Incidence, microbiology, and clinical impact of ventilator-associated pneumonia in traumatic brain injury: a single-center retrospective study.

Abstract

Objective: Ventilator-associated pneumonia (VAP) is a frequent complication in patients with traumatic brain injury (TBI) requiring mechanical ventilation. This study aimed to evaluate the incidence, microbiological characteristics, and clinical impact of VAP in mechanically ventilated patients with TBI.

Methods: During the 5-year study period, 565 patients with traumatic brain injury were screened; 340 met inclusion criteria and were included in the final analysis, divided into VAP (n = 170) and non-VAP (n = 170) groups. This retrospective observational study included adult patients with TBI who required invasive mechanical ventilation for ≥48 hours between January 2020 and December 2024. Patients with pneumonia at admission were excluded. VAP was diagnosed according to international guideline criteria using clinical, radiological, and microbiological findings. Demographic data, injury severity, microbiological results, and clinical outcomes were analyzed. Independent predictors of VAP and mortality were assessed using multivariate logistic regression and Cox proportional hazards models.

Results: Among 340 mechanically ventilated patients with TBI, 170 (50%) developed VAP, with a median onset of 5 days. Gram-negative pathogens predominated, mainly Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, with multidrug-resistant organisms accounting for 61% of isolates. VAP was associated with longer mechanical ventilation, prolonged intensive care unit stay, and higher mortality. Lower admission Glasgow Coma Scale scores, prolonged sedation exposure, and longer ventilation duration were independently associated with VAP. VAP remained an independent predictor of mortality.

Conclusions: VAP is highly prevalent in mechanically ventilated patients with TBI and is associated with adverse clinical outcomes, underscoring the importance of effective prevention strategies.