Sedation, Sucralfate, and Antibiotic Use Are Potential Means for Protection against Early-Onset Ventilator-Associated Pneumonia

Abstract

To examine risk factors for early-onset ventilator-associated pneumonia (EOP) in patients requiring mechanical ventilation (MV), we performed a prospective cohort study that included 747 patients. Pneumonia was defined as a positive result for a protected quantitative distal sample. EOP was defined as pneumonia that occurred from day 3 to day 7 of MV. Eighty patients (10.7%) experienced EOP. Independent predictors of EOP were male sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.18–3.63), actual Glasgow Coma Scale value of 6–13 (OR, 1.95; 95% CI, 1.2–3.18), high Logistic Organ Dysfunction score at day 2 (OR, 1.12 per point; 95% CI, 1.02–1.23), unplanned extubation (OR, 3.19; 95% CI, 1.28–7.92), and sucralfate use (OR, 1.81; 95% CI, 1.01–3.26). Protection occurred with use of aminoglycosides (OR, 0.36; 95% CI, 0.17–0.76), β-lactams and/or β-lactamase inhibitors (OR, 0.47; 95% CI, 0.28–0.83), or third-generation cephalosporins (OR, 0.33; 95% CI, 0.16–0.74). Sucralfate use and unplanned extubation are independent risk factors for EOP. Use of aminoglycosides, β-lactams/β-lactamase inhibitors, or third-generation cephalosporins protects against EOP.