Background. The microbial etiology and mortality risk factors of ventilator-associated pneumonia (VAP) have not been investigated extensively in Shanghai.
Methods. VAP cases were identified from the patients hospitalized during the period from 1 January 2013 to 30 December 2017 in Shanghai. The relevant data were reviewed and analyzed retrospectively.
Results. One hundred ninety-four VAP cases were included in this analysis. The overall mortality rate was 32.47%. The respiratory pathogens isolated from these patients included 212 bacterial strains and 54 fungal strains. The leading pathogens were Acinetobacter baumannii (33.96%), Klebsiella pneumoniae (23.58%), Pseudomonas aeruginosa (19.81%), and Staphylococcus aureus (7.08%). Candida colonization was associated with higher mortality of VAP patients compared to those without Candida colonization (45.45% vs 28.67%, P < .05). The VAP patients with Candida colonization also showed higher prevalence of P. aeruginosa, carbapenem-resistant P. aeruginosa (CRPA), K. pneumoniae, carbapenem-resistant K. pneumoniae (CRKP), A. baumannii, and carbapenem- resistant A. baumannii (CRAB) (P < .05). VAP nonsurvivors had higher prevalence of CRPA, K. pneumoniae, CRAB, and Candida than VAP survivors (P < .05). Multivariate analysis showed that prior antibiotic use was a significant risk factor for Candida colonization, while hypertension and length of hospital stay were significant risk factors of VAP mortality (P < .05).
Conclusions. The top pathogens of VAP patients in Shanghai tertiary teaching hospitals are A. baumannii, K. pneumoniae, and P. aeruginosa, with high prevalence of carbapenem resistance. Carbapenem-resistant bacterial pathogens and Candida may predict poor outcome.
[1]Naval Med Univ, Dept Pulm & Crit Care Med, Shanghai Changhai Hosp, Shanghai, Peoples R China.
[2]Fudan Univ, Dept Pulm & Crit Care Med, Zhongshan Hosp, Shanghai Med Coll, Shanghai, Peoples R China.
[3]Tongji Univ, Dept Pulm & Crit Care Med, Shanghai Pulm Hosp, Shanghai, Peoples R China.
[4]Shanghai Jiao Tong Univ, Dept Pulm & Crit Care Med, Ruijin Hosp, Sch Med, Shanghai, Peoples R China.
[5]Naval Med Univ, Hongkou Branch, Shanghai Changhai Hosp, Shanghai, Peoples R China.
[6]Fudan Univ, Dept Resp Med, Huadong Hosp, Shanghai, Peoples R China.
[7]Shanghai Jiao Tong Univ, Dept Resp Med, Xinhua Hosp, Sch Med, Shanghai, Peoples R China.
[8]Shanghai Jiao Tong Univ, Dept Resp Med, Sixth Peoples Hosp, Shanghai, Peoples R China.
[9]Shanghai Jiao Tong Univ, Dept Resp Med, Renji Hosp, Sch Med, Shanghai, Peoples R China.
[10]Fudan Univ, Dept Resp Med, Fifth Peoples Hosp, Shanghai, Peoples R China.
[11]Shanghai Univ Tradit Chinese Med, Dept Resp Med, Longhua Hosp, Shanghai, Peoples R China.
[12]Tongji Univ, Dept Resp Med, Tenth Peoples Hosp, Shanghai, Peoples R China.
[13]Fudan Univ, Dept Resp Med, Huashan Hosp, Shanghai Med Coll, Shanghai, Peoples R China.
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