Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates

Ana Carolina Souza-Oliveira, Thúlio Marquez Cunha, Liliane Barbosa da Silva Passos, Gustavo Camargo Lopes, Fabiola Alves Gomes, Denise Von Dolinger de Brito Röder

Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14-70%). This study evaluated factors influencing mortality of patients with VAP, including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy. This retrospective study included 120 cases of VAP admitted to the adult ICU of the Federal University of Uberlândia. The chi-square test was used to compare qualitative variables. Student's t-test was used for quantitative variables and multiple logistic regression analysis to identify independent predictors of mortality. De-escalation of antibiotic therapy and resistant bacteria did not influence mortality. Mortality was 4 times and 3 times higher, respectively, in patients who received an inappropriate antibiotic loading dose and in patients whose antibiotic dose was not adjusted for renal function. Multiple logistic regression analysis revealed the incorrect adjustment for renal function was the only independent factor associated with increased mortality. Prescription errors influenced mortality of patients with VAP, underscoring the challenge of proper VAP treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.