Epidemiology of Risk Factors for Hospital-acquired Pneumonia (HAP) in Intensive Care Unit (ICU) Patients

Epidemiology of Risk Factors for Hospital-acquired Pneumonia in ICU Patients

A retrospective, observational study compiled data from all consecutively admitted patients older than 18 years at ICU University Hospital in Olomouc in the period from 1 January 2011 to 31 December 2015 who fulfilled the criteria of HAP. The aim was to determine the severity of the specific risk factors of early and late HAP. Risk factors were divided into factors from the patient and from the hospitalization. Furthermore, an assessment of their relationship to mortality.

Study Overview

• Status: Completed
• Conditions: Ventilator-Associated Pneumonia
• Intervention / Treatment: Other: Epidemiology od HAP

Detailed Description

The primary outcome was to evaluate the relationship between risk factors and the development of early/late onset HAP. Another outcome was assessed to evaluate the relation of risk factors early/late onset HAP and mortality. The crucial time for evaluating the presence of risk factors was their presence from hospital admission to the moment of fulfilling the criteria for pneumonia. Risk factors were divided into two groups, on factors of the patient (uncontrollable) and by the hospitalization (controllable). Factors of the patient were: gender (male/female), age at enrollment (years), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, multi-organ failure presence (MOF), hypertension, ischemic heart disease (IHD) chronic renal insufficiency (CRI), continual use of renal replacement therapy (CRRT), acute renal insufficiency (ARI), diabetes mellitus (DM), Chronical Obstructive Pulmonary Disease (COPD), immunosuppression or leukopenia <1.5x109/l, impaired consciousness with Glasgow coma scale (GCS) <8 tracheotomy, head trauma/neurosurgery, abdominal surgery-thoracotomy. Side factors hospitalization were: aspiration into the lungs, urgent intubation, reintubated, sedation, bronchoscopy, nasogastric intubation, enteral feeding continuously/intermittently intolerance of enteral nutrition, physiotherapy, repeated transport of the patient from the ICU, length of hospital stay, length of mechanical ventilation, 30-day mortality.

• Study Type: Observational
• Enrollment (Actual): 310

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

The study included patients hospitalized in the ICU Department of Anesthesiology and Intensive Care Medicine, UH Olomouc. On inclusion did not affect the method of ensuring lower airways (invasive/non-invasive) or results (positivity/negativity) taken microbiological samples from the lower airways (endobronchial aspirate or bronchoalveolar lavage) as approximately one third of samples can be microbiologically negative even when overt bronchopneumonia. Patient cohort consisted of all patients older than 18 years who met the clinical criteria and HAP were consecutively admitted to the ICU.

Description

Inclusion Criteria:

• Hospital-Acquired Pneumonia
• Intensive Care patient
• X-ray signs of pneumonia

Exclusion Criteria:

• Age less than 18 years
• Negative culture findings in the airways
• Low quantity of culture findings

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
30-day mortality (non modifiable HAP risk factor)	Yes/No assessment	30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of mechanical ventilation before onset of HAP (non modifiable HAP risk factor)	Assessment if mechanical ventilation was provided, or for how long	7 days
Duration of hospital stay before onset of HAP (non modifiable HAP risk factor)	Assessment if hospital stay was present, or for how long	7 days
Repeated transport of the patient from the ICU (non modifiable HAP risk factor)	Assessment if repeated transports were present or not	30 days
Implementation of physiotherapy before onset of HAP (non modifiable HAP risk factor)	Assessment if physiotherapy was provided or not	7 days
Intolerance of enteral nutrition before onset of HAP (non modifiable HAP risk factor)	Yes/No assessment	7 days
Nasogastric intubation before onset of HAP (non modifiable HAP risk factor)	Yes/No assessment	7 days
Bronchoscopy before onset of HAP (non modifiable HAP risk factor)	Yes/No assessment	7 days
Sedation administration before onset of HAP (non modifiable HAP risk factor)	Yes/No assessment	7 days
Urgent tracheal intubation before onset of HAP (non modifiable HAP risk factor)	Yes/No assessment	7 days
Tracheal reintubation before onset of HAP (non modifiable HAP risk factor)	Yes/No assessment	7 days
Aspiration into the lungs before onset of HAP (non modifiable HAP risk factor)	Yes/No assessment	7 days
Condition after abdominal surgery or thoracotomy before onset of HAP (modifiable HAP risk factor)		7 days
Condition after head trauma or neurosurgery before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Condition after tracheotomy before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Impaired consciousness with Glasgow coma scale low than 8 before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Immunosuppression or leukopenia less than 1.5x10 9/L before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Chronical Obstructive Pulmonary Disease before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Diabetes mellitus before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Acute renal insufficiency without renal replacement therapy before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Acute renal insufficiency with renal replacement therapy before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Chronic renal insufficiency before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Ischemic heart disease before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Hypertension before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days
Multi-organ failure before onset of HAP (modifiable HAP risk factor)	Yes/No assessment	7 days

Collaborators and Investigators

• Sponsor: University Hospital Olomouc
• Investigators: Principal Investigator: Radovan Uvizl, UH Olomouc, Czech Republic

Publications and helpful links

General Publications

• Uvizl R, Kolar M, Herkel T, Vobrova M, Langova K. Possibilities for modifying risk factors for the development of hospital-acquired pneumonia in intensive care patients: results of a retrospective, observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017 Sep;161(3):303-309. doi: 10.5507/bp.2017.019. Epub 2017 Apr 26.

Study record dates

Study Major Dates

• Study Start: January 1, 2011
• Primary Completion (Actual): December 1, 2015
• Study Completion (Actual): May 1, 2016

Study Registration Dates

• First Submitted: May 12, 2016
• First Submitted That Met QC Criteria: May 18, 2016
• First Posted (Estimate): May 23, 2016

Study Record Updates

• Last Update Posted (Estimate): May 23, 2016
• Last Update Submitted That Met QC Criteria: May 18, 2016
• Last Verified: May 1, 2016

More Information

Terms related to this study

• Keywords: Epidemiology; Risk Factors; Hospital-acquired Pneumonia
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Disease Attributes; Cross Infection; Iatrogenic Disease; Healthcare-Associated Pneumonia; Pneumonia; Pneumonia, Ventilator-Associated
• Other Study ID Numbers: 63/16

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Collecting data from individual patients medical documentation