EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND
VENTILATOR-ASSOCIATED PNEUMONIA IN PATIENTS WITH INHALATION
INJURY AT THE BURN CENTRE IN BRNO (CZECH REPUBLIC)

J 2011

EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND VENTILATOR-ASSOCIATED PNEUMONIA IN PATIENTS WITH INHALATION INJURY AT THE BURN CENTRE IN BRNO (CZECH REPUBLIC)

LIPOVÝ, Břetislav, Hana ŘIHOVÁ, Nora GREGOROVÁ, Markéta HANSLIANOVÁ, Zuzana ŽALOUDÍKOVÁ et. al.

Basic information

Original name

EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND VENTILATOR-ASSOCIATED PNEUMONIA IN PATIENTS WITH INHALATION INJURY AT THE BURN CENTRE IN BRNO (CZECH REPUBLIC)

Authors

LIPOVÝ, Břetislav (203 Czech Republic, guarantor, belonging to the institution), Hana ŘIHOVÁ (203 Czech Republic), Nora GREGOROVÁ (203 Czech Republic, belonging to the institution), Markéta HANSLIANOVÁ (203 Czech Republic), Zuzana ŽALOUDÍKOVÁ (203 Czech Republic), Yvona KALOUDOVÁ (203 Czech Republic) and Pavel BRYCHTA (203 Czech Republic, belonging to the institution)

Edition

Annals of Burns and Fire Disasters, Palermo, Italy, Mediterranean Burns Club, 2011, 1592-9566

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30200 3.2 Clinical medicine

Country of publisher

Czech Republic

Confidentiality degree

není předmětem státního či obchodního tajemství

RIV identification code

RIV/00216224:14110/11:00053869

Organization unit

Faculty of Medicine

Keywords (in Czech)

Inhalační trauma; ventilatorová pnuemonie; ventilátorová tracheobronchitida; gramnegativní bakteriální kmeny; rezistence

Keywords in English

inhalation injury; ventilator associated pneumonia; ventilator associated tracheobronchitis; Gramnegative bacterial strains; resistance

Změněno: 11/7/2013 13:52, Soňa Böhmová

Abstract

V originále

Aim. The aim of this work is to determine the incidence of ventilator-associated tracheobronchitis (VAT) and ventilator- associated pneumonia (VAP) and to define the define the most important respiratory pathogens in patients with inhalation injury. Introduction. Infectious complications in severely burned patients present serious problems. Patients with inhalation injuries are exposed to greater risk owing to the possible development of infectious complications in the lower respiratory tract. VAP is the predominant cause of death in these patients. This is due to the increasing resistance of strains of Gram-negative bacteria such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. Design. Retrospective, monocentric. Setting. A five-bed burn intensive care unit. Material and methods. Between 2004 and 2009, 348 adult patients were hospitalized in the intensive care unit of the Department of Burns and Reconstructive Surgery, Brno University Hospital, Czech Republic. Of these, 127 (36.49%) were diagnosed by bronchoscopy as having inhalation injury. The prerequisite for inclusion in the cohort was an inhalation injury requiring artificial ventilation for at least 48 h. The lower airway microbiological condition was monitored regularly by sampling biological material for cultures (sputum, tracheobronchial aspirates, etc.). For the diagnosis of VAP and VAT we used the Centers for Disease Control and Prevention criteria and the Clinical Pulmonary Infection Score. Results. The average age of the 127 patients (31 women/96 men) included in the study was 38.4 yr (range, 21-69 yr) and the average total body surface area (TBSA) burned was 29.3% (range, 2-75%). The average length of hospital stay was 49.4 days (range, 4-150 days) and the duration of mechanical ventilation 8.7 days; 18 patients (14.2%) died. In patients with inhalation injury, 309 strains of bacteria were cultivated from the lower respiratory tract, of which 234 were Gram-negative. All of these bacterial strains were isolated in significant quantities for lower respiratory tract infection. The most common bacteria isolated from the lower respiratory tract was Klebsiella pneumoniae (78 times), followed by Pseudomonas aeruginosa (49x), and Acinetobacter baumannii (28x). VAT was diagnosed in 109 patients (85.8%) in the cohort. The incidence of VAT was calculated to be 98.8 per 1000 days of mechanical ventilation. VAP was diagnosed in 34 patients in the cohort (26.8%). The incidence of VAP was calculated as being 30.8 cases per 1,000 days of mechanical ventilation. In eight patients (23.5%), VAP was diagnosed within 5 days of initiation of mechanical ventilation (early onset) and in 26 patients (76.5%) after a longer period (late onset). The most common aetiological agent of VAT and VAP was Klebsiella pneumoniae (respectively 41.3% and 35.3%). Conclusion. In this study we were able to determine the incidence of VAP and VAT in patients with inhalation injury. In spite of the advances in diagnostics and therapy, inhalation injury is still burdened with disappointingly high morbidity and mortality rates. For this reason, the treatment of VAP remains a major challenge for all physicians caring for patients with inhalation injury.

Citovat

LIPOVÝ, Břetislav, Hana ŘIHOVÁ, Nora GREGOROVÁ, Markéta HANSLIANOVÁ, Zuzana ŽALOUDÍKOVÁ, Yvona KALOUDOVÁ and Pavel BRYCHTA. EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND VENTILATOR-ASSOCIATED PNEUMONIA IN PATIENTS WITH INHALATION INJURY AT THE BURN CENTRE IN BRNO (CZECH REPUBLIC). Annals of Burns and Fire Disasters. Palermo, Italy: Mediterranean Burns Club, 2011, vol. 24, No 3, p. 120-125. ISSN 1592-9566.

