Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017, 161(3):303-309 | DOI: 10.5507/bp.2017.019

Possibilities for modifying risk factors for the development of hospital-acquired pneumonia in intensive care patients: results of a retrospective, observational study

Radovan Uvizl^a, Milan Kolar^b, Tomas Herkel^a, Michaela Vobrova^a, Katerina Langova^c

^a Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic

^b Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic

^c Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

Background: Hospital-acquired pneumonia (HAP) development is affected by a range of risk factors.

Methods: A retrospective, observational study processing data on all consecutive intensive care patients older than 18 years of age between 1 January 2011 and 31 December 2015. The aim was to determine the incidence of potential risk factors and their impact on the development of HAP.

Results: A total of 2229 patients. The overall mortality was 24.0%; the mean APACHE II score 21.4. The mean length of ICU stay was 5.9 days and the mean length of hospital stay was 20.5 days. The criteria for HAP were met by 310 patients (13.9%). Early- and late-onset HAP was diagnosed in 45 (14.5%) and 265 (85.5%) patients, respectively. The mean APACHE II score was 22.1, the mean length of ICU stay was 7.6 days and the mean length of hospital stay was 23.5 days. The most important non-modifiable factors increasing the risk of HAP were multiple organ failure (OR 13.733; P<0.0001), cardiac heart disease (OR 2.255; P<0.0001) and chronic renal failure (OR 2.194; P<0.002). The most common modifiable factors were intolerance to enteral nutrition (OR 3.055; P<0.0001), urgent tracheal intubation (OR 1.511; P<0.024), reintubation (OR 1.851; P<0.001), and bronchoscopy (OR 2.558; P<0.0001). Stress ulcer prophylaxis was administered to 83% of HAP patients and 68% of patients without HAP. Prophylaxis with famotidine was associated with a lower risk of HAP in 40.0% of patients (non-HAP in 49.9%), (OR 0.669; P=0.001) than prophylaxis with pentoprazol in 42.6% and 49.5% of patients, respectively (OR 0.756; P=0.027).

Conclusions: . Factors associated with the highest risk of the development of HAP can be determined. Pharmacological prophylaxis of gastric and duodenal stress ulcers was identified as an independent risk factor for HAP. The study was registered in the ClinicalTrials.gov database under the number NCT02779933.

Keywords: hospital-acquired pneumonia, mortality, intensive care, risk factor

Received: January 13, 2017; Accepted: March 31, 2017; Prepublished online: April 26, 2017; Published: September 26, 2017  Show citation