Analysis of risk factors for poor clinical outcomes and pathogenic bacteria causing ventilator-associated pneumonia in ICU patients receiving mechanical ventilation

OBJECTIVE  To investigate the risk factors and etiological characteristics of different clinical outcomes of ventilator-associated pneumonia (VAP) in ICU patients receiving mechanical ventilation.

METHODS  A retrospective analysis was conducted on the clinical data of ICU patients receiving mechanical ventilation at the First Affiliated Hospital of Shihezi University and Shihezi City People's Hospital from 2020 to 2023. Clinical data of patients with VAP and non-VAP were compared, along with the risk factors and pathogenic bacteria characteristics of different clinical outcomes (survival/death) in patients with early-onset and late-onset VAP.

RESULTS  A total of 2 020 patients receiving mechanical ventilation were included, with 125 cases developing VAP. The incidence rate of VAP was 6.19% (125/2 020), and the average time of VAP occurrence was 6.9 days after intubation. The duration of mechanical ventilation and hospital stay in the VAP group were longer than those in the non-VAP group (median duration: 14 days vs. 7.94 days, 34.04 days vs. 20.95 days, P＜0.05). Multivariate logistic analysis of VAP revealed that hypoproteinemia (OR＝1.832, 95%CI: 1.224—2.741, P＝0.003), combined use of antibacterial agents (OR＝3.073, 95%CI: 1.096—8.616, P＝0.033) and surgery during hospitalization (OR＝1.880, 95%CI: 1.247—2.835, P＝0.003) were risk factors for VAP in ICU patients receiving mechanical ventilation. Age (OR＝1.045, 95%CI: 1.017—1.074, P＝0.002), diabetes (OR＝2.548, 95%CI: 1.003—6.472, P＝0.049) and maximum body temperature (OR＝3.156, 95%CI: 1.385—7.192, P＝0.006) were risk factors for death in VAP patients. A total of 291 strains of pathogenic bacteria were detected in the VAP group, including 228 strains of gram-negative bacteria, 39 strains of gram-positive bacteria, and 21 strains of fungi. The detection rates of fungi and multidrug-resistant Acinetobacter baumannii were higher in the VAP death group than in the survival group (P＜0.05).

CONCLUSIONS  Hypoproteinemia, combined use of antibacterial agents and surgery during hospitalization are risk factors for VAP. Age, diabetes and maximum body temperature are risk factors for death in VAP patients. VAP is closely related to the duration of mechanical ventilation and hospital stay in patients.