Abstract

Ventilator-associated pneumonia (VAP), multidrug-resistant (MDR) microorganisms and inappropriate empirical therapy poses a major therapeutic challenge in developing countries. The aim of this study was to investigate the risk factors of VAP due to MDR pathogens, to assess the rate of inappropriateness of empirical antimicrobial therapy and its subsequent impact on the outcome of VAPs. From May 2009 to August 2010, in a clinical-surgical intensive care unit (ICU) of a Brazilian hospital, patients with VAP were empirically treated with antibiotics. A case-control study was carried out using patients with VAP by MDR pathogens (case) and non-MDR pathogens (control). Appropriateness of empirical antimicrobial therapy and 30-day hospital mortality were evaluated. We found that among 320 patients requiring tracheal intubation for more than 48 h, 81(25.3%) developed VAP and 43(47.3%) due to MDR pathogens. The risk factors for this latter group were: Length of hospital stay, use of corticoids and prior use of antibiotics. Empirical antimicrobial therapy was inappropriate in 30.9% of patients, with 84.0 and 70.0% these with VAP by MDR pathogens and mixed etiology, respectively. VAP caused by MDR pathogens and the inappropriate empirical antimicrobial therapy were significantly associated with 30-day ICU mortality.

Key words: Ventilator-associated pneumonia, antimicrobial resistance, intensive care unit, empirical antimicrobial therapy, 30-day hospital mortality