (P = .01) controls. Attributable mortality of HA-VAP was similar in the two pairwise analyses, respectively, 28% (risk ratio = 3.0; 95% confidence interval, 1.32 to 6.82) and 26% (risk ratio = 2.57; 95% confidence interval, 1.2 to 5.52).

Conclusion: When confounding factors were controlled, HA-VAP appeared to increase mortality of severe CAP requiring ICU admission.

MeSH terms

  • Aged
  • Case-Control Studies
  • Community-Acquired Infections / complications*
  • Community-Acquired Infections / mortality
  • Community-Acquired Infections / therapy
  • Confounding Factors, Epidemiologic
  • Critical Care*
  • Cross Infection / complications*
  • Cross Infection / etiology
  • Cross Infection / mortality
  • Female
  • Glasgow Coma Scale
  • Humans
  • Male
  • Middle Aged
  • Pneumonia, Bacterial / complications
  • Pneumonia, Bacterial / mortality*
  • Pneumonia, Bacterial / therapy
  • Prognosis
  • Prospective Studies
  • Respiration, Artificial / adverse effects*
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Analysis