Hospital Readmissions and Mortality Among Intubated and Mechanically Ventilated Adult Subjects With Pneumonia Due to Gram-Negative Bacteria
- 16 February 2021
- journal article
- research article
- Published by Daedalus Enterprises in Respiratory Care
- Vol. 66 (5), 742-750
- https://doi.org/10.4187/respcare.07754
Abstract
BACKGROUND: Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections in ICUs and is associated with significant morbidity and mortality. Gram-negative bacteria cause 55–85% of hospital-acquired pneumonia and are associated with increased mortality. METHODS: This study sought to describe mortality rates and 30-d readmission rates among intubated and mechanically ventilated subjects with Gram-negative pneumonia and to explore associated risk factors for mortality and rehospitalization using data from the 2013 Healthcare Cost and Utilization Project (HCUP) National Readmission Database. The study sample included adults age ≥ 18 y who were hospitalized with invasive, continuous mechanical ventilation; were discharged between February 1, 2013, and November 30, 2013; and had a primary or secondary diagnosis of Gram-negative bacterial pneumonia. Logistic regression was used to identify subject characteristics significantly associated with mortality and readmissions. RESULTS: Using the HCUP projected sample of 32,683 intubated and mechanically ventilated subjects with Gram-negative pneumonia, the mortality rate during the index hospitalization was 24.3%. More than one fifth of subjects (22.9%) who survived the index hospitalization were readmitted within 30 d of discharge. Among subjects with readmissions, 18% occurred within 3 d of discharge, 39% occurred within 7 d of discharge, and 65% occurred within 14 d of discharge. Subjects with prior hospitalization within 30 d of the index hospitalization had a higher risk of readmission with an odds ratio of 1.70 (95% CI 1.48–1.94). CONCLUSIONS: Mortality was high and readmissions were substantial among intubated and mechanically ventilated subjects with Gram-negative pneumonia.This publication has 13 references indexed in Scilit:
- Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of CareHealth Affairs, 2016
- Cost comparison of mechanically ventilated patients across the age spanJournal of Perinatology, 2015
- Prevalence, Risk Factors, and Mortality for Ventilator-Associated Pneumonia in Middle-Aged, Old, and Very Old Critically Ill Patients*Critical Care Medicine, 2014
- Readmission Following Hospitalization for Pneumonia: The Impact of Pneumonia Type and Its Implication for HospitalsClinical Infectious Diseases, 2013
- Comparative Effectiveness of Noninvasive Ventilation vs Invasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Patients With Acute Respiratory FailureJournal of Hospital Medicine, 2013
- Diagnoses and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, or PneumoniaJAMA, 2013
- Management of ventilator-associated pneumonia: epidemiology, diagnosis and antimicrobial therapyExpert Review of Anti-infective Therapy, 2012
- The epidemiology of mechanical ventilation use in the United States*Critical Care Medicine, 2010
- Clinical and economic consequences of ventilator-associated pneumonia: A systematic reviewCritical Care Medicine, 2005
- Ventilator-associated PneumoniaAmerican Journal of Respiratory and Critical Care Medicine, 2002