The Outcome of Healthcare-Associated Pseudomonas Aeruginosa Infection in Chronically Ventilated Patients in a Tertiary Care Hospital in Taiwan

Introduction: Most studies related to healthcare-associated infection with Pseudomonas aeruginosa (HAI-PA) are on acutely ventilated patients. Little is known regarding the incidence and outcomes of HAI-PA in chronically ventilated patients. This retrospective study aimed to study HAI-PA in chronically ventilated patients and the factors that affect outcome in those requiring intensive care unit (ICU) admission.Patients and Method: From 2002 to 2006, a total of 179 chronically ventilated patients and 66 patients with HAI-PA were enrolled in the study for analysis of patients' characteristics and factors that predict ICU mortality when these subjects need ICU admission.Results: The median ventilated duration of all chronically ventilated patients was 206 days. Twenty four (36.4%) patients with HAI-PA needed ICU admission and 14 (58.3%) died. By multivariate analysis adjusted by age and gender after selection by bivariate analysis, APACHE II score (adjusted odds ratio, 5.23; 95% CI, 1.07 to 2.28; p=0.02), the presence of shock (adjusted odds ratio, 4.58; 95% CI, 1.21 to 2.68; p=0.03), and time to receive appropriate antibiotics (adjusted odds ratio, 3.82, 95% CI,1.01 to 2.81; p=0.05) were independent factors that predict ICU mortality of patients with HAI-PA requiring ICU admission.Conclusions: HAI-PA is not only increasing in chronic ventilated patients and but also important to their ICU admission and mortality. APACHE II scores, the presence of shock, and the time to receive appropriate antibiotics are the independent factors of mortality. Delayed treatment may cause a higher mortality and proper antibiotic treatment is important to improve outcome.