Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital's Intensive Care Unit: A case-control study

Abstract

Background: Ventilator-associated pneumonia (VAP) which is an important part of all nosocomial infections in intensive care unit (ICU) is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU. Methods: This is a-three year retrospective case-control study. The data were collected between 01 January 2000 and 31 December 2002. During the study period, 132 patients were diagnosed as nosocomial pneumonia of 731 adult medical-surgical ICU patients. Of these only 37 VAP patients were assessed, and multiple nosocomially infected patients were excluded from the study. Sixty non-infected ICU patients were chosen as control patients. Results: Median length of stay in ICU in patients with VAP and without were 8.0 (IQR: 6.5) and 2.5 (IQR: 2.0) days respectively (P<0.0001). Respiratory failure (OR, 11.8; 95%, CI, 2.2- 62.5; P<0.004), coma in admission (Glasgow coma scale<9) (OR, 17.2; 95% CI, 2.7-107.7; P< 0.002), depressed consciousness (OR, 8.8; 95% CI, 2.9-62.5; P<0.02), enteral feeding (OR, 5.3; 95% CI, 1.0-27.3; P=0.044) and length of stay (OR, 1.3; 95% CI, 1.0-1.7; P<0.04) were found as important risk factors. Most commonly isolated microorganism was methicillin resistant Staphylococcus aureus (30.4%). Mortality rates were higher in patients with VAP (70.3%) than the control patients (35.5%) (P<0.003). Mean cost of patients with and without VAP were 2832.2+/-1329.0 and 868.5+/-428.0 US Dollars respectively (P<0.0001). Conclusion: Respiratory failure, coma, depressed consciousness, enteral feeding and length of stay are independent risk factors for developing VAP. The cost of VAP is approximately fivefold higher than non-infected patients. © 2004 Erbay et al, licensee BioMed Central Ltd