L Papazian, F Bregeon, X Thirion, R Gregoire, P Saux, JP Denis, G Perin, J Charrel, JF Dumon, JP Affray and F Gouin
Department of Anesthesia and Intensive Care, Hopital Sainte-Marguerite, Marseille, France.

The aim of this study was to evaluate the attributable mortality and excess intensive care unit (ICU) stay as linked to ventilator- associated pneumonia (VAP) in a medical-surgical ICU. We performed a matched cohort study. The diagnosis of VAP was established when clinical, biologic, and radiologic signs of VAP were associated with the presence of at least one microorganism at a concentration > or = 10(3) CFU/ml on the protected specimen brush sample. Each case patient with VAP was matched to one control patient on the basis of the following potential confounding factors: same diagnosis and same indication for mechanical ventilation, same age +/-5 yr, same sex, same APACHE II score +/-5 on admission. In addition, control patients had to be ventilated for at least as long as the case patient prior to the onset of VAP, and date of admission of the case and control patients had to be matched within 1 yr. In 85 of the 97 patients with VAP, we were able to match one case patient with one control patient. Mortality was similar in both case (40%) and control (38.8%) patients. The duration of mechanical ventilation was increased in survivor case patients (27.2 +/- 24.7 d) compared with survivor control patients (18.5 +/- 15.7 d) (p < 0.01). The duration of hospitalization in ICU was increased in survivor case patients (34.9 +/- 23.6 d) compared with survivor control patients (26.1 +/- 18.6 d) (p < 0.02). When confounding factors were controlled, VAP did not appear to increase mortality.

This article has been cited by other articles:

				E. Foglia, M. D. Meier, and A. Elward Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients Clin. Microbiol. Rev., July 1, 2007; 20(3): 409 - 425. [Abstract] [Full Text] [PDF]

				M. Klompas Does This Patient Have Ventilator-Associated Pneumonia? JAMA, April 11, 2007; 297(14): 1583 - 1593. [Abstract] [Full Text] [PDF]

				V. D. Rosenthal, D. G. Maki, R. Salomao, C. A. Moreno, Y. Mehta, F. Higuera, L. E. Cuellar, O. A. Arikan, R. Abouqal, H. Leblebicioglu, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med, October 17, 2006; 145(8): 582 - 591. [Abstract] [Full Text] [PDF]

				S. M. Koenig and J. D. Truwit Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention Clin. Microbiol. Rev., October 1, 2006; 19(4): 637 - 657. [Abstract] [Full Text] [PDF]

				S. Biswal, P. Mishra, S. Malhotra, G. D. Puri, and P. Pandhi Drug utilization pattern in the intensive care unit of a tertiary care hospital. J. Clin. Pharmacol., August 1, 2006; 46(8): 945 - 951. [Abstract] [Full Text] [PDF]

				M. Koeman, A. J. A. M. van der Ven, E. Hak, H. C. A. Joore, K. Kaasjager, A. G. A. de Smet, G. Ramsay, T. P. J. Dormans, L. P. H. J. Aarts, E. E. de Bel, et al. Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1348 - 1355. [Abstract] [Full Text] [PDF]

				J D Hunter Ventilator associated pneumonia. Postgrad. Med. J., March 1, 2006; 82(965): 172 - 178. [Abstract] [Full Text] [PDF]

				M. Kollef, D. Pittet, M. Sanchez Garcia, J. Chastre, J.-Y. Fagon, M. Bonten, R. Hyzy, T. R. Fleming, H. Fuchs, L. Bellm, et al. A Randomized Double-Blind Trial of Iseganan in Prevention of Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., January 1, 2006; 173(1): 91 - 97. [Abstract] [Full Text] [PDF]

				S. Nseir, C. Di Pompeo, S. Soubrier, B. Cavestri, E. Jozefowicz, F. Saulnier, and A. Durocher Impact of Ventilator-Associated Pneumonia on Outcome in Patients With COPD Chest, September 1, 2005; 128(3): 1650 - 1656. [Abstract] [Full Text] [PDF]

				Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 388 - 416. [Full Text] [PDF]

				F. Michel, B. Franceschini, P. Berger, J.-M. Arnal, M. Gainnier, J.-M. Sainty, and L. Papazian Early Antibiotic Treatment for BAL-Confirmed Ventilator-Associated Pneumonia: A Role for Routine Endotracheal Aspirate Cultures Chest, February 1, 2005; 127(2): 589 - 597. [Abstract] [Full Text] [PDF]

