Predictors and Outcomes of Ventilated Hospital-acquired Pneumonia

Hospital-acquired pneumonia (HAP) is defined as an infection of the pulmonary parenchyma that develops in patients admitted to hospital for more than 48 hours and that was not incubating at the time of admission. It represents one of the most common and serious nosocomial infections, associated with significant morbidity, prolonged hospitalisation, and increased mortality in critically ill patients.

The aetiology of HAP is primarily driven by micro-aspiration of bacteria colonising the oropharynx and upper gastrointestinal tract. Pathogen distribution is shaped by the duration of hospitalisation, prior antibiotic exposure, local epidemiology, and patient characteristics. Multidrug-resistant (MDR) organisms are particularly prevalent in patients with prolonged inpatient stay and intensive care unit (ICU) admission, as critically ill patients become rapidly colonised with nosocomial pathogens.

Ventilator-associated pneumonia (VAP), a subgroup of nosocomial pneumonia, occurs in patients requiring tracheal intubation and mechanical ventilation for at least 48 hours. A clinically important and increasingly recognised entity is ventilated HAP (v-HAP), defined as HAP that subsequently requires tracheal intubation and mechanical ventilation. Emerging evidence indicates that v-HAP carries the highest mortality among nosocomial pneumonia subtypes in ICU patients - exceeding VAP - while non-ventilated ICU-acquired HAP carries the lowest mortality.

Study Overview

• Status: Recruiting
• Conditions: Hospital Acquired Pneumonia
• Intervention / Treatment: Behavioral: mechanical ventilation (MV)

Detailed Description

All subjects will be subjected to Complete history taking including demographic characteristics, diagnosis on admission to hospital, previous antibiotic treatment in the last 90 days, antibiotics upon which HAP developed, antibiotics described for HAP treatment, hospital stay before diagnosis of hospital-acquired pneumonia and before ICU admission, steroid use, inhalation antibiotic use, length of ICU stay, length of hospital stay, chronic underlying diseases,and APACHE II score. Vital signs, complete lab investigation sputum and blood cultures, Imaging, and arterial blood gases will be collected as soon as HAP diagnosis is settled and the following indices will be recorded

1. CURB-65 and CRB-65 scores: The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5: Confusion of new onset, Urea > 7 mmol/l (Blood Urea Nitrogen >19), Respiratory rate of 30 breaths per minute or greater, Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less and Age 65 or older [4].
2. SMART-COP and SMRT-CO: The score is also an acronym for each of the risk factors measured; Systolic blood pressure (<90 mmHg, 2 points); Multilobar chest radiography involvement (1 point); low Albumin level (<3.5 g/dl, 1 point); high respiratory Rate (≤50 years: ≥25 br/min,>50 years: ≥30 br/min; 1 point); Tachycardia (≥125 bpm; 1 point); Confusion (new onset; 1 point); poor Oxygenation (≤50 years: PaO2 < 70 mmHg or O2 saturation ≤ 93%,>50 years: PaO2 <60 mmHg or O2 saturation <90%; 2 points); and low arterial PH (<7.35; 2 points)[5].

• Study Type: Observational
• Enrollment (Estimated): 151

Contacts and Locations

• Study Contact: Name: Entsar Hsanen Mohamed, dr; Phone Number: 01019968106; Email: entsar.hsanen@aun.edu.eg

Study Locations

• Egypt
  • Asyut Governorate
    • Asyut, Asyut Governorate, Egypt, 71515
      • Recruiting
      • Assiut University Gospital
      • Contact: Entsar H Mohamed, DR; Phone Number: 01019968106; Email: entsar.hsanen@aun.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

• Adult patients (age ≥18 years) admitted to the Chest Department or Respiratory ICU, Assiut University Hospitals
• Diagnosis of HAP confirmed according to standard clinical, radiological, and microbiological criteria
• Hospital admission for more than 48 hours prior to pneumonia onset
• Ability to provide informed consent

Description

Inclusion Criteria:

All patients diagnosed with HAP in the chest department, Assiut University

Exclusion Criteria:

1. Post operative patients
2. Tracheostomized patients
3. Comatosed patient since admission
4. Suspected aspiration

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
HAP; Diagnosis of HAP confirmed according to standard clinical, radiological, and microbiological criteria	Behavioral: mechanical ventilation (MV); need for mechanical ventilation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Prevalence of mechanical ventilation among HAP patients (v-HAP rate).	1 year

Collaborators and Investigators

• Sponsor: Assiut University

Publications and helpful links

General Publications

• 1-Miron M., Blaj M., Ristescu A. I., et al. Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review. Microorganisms 2024 , 12(1), 213. 2-Szychowiak P., Villageois-Tran K. The role of the microbiota in the management of intensive care patients. Annals of intensive care2022, 12(1), 3. 3-Howroyd F., Chacko C., MacDuff A., et al Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nature communications 2024, 15(1), 6447. 4-Bradley J, Sbaih N, Chandler TR, et al. Pneumonia Severity Index and CURB-65 Score Are Good Predictors of Mortality in Hospitalized Patients with SARS-CoV-2 Community-Acquired Pneumonia. Chest. 2022 Apr;161(4):927-936. 5-Al-Badawy T. H., Abouelela A. M., & Kawi, M. A. G. A. Predictive value of different scoring systems for critically ill patients with hospital-acquired pneumonia. Egyptian Journal of Chest Diseases and Tuberculosis 2016, 65(4), 757-763. 6-Metlay J. P., Waterer G. W., Long A. C., et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American journal of respiratory and critical care medicine 2019, 200(7), e45-e67. 7-Zhang S, Zhang K, Yu Y, et al. A new prediction model for assessing the clinical outcomes of ICU patients with community-acquired pneumonia: a decision tree analysis. Ann Med. 2019 Feb;51(1):41-50. 8-Reyes LF, Bastidas AR, Quintero ET,et al. Performance of the CORB (Confusion, Oxygenation, Respiratory Rate, and Blood Pressure) Scale for the Prediction of Clinical Outcomes in Pneumonia. Can Respir J. 2022 Jun 3;2022:4493777. 9-Brown SM, Dean NC. Defining and predicting severe community-acquired pneumonia. Curr Opin Infect Dis. 2010 Apr;23(2):158-64. 10-Kaya AE, Ozkan S, Usul E, et al. Comparison of pneumonia severity scores for patients diagnosed with pneumonia in emergency department. Indian J Med Res. 2020 Oct;152(4):

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 30, 2027

Study Registration Dates

• First Submitted: June 18, 2026
• First Submitted That Met QC Criteria: June 24, 2026
• First Posted (Actual): June 25, 2026

Study Record Updates

• Last Update Posted (Actual): June 25, 2026
• Last Update Submitted That Met QC Criteria: June 24, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: HAP; ventilated HAP
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Respiratory Tract Infections; Infections; Respiratory Tract Diseases; Lung Diseases; Pneumonia; Cross Infection; Iatrogenic Disease; Pathological Conditions, Signs and Symptoms; Healthcare-Associated Pneumonia; Therapeutics; Airway Management; Resuscitation; Emergency Treatment; Respiratory Therapy; Respiration, Artificial
• Other Study ID Numbers: Predictors of ventilated HAP

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No