Archives of Clinical Infectious Diseases

Published by: Kowsar

Bacteriologic Evaluation of Ventilator-Associated Pneumonia According to Stress Related Mucosal Disease Prophylaxis in the Intensive Care Unit

Farshid Rahimi Bashar 1 , Zahra Doosti 2 , Arezoo Chouhdari 3 , 4 , Shervin Shokouhi 2 , Saadat Torabian 5 , Zahra Sahraei 6 , Seyed Pouzhia Shojaei 7 , Mohammad Fathi 7 , Reza Goharani 7 and Mohammadreza Hajiesmaeili 7 , *
Authors Information
1 Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
2 Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Skull Base Research Center, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Clinical Research Development Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
6 Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
7 Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Article information
  • Archives of Clinical Infectious Diseases: December 31, 2018, 13 (6); e82521
  • Published Online: November 17, 2018
  • Article Type: Research Article
  • Received: January 27, 2018
  • Revised: July 23, 2018
  • Accepted: August 12, 2018
  • DOI: 10.5812/archcid.82521

To Cite: Rahimi Bashar F, Doosti Z, Chouhdari A, Shokouhi S, Torabian S, et al. Bacteriologic Evaluation of Ventilator-Associated Pneumonia According to Stress Related Mucosal Disease Prophylaxis in the Intensive Care Unit, Arch Clin Infect Dis. 2018 ; 13(6):e82521. doi: 10.5812/archcid.82521.

