Factors related to mortality by pneumonia unrelated to mechanical ventilation

Abstract

Objective: to analyze the factors related to mortality by nosocomial pneumonia unrelated to mechanical ventilation. Methods: retrospective cohort study with a sample acquired using the 538 notification forms for health care-related infections. The relative risk was calculated and a multivariable analysis was carried out using Poisson regression with a significance level of 5%. Results: the multivariable analysis showed that being under 59 years old and taking only one antimicrobial drug were protective factors against death. The main microorganisms responsible for the increase in the risk of death were: Acinetobacter baumannii, Klebsiella pneumoniae and species of Candida (Candida spp). Conclusion: the factors related to mortality were being 60 years old or older, using two or more antimicrobial substances, and being affected by the microorganisms Acinetobacter baumannii, Klebsiella pneumonia, and species of Candida (Candida spp). Descriptors: Pneumonia; Mortality; Cross Infection; Hospital Mortality. RESUMO Objetivos: analisar os fatores relacionados com mortalidade por pneumonia hospitalar não associada à ventilação mecânica. Métodos: estudo do tipo coorte retrospectiva com amostra obtida por meio das 538 fichas de notificação das infecções relacionadas com a assistência à saúde. Calculado o Risco Relativo e realizada análise multivariável por meio de regressão de Poisson com nível de significância de 5%. Resultados: na análise multivariável, percebeu-se que os indivíduos com idade inferior a 59 anos e que receberam apenas um antimicrobiano apresentaram proteção para óbito. Os principais microrganismos responsáveis pelo aumento do risco para óbito foram: Acinetobacter baumannii, Klebsiella pneumoniae e Espécies de Candida (Candida spp). Conclusão: foram fatores relacionados com a mortalidade os indivíduos com idade maior que 60 anos, em uso de dois ou mais antimicrobianos, assim como a identificação dos microrganismos Acinetobacter baumannii, Klebsiella pneumoniae e Espécies de Candida (Candida spp). Descritores: Pneumonia; Mortalidade; Infecção Hospitalar; Mortalidade Hospitalar. *Extract from the dissertation “Fatores de risco para óbito por pneumonia hospitalar não associada a ventilação mecânica”, Universidade Estadual de Londrina, 2019. 1Universidade Estadual de Londrina. Londrina, PR, Brazil. 2Instituto Federal do Paraná. Londrina, PR, Brazil. Corresponding author: Carla Fernanda Tiroli Rua José Manoel Ruiz, 52, CEP: 86076-200. Londrina, PR, Brazil. E-mail: [email protected] EDITOR IN CHIEF: Viviane Martins da Silva ASSOCIATE EDITOR: Renan Alves Silva Jucinay Phaedra Silva Sanches1 Carla Fernanda Tiroli1 Erika Bernardo da Silva1 Gabriela Machado Ezaias Paulino2 Gilselena Kerbauy1 Renata Aparecida Belei1 Flávia Meneguetti Pieri1 How to cite this article: Sanches JPS, Tiroli CF, Silva EB, Paulino GME, Kerbauy G, Belei RA, et al. Factors related to mortality by pneumonia unrelated to mechanical ventilation. Rev Rene. 2021;22:e62553. DOI: https://doi.org/10.15253/2175-6783.20212262553 Sanches JPS, Tiroli CF, Silva EB, Paulino GME, Kerbauy G, Belei RA, et al Rev Rene. 2021;22:e62553. 2 Introduction Acquired nosocomial pneumonia, related or not to mechanical ventilation, is one of the main infections in health services and is responsible for a high level of mortality. According to the World Health Organization, infections in the respiratory tract are highly lethal, causing three million deaths worldwide(1). Brazil is one of the countries with the highest incidence of this type of disease(2). Currently, it is seen as an adverse and persistent event, that leads to greater morbidity, increased hospitalization time and high treatment costs, not to mention the need for intensive care including mechanical ventilation, also leading to a higher risk of death(3). A North American multicentric study, involving 21 hospitals, presented a prevalence of nosocomial pneumonia unrelated to mechanical ventilation that varied from 0.12 to 2.28 cases per 1,000 patients/day. 15.8% of these cases were associated with death(4). Another study in a university hospital, in the Brazilian Northeast, described that, from the total number of infections related to health care, 30.2% were diagnosed as having pneumonia(5). It should be noted that this infection is considered to be undernotified, since there were no attempts to identify its rates of incidence in the services(4,6-7). A narrative review presented a scientific gap in the evaluation of measures to prevent and control nosocomial pneumonia unrelated to mechanical ventilation. Certain risk factors can be considered as unavoidable, including age, nutritional conditions, the presence of comorbidities, while others are avoidable, such as those related to conditions of hospitalization, to the treatment provided, and to environmental contamination(8-9). Pneumonia related to mechanical ventilation was and still is investigated with great interest, especially regarding prevention and control measures. However, the knowledge about preventive measures led its incidence to diminish, and the pneumonia unrelated to mechanical ventilation began to stood out, becoming one of the main preoccupations with the safety of the patient. It is considered to be a persisting adverse event in the health services and, as a consequence, it leads to longer hospitalization times, morbidity and mortality, and increases the cost of treatments(9). It should also be highlighted that knowing factors associated to death allows for early diagnosis and treatment, giving support to the development of protocols about the prevention and clinical evolution of these cases and helping to provide the patient with a better prognosis. Considering the above, this study aimed to analyze the factors related to mortality by nosocomial pneumonia unrelated to mechanical ventilation.