MJ Bonten, DC Bergmans, AW Ambergen, PW de Leeuw, S van der Geest, EE Stobberingh and CA Gaillard
Department of Internal Medicine, University Hospital Maastricht, the Netherlands.

Risk factors for the development of ventilator-associated pneumonia (VAP) and colonization of the respiratory tract and stomach with enteric gram-negative bacteria (EGB) and Pseudomonadaceae were determined in 141 ventilated patients using univariate analysis and the Cox proportional hazards model. VAP was caused by EGB in 14 patients (10%), and by Pseudomonadaceae in 19 patients (13%). The duration of ventilation was a significant risk factor for VAP caused by EGB and Pseudomonadaceae, and for acquired colonization in oropharynx, stomach, and trachea with these species. Of 20 other variables, oropharyngeal colonization with EGB on admission (hazard ratio [HR] = 4.5) and an infection on admission (HR = 2.7) were selected as risk factors for VAP caused by EGB. Acquired colonization with Pseudomonadaceae in oropharynx (HR = 5.0) was the most important risk factor for VAP caused by these species. Gastric colonization with EGB or Pseudomonadaceae were no risk factors for VAP. For acquired oropharyngeal colonization with EGB only the duration of ventilation was a risk factor, whereas preceding colonization of the trachea with Pseudomonodaceae and duration of ventilation were risk factors for acquired oropharyngeal colonization with these species. In the Cox model, only the duration of ventilation was significantly related to acquired gastric colonization with EGB. Preceding colonization of the orophayrnx and of the trachea with Pseudomonadaceae were risk factors for acquired colonization with these species in the stomach. Twelve patients with VAP (46%) and 38 without VAP (33%) died (p = 0.21). In conclusion, duration of ventilation and colonization of the upper respiratory tract are the most important risk factors for VAP caused by EGB or Pseudomonadaceae.

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