Copyright © 2018, Archives of Clinical Infectious Diseases. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med. 2005;33(10):2184-93. [PubMed: 16215368].
  • 2. Melsen WG, Rovers MM, Bonten MJM. Ventilator-associated pneumonia and mortality: A systematic review of observational studies. Crit Care Med. 2009;37(10):2709-18. doi: 10.1097/CCM.0b013e3181ab8655.
  • 3. Warren DK, Shukla SJ, Olsen MA, Kollef MH, Hollenbeak CS, Cox MJ, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med. 2003;31(5):1312-7. doi: 10.1097/01.CCM.0000063087.93157.06. [PubMed: 12771596].
  • 4. Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009;301(20):2120-8. doi: 10.1001/jama.2009.722. [PubMed: 19470989].
  • 5. Nguile-Makao M, Zahar JR, Francais A, Tabah A, Garrouste-Orgeas M, Allaouchiche B, et al. Attributable mortality of ventilator-associated pneumonia: Respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med. 2010;36(5):781-9. doi: 10.1007/s00134-010-1824-6. [PubMed: 20232046].
  • 6. Wolkewitz M, Beyersmann J, Gastmeier P, Schumacher M. Modeling the effect of time-dependent exposure on intensive care unit mortality. Intensive Care Med. 2009;35(5):826-32. doi: 10.1007/s00134-009-1423-6. [PubMed: 19183943].
  • 7. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32. doi: 10.1016/j.ajic.2008.03.002. [PubMed: 18538699].
  • 8. Klompas M. Interobserver variability in ventilator-associated pneumonia surveillance. Am J Infect Control. 2010;38(3):237-9. doi: 10.1016/j.ajic.2009.10.003. [PubMed: 20171757].
  • 9. Schreiber MP, Chan CM, Shorr AF. Resistant pathogens in nonnosocomial pneumonia and respiratory failure: Is it time to refine the definition of health-care-associated pneumonia? Chest. 2010;137(6):1283-8. doi: 10.1378/chest.09-2434. [PubMed: 20154075].
  • 10. Giannella M, Pinilla B, Capdevila JA, Martinez Alarcon J, Munoz P, Lopez Alvarez J, et al. Pneumonia treated in the internal medicine department: Focus on healthcare-associated pneumonia. Clin Microbiol Infect. 2012;18(8):786-94. doi: 10.1111/j.1469-0691.2011.03757.x. [PubMed: 22284436].
  • 11. Metheny NA, Clouse RE, Chang YH, Stewart BJ, Oliver DA, Kollef MH. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors. Crit Care Med. 2006;34(4):1007-15. doi: 10.1097/01.CCM.0000206106.65220.59. [PubMed: 16484901]. [PubMed Central: PMC2396145].
  • 12. Bercault N, Boulain T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: A prospective case-control study. Crit Care Med. 2001;29(12):2303-9. [PubMed: 11801831].
  • 13. Bornstain C, Azoulay E, De Lassence A, Cohen Y, Costa MA, Mourvillier B, et al. Sedation, sucralfate, and antibiotic use are potential means for protection against early-onset ventilator-associated pneumonia. Clin Infect Dis. 2004;38(10):1401-8. doi: 10.1086/386321. [PubMed: 15156478].
  • 14. Vincent JL. Nosocomial infections in adult intensive-care units. The Lancet. 2003;361(9374):2068-77. doi: 10.1016/s0140-6736(03)13644-6.
  • 15. Hamishekar H, Shadvar K, Taghizadeh M, Golzari SE, Mojtahedzadeh M, Soleimanpour H, et al. Ventilator-associated pneumonia in patients admitted to intensive care units, using open or closed endotracheal suctioning. Anesth Pain Med. 2014;4(5). e21649. doi: 10.5812/aapm.21649. [PubMed: 25729677]. [PubMed Central: PMC4333305].
  • 16. Darlong V, Jayalakhsmi TS, Kaul HL, Tandon R. Stress ulcer prophylaxis in patients on ventilator. Trop Gastroenterol. 2003;24(3):124-8. [PubMed: 14978984].
  • 17. Huang J, Cao Y, Liao C, Wu L, Gao F. Effect of histamine-2-receptor antagonists versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients: A meta-analysis of 10 randomized controlled trials. Crit Care. 2010;14(5):R194. doi: 10.1186/cc9312. [PubMed: 21034484]. [PubMed Central: PMC3219301].
  • 18. Kantorova I, Svoboda P, Scheer P, Doubek J, Rehorkova D, Bosakova H, et al. Stress ulcer prophylaxis in critically ill patients: A randomized controlled trial. Hepatogastroenterology. 2004;51(57):757-61. [PubMed: 15143910].
  • 19. Conrad SA, Gabrielli A, Margolis B, Quartin A, Hata JS, Frank WO, et al. Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Crit Care Med. 2005;33(4):760-5. [PubMed: 15818102].
  • 20. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416. doi: 10.1164/rccm.200405-644ST. [PubMed: 15699079].
  • 21. Williams C, McColl KE. Review article: proton pump inhibitors and bacterial overgrowth. Aliment Pharmacol Ther. 2006;23(1):3-10. doi: 10.1111/j.1365-2036.2006.02707.x. [PubMed: 16393275].
  • 22. Solouki M, Marashian SM, Kouchak M, Nasiri AA, Mokhtari M, Amirpour A. Ventilator-associated pneumonia among ICU patients receiving mechanical ventilation and prophylaxis of gastrointestinal bleeding. Iranian J Clin Infect Dis. 2009;4(3):177-80.
  • 23. Rahimi Bashar F, Rastgouyhaghi AR, Torabian S, Hajiesmaeili MR, Sedaghat AR, Seifi S, et al. Prevention of Stress Related Mucosal Disease with Intermittent Intravenous Pantoprazole and Ranitidine in Critically Ill Patients. J Pharm Care. 2013;1(3):81-4.