				C. M. Parker and D. K. Heyland Aspiration and the Risk of Ventilator-Associated Pneumonia Nutr Clin Pract, December 1, 2004; 19(6): 597 - 609. [Abstract] [Full Text] [PDF]

				P. Dodek, S. Keenan, D. Cook, D. Heyland, M. Jacka, L. Hand, J. Muscedere, D. Foster, N. Mehta, R. Hall, et al. Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia Ann Intern Med, August 17, 2004; 141(4): 305 - 313. [Abstract] [Full Text] [PDF]

				R. M. Mehta and M. S. Niederman Nosocomial Pneumonia in the Intensive Care Unit: Controversies and Dilemmas J Intensive Care Med, July 1, 2003; 18(4): 175 - 188. [Abstract] [PDF]

				O. Leroy, S. Jaffre, T. d'Escrivan, P. Devos, H. Georges, S. Alfandari, and G. Beaucaire Hospital-Acquired Pneumonia: Risk Factors for Antimicrobial-Resistant Causative Pathogens in Critically Ill Patients Chest, June 1, 2003; 123(6): 2034 - 2042. [Abstract] [Full Text] [PDF]

				R. A. Fowler, K. E. Flavin, J. Barr, A. B. Weinacker, J. Parsonnet, and M. K. Gould Variability in Antibiotic Prescribing Patterns and Outcomes in Patients With Clinically Suspected Ventilator-Associated Pneumonia Chest, March 1, 2003; 123(3): 835 - 844. [Abstract] [Full Text] [PDF]

				G. Hoffken and M. S. Niederman Nosocomial Pneumonia: The Importance of a De-escalating Strategy for Antibiotic Treatment of Pneumonia in the ICU Chest, December 1, 2002; 122(6): 2183 - 2196. [Abstract] [Full Text] [PDF]

				R. Farre, M. Rotger, M. Ferrer, A. Torres, and D. Navajas Automatic regulation of the cuff pressure in endotracheally-intubated patients Eur. Respir. J., October 1, 2002; 20(4): 1010 - 1013. [Abstract] [Full Text] [PDF]

				O. Leroy, P. Giradie, Y. Yazdanpanah, H. Georges, S. Alfandari, V. Sanders, P. Devos, and G. Beaucaire Hospital-acquired pneumonia: microbiological data and potential adequacy of antimicrobial regimens Eur. Respir. J., August 1, 2002; 20(2): 432 - 439. [Abstract] [Full Text] [PDF]

				A. M. Elward, D. K. Warren, and V. J. Fraser Ventilator-Associated Pneumonia in Pediatric Intensive Care Unit Patients: Risk Factors and Outcomes Pediatrics, May 1, 2002; 109(5): 758 - 764. [Abstract] [Full Text] [PDF]

				J. Chastre and J.-Y. Fagon Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., April 1, 2002; 165(7): 867 - 903. [Abstract] [Full Text] [PDF]

				S Ewig, T Bauer, and A Torres The pulmonary physician in critical care * 4: Nosocomial pneumonia Thorax, April 1, 2002; 57(4): 366 - 371. [Abstract] [Full Text] [PDF]

				M. Meade, G. Guyatt, L. Griffith, L. Booker, J. Randall, and D. J. Cook Introduction to a Series of Systematic Reviews of Weaning From Mechanical Ventilation* Chest, December 1, 2001; 120(6_suppl): 396S - 399S. [Full Text] [PDF]

				M. Ioanas, R. Ferrer, J. Angrill, M. Ferrer, and A. Torres Microbial investigation in ventilator-associated pneumonia Eur. Respir. J., April 1, 2001; 17(4): 791 - 801. [Abstract] [Full Text] [PDF]

				J. P. Lynch III Hospital-Acquired Pneumonia : Risk Factors, Microbiology, and Treatment Chest, February 1, 2001; 119(2_suppl): 373S - 384S. [Abstract] [Full Text] [PDF]

				M. J. M. Bonten, B. J. Kullberg, R. van Dalen, A. R. J. Girbes, I. M. Hoepelman, W. Hustinx, J. W. M. van der Meer, P. Speelman, E. E. Stobberingh, H. A. Verbrugh, et al. Selective digestive decontamination in patients in intensive care J. Antimicrob. Chemother., September 1, 2000; 46(3): 351 - 362. [Abstract] [Full Text] [PDF]

				R. S. Morehead and S. J. Pinto Ventilator-Associated Pneumonia Arch Intern Med, July 10, 2000; 160(13): 1926 - 1936. [Abstract] [Full Text] [PDF]

