362. Risk Factors Associated with Mortality in Patients with Ventilator-Associated Pneumonia (VAP):  An Evaluation of Patients Enrolled in an International Trial for the Treatment of Nosocomial Pneumonia (NP)
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • ZY11-093 IBMP-10 - IDSA11.pdf (861.5 kB)
  • Background: Early mortality may be the outcome that best represents attributable mortality for patients with ventilator-associated pneumonia (VAP). We sought to define risk factors associated with day 14 all cause mortality and to assess mortality prediction scores in patients with VAP.

    Methods: We identified all patients with VAP who were enrolled in an international double-blind randomized controlled trial (DBRCT) comparing linezolid vs vancomycin for the treatment of nosocomial pneumonia (NP). Patients who received at least one dose of study drug (intent-to-treat population) were evaluated. VAP was defined post hoc based on the development of clinical signs and symptoms of pneumonia, along with a new or evolving radiographic infiltrate in patients who had undergone ≥48 hours of mechanical ventilation. Demographics, clinical characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II, and the published Immunosuppression, low Blood Pressure, Multi-lobar, low Platelet, 10 day prior hospitalization (IBMP-10) scores were evaluated as potential risk factors for 14-day all cause mortality.  

    Results: A total of 579 patients were eligible and evaluated. Variables associated with day 14 all cause mortality among patients with VAP are shown in the following table.  


     

    Non-Survivors
    (n=51)

    Survivors
    (n=528)

    P-value

    Age >65y, n (%)

    33 (64.7)

    198 (37.5)

    <0.01

    DM, n (%)

    25 (49.0)

    165 (31.3)

    0.01

    Fever, n (%)

    17 (33.3)

    259 (49.1)

    0.04

    APACHE II, mean (SD)

    19.8 (4.7)

    17.7 (5.8)

    0.01

    IBMP-10, mean (SD)

    1.8 (1.0)

    1.6 (1.0)

    0.06

    Immunosuppression, n (%)

    15 (29.4)

    99 (18.8)

    0.09

    Systolic BP <90, n (%)

    4 (7.8)

    15 (2.8)

    0.08

    Diastolic BP <60, n (%)

    23 (45.1)

    175 (33.1)

    0.09

    DM; diabetes mellitus; BP; blood pressure.

    Conclusion: Age >65 years, DM, absence of fever, and higher APACHE II were associated with day 14 all cause mortality in patients with VAP enrolled in a DBRCT for the treatment of NP. There was a trend between day 14 all cause mortality and immunosuppression, low BP, and IBMP-10. When performing clinical trials evaluating antibiotics for the treatment of VAP, the APACHE II and IBMP-10 scores may not be the ideal tools to adjust for severity of disease. An alternative scoring system to predict early mortality in patients with VAP enrolled in clinical trials is needed.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Paula Peyrani, MD1, Michele Wible2, Kimbal D. Ford, PharmD2, David Huang, MD, PhD, MPH2, Timothy Wiemken, PhD1 and Julio Ramirez, MD1, (1)Division of Infectious Diseases, University of Louisville, Louisville, KY, (2)Specialty Care Medicines Development Group, Pfizer Inc, Collegeville, PA

    Disclosures:

    P. Peyrani, None

    M. Wible, Pfizer Inc: Employee, Salary

    K. D. Ford, Pfizer, Inc.: Employee and Shareholder, Salary

    D. Huang, Pfizer Inc: Employee, Salary

    T. Wiemken, None

    J. Ramirez, Pfizer: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium
    Cubist: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium
    Ortho McNeil: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.