Risk factors and pathogens involved in early ventilator-acquired pneumonia in patients with severe subarachnoid hemorrhage

  • R. Cinotti
  • A. Dordonnat-Moynard
  • F. Feuillet
  • A. Roquilly
  • N. Rondeau
  • D. Lepelletier
  • J. Caillon
  • N. Asseray
  • Y. Blanloeil
  • B. Rozec
  • K. Asehnoune
Article

Abstract

Ventilator-acquired pneumonia (VAP) is a common burden in intensive care unit (ICU) patients, but, to date, specific data are not available in patients with severe aneurysmal subarachnoid hemorrhage (SAH). A single neuro-ICU retrospective analysis of 193 patients with SAH requiring mechanical ventilation (MV) ≥48 h admitted from January 2005 to May 2010 was undertaken. The diagnosis of early VAP was prospectively upheld during a multidisciplinary staff meeting, according to the American Thoracic Society (ATS) 2005 guidelines with a threshold of 7 days after the onset of MV. Patients had a median age of 53 (44–62) years and 70 (36 %) were male. The median Glasgow coma scale (GCS) score before MV was 9 (5–14). 142 (74 %) patients had a World Federation of Neurosurgeons (WFNS) score ≥III. Aneurysm was secured with an endovascular coiling procedure in 162 (84 %) patients. 81 (48.7 %) patients declared an early VAP. On multivariate analysis, male sex (odds ratio [OR] 2.26, 95 % confidence interval [CI] [1.14–4.46]), use of mannitol before day 7 (OR 3.03, 95 % CI [1.54–5.95]), and achieving enteral nutrition ≥20 kcal kg−1 day−1 after day 7 (OR 2.91, 95 % CI [1.27–6.67]) remained independent risk factors of VAP. The main pathogens involved were methicillin-susceptible Staphylococcus aureus (MSSA) (34.9 %), Haemophilus influenzae (28.1 %), Streptococcus pneumoniae (15.5 %), and Enterobacteriaceae (10.7 %). Early VAP was associated with a longer duration of MV and ICU stay, but not with an excess of mortality. Early VAP bears significant morbidity in patients with severe SAH. Pathogens involved in early VAP are susceptible to antibiotics. Among modifiable risk factors of VAP, early enteral nutrition could be an easy and effective target.

Notes

Acknowledgments

None.

Author contributions

Raphaël Cinotti designed the study, analyzed the data, and wrote the paper. Audrey Dordonnat-Moynard retrieved and analyzed the data, and edited the manuscript. Fanny Feuillet performed the statistical analysis. Antoine Roquilly designed the study and edited the manuscript. Nelly Rondeau edited the manuscript. Nathalie Asseray, Jocelyne Caillon, and Didier Lepelletier collected the data and edited the manuscript. Yvonnick Blanloeil and Bertrand Rozec edited the manuscript. Karim Asehnoune analyzed the data and wrote the paper.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • R. Cinotti
    • 1
    • 2
  • A. Dordonnat-Moynard
    • 3
  • F. Feuillet
    • 4
    • 5
  • A. Roquilly
    • 3
    • 6
  • N. Rondeau
    • 1
    • 2
  • D. Lepelletier
    • 7
  • J. Caillon
    • 6
    • 7
  • N. Asseray
    • 8
  • Y. Blanloeil
    • 1
    • 2
  • B. Rozec
    • 1
    • 2
    • 9
  • K. Asehnoune
    • 3
    • 6
    • 10
  1. 1.Service Anesthésie-RéanimationHôpital Guillaume et René LaennecSaint-HerblainFrance
  2. 2.CHU de NantesNantes CedexFrance
  3. 3.Service Anesthésie-Réanimation Chirurgicale, Hôtel DieuCHU de NantesNantes CedexFrance
  4. 4.EA 4275 “Biostatistique, Recherche Clinique et Mesures Subjectives en Santé”, Faculté de PharmacieUniversité de NantesNantes Cedex 1France
  5. 5.Plateforme de Biométrie, Cellule de Promotion de la Recherche CliniqueCHU de NantesNantesFrance
  6. 6.Laboratoire UPRES EA 3826 «Thérapeutiques Cliniques et Expérimentales des Infections», Faculté de MédecineUniversité de NantesNantesFrance
  7. 7.Pôle Biologie, Service de Bactériologie et Hygiène HospitalièreCHU de NantesNantes CedexFrance
  8. 8.Service Maladies Infectieuses et Tropicales, Hôtel DieuCHU de NantesNantes CedexFrance
  9. 9.Institut du Thorax, INSERM UMR1087 IRT, UN 8 quai MoncousuNantes Cedex 1France
  10. 10.Hôtel Dieu—HME Centre Hospitalier Universitaire de NantesNantes Cedex 9France

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