				M. RUIZ, A. TORRES, S. EWIG, M. A. MARCOS, A. ALCÓN, R. LLEDÓ, M. A. ASENJO, and A. MALDONALDO Noninvasive Versus Invasive Microbial Investigation in Ventilator-associated Pneumonia . Evaluation of Outcome Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 119 - 125. [Abstract] [Full Text]

				P. MARKOWICZ, M. WOLFF, K. DJEDAÏNI, Y. COHEN, J. CHASTRE, C. DELCLAUX, J. MERRER, B. HERMAN, B. VEBER, A. FONTAINE, et al. Multicenter Prospective Study of Ventilator-Associated Pneumonia During Acute Respiratory Distress Syndrome . Incidence, Prognosis, and Risk Factors Am. J. Respir. Crit. Care Med., June 1, 2000; 161(6): 1942 - 1948. [Abstract] [Full Text]

				M. S. Niederman Bronchoscopy in Nonresolving Nosocomial Pneumonia Chest, April 1, 2000; 117(4_suppl_2): 212S - 218S. [Full Text] [PDF]

				J. A. C. Cendrero, J. Sole-Violan, A. B. Benitez, J. N. Catalan, J. A. Fernandez, P. S. Santana, and F. R. de Castro Role of Different Routes of Tracheal Colonization in the Development of Pneumonia in Patients Receiving Mechanical Ventilation Chest, August 1, 1999; 116(2): 462 - 470. [Abstract] [Full Text] [PDF]

				C. GIRAULT, I. DAUDENTHUN, V. CHEVRON, F. TAMION, J. LEROY, and G. BONMARCHAND Noninvasive Ventilation as a Systematic Extubation and Weaning Technique in Acute-on-Chronic Respiratory Failure . A Prospective, Randomized Controlled Study Am. J. Respir. Crit. Care Med., July 1, 1999; 160(1): 86 - 92. [Abstract] [Full Text]

				D. K. HEYLAND, D. J. COOK, L. GRIFFITH, S. P. KEENAN, and C. BRUN-BUISSON The Attributable Morbidity and Mortality of Ventilator-Associated Pneumonia in the Critically Ill Patient Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1249 - 1256. [Abstract] [Full Text] [PDF]

				M. H. Kollef The Prevention of Ventilator-Associated Pneumonia N. Engl. J. Med., February 25, 1999; 340(8): 627 - 634. [Full Text] [PDF]

				D. C J J Bergmans, M. J M Bonten, F. H van Tiel, C. A Gaillard, S. van der Geest, R. M Wilting, P. W de Leeuw, and E. E Stobberingh Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit Thorax, December 1, 1998; 53(12): 1053 - 1058. [Abstract] [Full Text]

				D. Cook, G. Guyatt, J. Marshall, D. Leasa, H. Fuller, R. Hall, S. Peters, F. Rutledge, L. Griffith, A. McLellan, et al. A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation N. Engl. J. Med., March 19, 1998; 338(12): 791 - 797. [Abstract] [Full Text] [PDF]

				M. Wolff Comparison of Strategies Using Cefpirome and Ceftazidime for Empiric Treatment of Pneumonia in Intensive Care Patients Antimicrob. Agents Chemother., January 1, 1998; 42(1): 28 - 36. [Abstract] [Full Text]

				O Leroy, C Vandenbussche, C Coffinier, C Bosquet, H Georges, B Guery, D Thevenin, and G Beaucaire Community-acquired aspiration pneumonia in intensive care units. Epidemiological and prognosis data Am. J. Respir. Crit. Care Med., December 1, 1997; 156(6): 1922 - 1929. [Abstract] [Full Text]

				M. S. Niederman Is "Crop Rotation" of Antibiotics the Solution to a "Resistant" Problem in the ICU? Am. J. Respir. Crit. Care Med., October 1, 1997; 156(4): 1029 - 1031. [Full Text] [PDF]

				J. M. SANCHEZ-NIETO, A. TORRES, F. GARCIA-CORDOBA, M. EL-EBIARY, A. CARRILLO, J. RUIZ, M. L. NUÑEZ, and M. NIEDERMAN Impact of Invasive and Noninvasive Quantitative Culture Sampling on Outcome of Ventilator-Associated Pneumonia . A Pilot Study Am. J. Respir. Crit. Care Med., February 1, 1997; 157(2): 371 - 376. [Abstract] [Full Text]