@article{957199,
   author = {Lipový, Břetislav and Řihová, Hana and Gregorová, Nora and Hanslianová, Markéta and Žaloudíková, Zuzana and Kaloudová, Yvona and Brychta, Pavel},
   article_location = {Palermo, Italy},
   article_number = {3},
   keywords = {inhalation injury; ventilator associated pneumonia; ventilator associated tracheobronchitis; Gramnegative bacterial strains; resistance},
   language = {eng},
   issn = {1592-9566},
   journal = {Annals of Burns and Fire Disasters},
   title = {EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND VENTILATOR-ASSOCIATED PNEUMONIA IN PATIENTS WITH INHALATION INJURY AT THE BURN CENTRE IN BRNO (CZECH REPUBLIC)},
   volume = {24},
   year = {2011}
}

TY  - JOUR
ID  - 957199
AU  - Lipový, Břetislav - Řihová, Hana - Gregorová, Nora - Hanslianová, Markéta - Žaloudíková, Zuzana - Kaloudová, Yvona - Brychta, Pavel
PY  - 2011
TI  - EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND VENTILATOR-ASSOCIATED PNEUMONIA IN PATIENTS WITH INHALATION INJURY AT THE BURN CENTRE IN BRNO (CZECH REPUBLIC)
JF  - Annals of Burns and Fire Disasters
VL  - 24
IS  - 3
SP  - 120-125
EP  - 120-125
PB  - Mediterranean Burns Club
SN  - 15929566
KW  - inhalation injury
KW  - ventilator associated pneumonia
KW  - ventilator associated tracheobronchitis
KW  - Gramnegative bacterial strains
KW  - resistance
N2  - Aim. The aim of this work is to determine the incidence of ventilator-associated tracheobronchitis (VAT) and ventilator- associated pneumonia (VAP) and to define the define the most important respiratory pathogens in patients with inhalation injury. Introduction. Infectious complications in severely burned patients present serious problems. Patients with inhalation injuries are exposed to greater risk owing to the possible development of infectious complications in the lower respiratory tract. VAP is the predominant cause of death in these patients. This is due to the increasing resistance of strains of Gram-negative bacteria such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. Design. Retrospective, monocentric. Setting. A five-bed burn intensive care unit. Material and methods. Between 2004 and 2009, 348 adult patients were hospitalized in the intensive care unit of the Department of Burns and Reconstructive Surgery, Brno University Hospital, Czech Republic. Of these, 127 (36.49%) were diagnosed by bronchoscopy as having inhalation injury. The prerequisite for inclusion in the cohort was an inhalation injury requiring artificial ventilation for at least 48 h. The lower airway microbiological condition was monitored regularly by sampling biological material for cultures (sputum, tracheobronchial aspirates, etc.). For the diagnosis of VAP and VAT we used the Centers for Disease Control and Prevention criteria and the Clinical Pulmonary Infection Score. Results. The average age of the 127 patients (31 women/96 men) included in the study was 38.4 yr (range, 21-69 yr) and the average total body surface area (TBSA) burned was 29.3% (range, 2-75%). The average length of hospital stay was 49.4 days (range, 4-150 days) and the duration of mechanical ventilation 8.7 days; 18 patients (14.2%) died. In patients with inhalation injury, 309 strains of bacteria were cultivated from the lower respiratory tract, of which 234 were Gram-negative. All of these bacterial strains were isolated in significant quantities for lower respiratory tract infection. The most common bacteria isolated from the lower respiratory tract was Klebsiella pneumoniae (78 times), followed by Pseudomonas aeruginosa (49x), and Acinetobacter baumannii (28x). VAT was diagnosed in 109 patients (85.8%) in the cohort. The incidence of VAT was calculated to be 98.8 per 1000 days of mechanical ventilation. VAP was diagnosed in 34 patients in the cohort (26.8%). The incidence of VAP was calculated as being 30.8 cases per 1,000 days of mechanical ventilation. In eight patients (23.5%), VAP was diagnosed within 5 days of initiation of mechanical ventilation (early onset) and in 26 patients (76.5%) after a longer period (late onset). The most common aetiological agent of VAT and VAP was Klebsiella pneumoniae (respectively 41.3% and 35.3%). Conclusion. In this study we were able to determine the incidence of VAP and VAT in patients with inhalation injury. In spite of the advances in diagnostics and therapy, inhalation injury is still burdened with disappointingly high morbidity and mortality rates. For this reason, the treatment of VAP remains a major challenge for all physicians caring for patients with inhalation injury.
ER  -

LIPOVÝ, Břetislav, Hana ŘIHOVÁ, Nora GREGOROVÁ, Markéta HANSLIANOVÁ, Zuzana ŽALOUDÍKOVÁ, Yvona KALOUDOVÁ and Pavel BRYCHTA. EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND VENTILATOR-ASSOCIATED PNEUMONIA IN PATIENTS WITH INHALATION INJURY AT THE BURN CENTRE IN BRNO (CZECH REPUBLIC). \textit{Annals of Burns and Fire Disasters}. Palermo, Italy: Mediterranean Burns Club, 2011, vol.~24, No~3, p.~120-125. ISSN~1592-9566.

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