DO CLINICAL AND LABORATORY CHARACTERISTICS OF VENTILATOR ASSOCIATED PNEUMONIA DIFFER IN ELDERLY?

1. DO CLINICAL AND LABORATORY CHARACTERISTICS OF VENTILATOR ASSOCIATED PNEUMONIA DIFFER IN ELDERLY? Müge AYDOĞDU, Gül GÜRSEL, Seçil TAŞYÜREK Gazi University Medical Faculty Pulmonary Diseases Department Intensive Care Unit, ANKARA

2. INTRODUCTION • Ventilator Associated Pneumonia (VAP) is a pulmonary infection developing after 48 hours of mechanical ventilation. • It is the most important complication of mechanical ventilation and one of the most important reason for ICU mortality amd morbidity. • Its incidence differs from 9% to 70%

3. INTRODUCTION • Most important risk factors for the development of VAP; • Prolonged mechanical ventilation • Old patient age • Supine position • Comorbidities

4. INTRODUCTION • More and more elderly people are being followed in ICUs due to continuously increasing number of elderly people in the world and in our country. • Although there are many studies about the characteristics of community acquired pneumonia in elderly; there are just a few about the hospital acquired and ventilator associated pneumonia.

5. AIM • In this study we aimed to evaluate the effects of old age on clinical and laboratory characteristics of patients with VAP.

6. METHOD • An observational cohort study • A total of 160 patients, who were diagnosed as VAP clinically and microbiologically and followed with mechanical ventilation for > 48 hours, were included in the study. • Patients were divided into 2 groups and compared for demographical, clinical and laboratory characteristics; • Group 1 (< 70 years old) • Group 2 (≥ 70 years old) • In statistical analysis t-test,2 test and logistic regression analysis were used.

7. RESULTS Demographical Properties

8. ICU characteristics:

9. VAP Characteristics:

10. CAUSATIVE PATHOGENS * * p= 0.004 ** p= 0.002 *** p= 0.009 ** *** % (percentage)

11. Although there are no significant differences between the two groups for laboratory and arterial blood gas analysis, clinical characteristics, development of sepsis and septic shock, appropriate antibiotic usage; • Comorbidity (p= 0.009, OR=1.6,%95 CI: 0.920-3.045) and Acinetobacter infection (p=0.001, OR= 3.4, CI: 1.8-6.2) were identified as independent risk factors of mortality in elderly VAP patients.

12. DISCUSSION • Today, elderly people compose an important part of patients treated in ICUs. • In those patients nosocomial pneumonia and VAP develop more frequently; • Their prolonged stay in ICUs and the use of broad spectrum antibiotics increase the cost burden and most of them result with mortality.

13. DISCUSSION • So inorder to prevent the development and mortality of VAP in elderly patients, it is important to identify the risk factors.

14. There are many studies evaluating the development of community acquired pneumonia in elderly people; • In those studies; • Comorbidities • Impaired mucocilliary clearence and cough reflex • Immunsupression, decreased lymphocyte response due to malnutrition, impaired T cell function. • Unconsciousness, aspiration • Colonization of upper respiratory tract with Gr(+) and Gr(-) microorganisms were identified as risk factors. • Chong CP, Street PR. Pneumonia in the elderly: A review of the epidemiology, pathogenesis, microbiology and clinical features. Southern Medical Journal 2008; 101: 1141-5 • Niederman MS, Brito V.. Pneumonia in the older patient.. Clin Chest Med 28(2007),751-771

15. In the study of Rothan-Tondeur et al.the risk factors for nosocomial pneumonia were identified in 2142 geriatic patients as; • History of pneumonia in the last 6 month • Oxygen therapy • Severe malnutrition • Heart failure • Antibiotic usage in the last 6 month • Feeding with nasogastric tube *Rothan-Tondeur M et al.Risk factors for nosocomial pneumonia in a geriatric hospital: a control-case one-center study. J Am Geriatr Soc 2003 Jul,; 51(7): 997-1001

16. There are just a few study about the elderly patients being followed in ICUs and developing nosocomial pneumonia and VAP. • El-Solh et al. evaluated the upper airway colonization in elderly patients being followed in ICU and identified; • 57% colonization with aerobic pathogens • %45 with Staph aureus • %42 with Enteric Gr(-) bacteria • %13 with Pseudomonas aeroginosa *El-Solh AA et al. Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumoniai in institiuonalized elders. Chest 2004 Nov; 126(5): 1575-82

17. In editorial comment to this study it was claimed that VAP development with multidrug resistant pathogens can be prevented with the establishment of good oral hygiene and the prevention of aspiration of gastrointestinal and oropharyngeal content in intubated patients. • * Pesola GR. Ventilator-Associated Pneumonia in Institutionalized Elders. Chest 2004; 126; 1401-1403

18. CONCLUSION • In our study the increased mortality of VAP in elderly can be explained with comorbidities and more frequent infection with multidrug resistant Acinetobacter Baumanii. • Precautions must be targetted to prevent the development colonization and infection with multidrug resistant pathogens such as Acinetobacter Baumanii in those elderly patients.

19. Thank You……