Respiratory infections in mechanically ventilated patients

Abstract

Cilj istraživanja: Utvrditi učestalost respiratornih infekcija strojno ventiliranih bolesnika, najvažnije rizične čimbenike odgovorne za nastanak tih infekcija, udio VAP-a i VAT-a u ukupnom broju infekcija te trajanje i ishod liječenja bolesnika. Ustroj studije: Retrospektivna studija. Ispitanici i metode: U istraživanje je uključeno 106 bolesnika liječenih u JIL-u Klinike za anesteziologiju od 1. 1. 2014. do 31. 12. 2016. kod kojih se tijek liječenja zakomplicirao pojavom respiratorne infekcije. Kriterij uključivanja bio je strojna ventilacija dulja od 48 sati te klinička i mikrobiološka potvrda infekcije. Podatci su prikupljeni iz medicinskih zapisa i statistički obrađeni pomoću programa MedCalc. Rezultati: Učestalost respiratorne infekcije iznosi 8,5 na 1000 BD-a i 20,1 na 1000 respiratorskih dana. Većina bolesnika (50 %) ima poremećaj SŽS-a pri prijemu, 96 % prijašnju antimikrobnu terapiju i svi su na invazivnoj strojnoj potpori. Od ukupnog broja respiratornih infekcija, 74 % bolesnika ima VAT, a preostali dio VAP. Uzročnik je infekcija u 72 % slučajeva Acinetobacter baumannii. Nema značajne razlike između VAT-a i VAP-a u odnosu na SAPS II i SOFA skor, vrijeme nastupa infekcije, trajanje terapije i mehaničke ventilacije, duljinu boravka u JIL-u i ishodu liječenja. Zaključak: Pojavi respiratornih infekcija skloni su bolesnici s primarnim poremećajem svijesti i dugotrajno ovisni o respiratoru. Narušenost općeg stanja pridonosi nastanku infekcijskih komplikacija bolesnika, a nepotrebna antimikrobna terapija pogoduje selekciji i širenju rezistentnih uzročnika. Nerazmjer u pojavnosti VAT-a i VAP-a posljedica je teškoća u dijagnostici tih stanja, izuzme li se radiološki nalaz, infekcije se ne razlikuju po utjecaju na tijek i ishod liječenja bolesnika.Objectives: The aim of this study was to determine the frequency of respiratory infections in mechanically ventilated patients, the most important risk factors responsible for the occurrence of the infections, the share of VAT and VAP in the total number of infections and the duration and outcome of the treatment. Study design: Retrospective study. Participants and methods: The study included 106 patients treated in the ICU Clinic for Anestesiology from 1 st January 2014 to 31 st December 2016. The treatment was complicated by the onset of respiratory infection. The inclusive criteria were machine ventilation longer than 48 hours and clinical and microbiological confirmation of the infection. The data were collected from medical records and statistically processed using MedCalc programme. Results: The frequency of respiratory infections is 8.5 per 1000 patient days, i.e. 20.1 per 1000 respirator days. Most patients (50%) have a CNS disorder upon reception, 96% have prior antimicrobial therapy. All patients receive invasive machine support. Of the total number of respiratory infections, 74% of patients have VAT and the rest have VAP. The cause of infection in 72% of cases is Acinetobacter baumannii. There is no significant difference between VAT and VAP in relation to SAPS II and SOFA scores, time of the onset of the infection, duration of therapy and mechanical ventilation, the length of stay in the ICU and the outcome of the treatment. Conclusion: Respiratory infections are common in patients with primary disturbance of consciousness and long-term respiratory dependence. General state of impaired health contributes to the emergence of infections in patients, and unnecessary antimicrobial therapy favours the selection and dissemination of resistant agents. The disproportion in the occurrence of VAT and VAP is a consequence of difficulties in diagnosing these conditions. Finally, if radiological findings are excluded, infections are not different in terms of the course and outcome of the treatment