  • 24. Hajiesmaeili MR, Moradi Moghadam O, Sedaghat A, Niakan M, Seifi S, Bashar FR, et al. Evaluation of ventilator-associated pneumonia according to stress related mucosal disease prophylaxis regimen in the intensive care unit. Arch Anesthesiol Critical Care. 2015;1(4):116-9.
  • 25. Bashar FR, Manuchehrian N, Mahmoudabadi M, Hajiesmaeili MR, Torabian S. Effects of ranitidine and pantoprazole on ventilator-associated pneumonia: A randomized double-blind clinical trial. Tanaffos. 2013;12(2):16-21. [PubMed: 25191457]. [PubMed Central: PMC4153243].
  • 26. Miano TA, Reichert MG, Houle TT, MacGregor DA, Kincaid EH, Bowton DL. Nosocomial pneumonia risk and stress ulcer prophylaxis: A comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest. 2009;136(2):440-7. doi: 10.1378/chest.08-1634. [PubMed: 19318661].
  • 27. Schurink CAM, Nieuwenhoven CAV, Jacobs JA, Rozenberg-Arska M, Joore HCA, Buskens E, et al. Clinical pulmonary infection score for ventilator-associated pneumonia: Accuracy and inter-observer variability. Intensive Care Med. 2004;30(2):217-24. doi: 10.1007/s00134-003-2018-2. [PubMed: 14566455].
  • 28. Husebye E. The pathogenesis of gastrointestinal bacterial overgrowth. Chemotherapy. 2005;51 Suppl 1:1-22. doi: 10.1159/000081988. [PubMed: 15855746].
  • 29. Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med. 2004;141(4):305-13. [PubMed: 15313747].
  • 30. Bergmans DC, Bonten MJ, Gaillard CA, Paling JC, van der Geest S, van Tiel FH, et al. Prevention of ventilator-associated pneumonia by oral decontamination: A prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med. 2001;164(3):382-8. doi: 10.1164/ajrccm.164.3.2005003. [PubMed: 11500337].
  • 31. Tlaskalova-Hogenova H, Stepankova R, Hudcovic T, Tuckova L, Cukrowska B, Lodinova-Zadnikova R, et al. Commensal bacteria (normal microflora), mucosal immunity and chronic inflammatory and autoimmune diseases. Immunol Lett. 2004;93(2-3):97-108. doi: 10.1016/j.imlet.2004.02.005. [PubMed: 15158604].
  • 32. Grap MJ, Munro CL, Unoki T, Hamilton VA, Ward KR. Ventilator-associated pneumonia: The potential critical role of emergency medicine in prevention. J Emerg Med. 2012;42(3):353-62. doi: 10.1016/j.jemermed.2010.05.042. [PubMed: 20692786].
  • 33. Faisy C, Guerot E, Diehl JL, Iftimovici E, Fagon JY. Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Intensive Care Med. 2003;29(8):1306-13. doi: 10.1007/s00134-003-1863-3. [PubMed: 12830375].
  • 34. Hsu TC, Su CF, Leu SC, Huang PC, Wang TE, Chu CH. Omeprazole is more effective than a histamine H2-receptor blocker for maintaining a persistent elevation of gastric PH after colon resection for cancer. Am J Surg. 2004;187(1):20-3. [PubMed: 14706580].
  • 35. Prakash S, Rai A, Gogia AR, Prakash S. Nosocomial pneumonia in mechanically ventilated patients receiving ranitidine or sucralfate as stress ulcer prophylaxis. Indian J Anaesth. 2008;52(2):179-84.
  • 36. Lopriore E, Markhorst DG, Gemke RJ. Ventilator-associated pneumonia and upper airway colonisation with gram negative bacilli: The role of stress ulcer prophylaxis in children. Intensive Care Med. 2002;28(6):763-7. doi: 10.1007/s00134-002-1289-3. [PubMed: 12107684].
  • 37. Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: An evidence-based systematic review. Ann Intern Med. 2003;138(6):494-501.
  • 38. Kallet RH, Quinn TE. The gastrointestinal tract and ventilator-associated pneumonia. Respir Care. 2005;50(7):910-21. discussion 921-3. [PubMed: 15972112].
  • 39. Mallow S, Rebuck JA, Osler T, Ahern J, Healey MA, Rogers FB. Do proton pump inhibitors increase the incidence of nosocomial pneumonia and related infectious complications when compared with histamine-2 receptor antagonists in critically ill trauma patients? Curr Surg. 2004;61(5):452-8. doi: 10.1016/j.cursur.2004.03.014. [PubMed: 15475094].
  • 40. Sasaki T, Yamaya M, Yasuda H, Inoue D, Yamada M, Kubo H, et al. The proton pump inhibitor lansoprazole inhibits rhinovirus infection in cultured human tracheal epithelial cells. Eur J Pharmacol. 2005;509(2-3):201-10. doi: 10.1016/j.ejphar.2004.12.042. [PubMed: 15733557].
  • 41. Ichikawa H, Yoshida N, Takagi T, Tomatsuri N, Katada K, Isozaki Y, et al. Lansoprazole ameliorates intestinal mucosal damage induced by ischemia-reperfusion in rats. World J Gastroenterol. 2004;10(19):2814-7. [PubMed: 15334676]. [PubMed Central: PMC4572108].
  • 42. Tabeefar H, Beigmohammadi MT, Javadi MR, Abdollahi M, Mahmoodpoor A, Ahmadi A, et al. Effects of pantoprazole on systemic and gastric pro- and anti-inflammatory cytokines in critically ill patients. Iran J Pharm Res. 2012;11(4):1051-8. [PubMed: 24250536]. [PubMed Central: PMC3813167].
  • 43. Alroumi F, Sarwar A, Grgurich PE, Lei Y, Hudcova J, Craven DE. Strategies for prevention of ventilator-associated pneumonia: Bundles, devices, and medications for improved patient outcomes. Hosp Pract (1995). 2012;40(1):81-92. doi: 10.3810/hp.2012.02.949. [PubMed: 22406884].

Featured Image:

Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments