Respiratory medicine · 2026
Risk factors and microbiological characteristics of ventilator-associated pneumonia in a Tunisian intensive care unit during the COVID-19 pandemic.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Ben Fredj Hallouma, Sakhri Saida, Hafyene Abdelmajid, Mtimet Firas, Abdeljaoued Yassine, Jebri Alia
Аннотация
BACKGROUND: Ventilator-associated pneumonia (VAP) is a major intensive care unit (ICU) complication, particularly in North Africa where multidrug-resistant (MDR) organisms are frequent. This study aimed to determine risk factors, microbiological patterns, and outcomes of VAP in a Tunisian tertiary ICU during the COVID-19 pandemic.
METHODS: We conducted a retrospective observational study including 422 mechanically ventilated patients. VAP was defined using modified Johanson criteria. A multivariable logistic regression model was performed to identify independent risk factors for VAP development, in accordance with STROBE guidelines. Time-related outcomes were not included in the model to avoid temporal bias.
RESULTS: The VAP incidence was 24.2% (6.2 per 1000 ventilator-days), with a median onset of 8 days after intubation. Independent risk factors for VAP included polytrauma, intrahospital transport, diabetes, male sex, and age >75 years. COVID-19 ARDS was associated with a lower adjusted risk of VAP, likely reflecting selection and competing risk biases during the pandemic. Microbiological analysis showed a strong predominance of Gram-negative bacilli. Overall, 59% of isolates were MDR, mainly Acinetobacter baumannii and Klebsiella pneumoniae. Prior antibiotic exposure was strongly associated with MDR infections. ICU mortality among VAP patients was 40%, and hospital mortality reached 44%.
CONCLUSION: In this pandemic-era single-center ICU cohort, VAP was associated with high morbidity and mortality and a substantial burden of MDR Gram-negative pathogens. These results highlight the impact of ICU-specific risk factors and prior antibiotic exposure, and should be interpreted within the context of a COVID-19-dominated ICU, limiting generalizability to non-pandemic settings.
METHODS: We conducted a retrospective observational study including 422 mechanically ventilated patients. VAP was defined using modified Johanson criteria. A multivariable logistic regression model was performed to identify independent risk factors for VAP development, in accordance with STROBE guidelines. Time-related outcomes were not included in the model to avoid temporal bias.
RESULTS: The VAP incidence was 24.2% (6.2 per 1000 ventilator-days), with a median onset of 8 days after intubation. Independent risk factors for VAP included polytrauma, intrahospital transport, diabetes, male sex, and age >75 years. COVID-19 ARDS was associated with a lower adjusted risk of VAP, likely reflecting selection and competing risk biases during the pandemic. Microbiological analysis showed a strong predominance of Gram-negative bacilli. Overall, 59% of isolates were MDR, mainly Acinetobacter baumannii and Klebsiella pneumoniae. Prior antibiotic exposure was strongly associated with MDR infections. ICU mortality among VAP patients was 40%, and hospital mortality reached 44%.
CONCLUSION: In this pandemic-era single-center ICU cohort, VAP was associated with high morbidity and mortality and a substantial burden of MDR Gram-negative pathogens. These results highlight the impact of ICU-specific risk factors and prior antibiotic exposure, and should be interpreted within the context of a COVID-19-dominated ICU, limiting generalizability to non-pandemic settings.