Abstract
Background
Ventilator-associated pneumonia (VAP) is a frequent complication in brain-injured patients requiring mechanical ventilation. Staphylococcus aureus (S. aureus) is a major causative pathogen, but the role of nasal carriage at Intensive Care Unit (ICU) admission in the development of S. aureus VAP in this specific population remains poorly defined.Methods
We conducted a single-center observational study including consecutive adults admitted to the ICU with acute brain injury requiring invasive mechanical ventilation for at least 48 hours. Nasal screening for S. aureus was performed within 24 hours of ICU admission. Patients were classified as carriers or non-carriers. The primary outcome was the occurrence of S. aureus VAP during ICU stay. Secondary outcomes included overall VAP incidence, duration of mechanical ventilation, ICU length of stay, neurological status at ICU discharge, catheter, vasoactive support, and antibiotic exposure, and ICU mortality.Results
Ninety-six patients were included, of whom 37 (38.5%) were nasal carriers of S. aureus. Overall, 44 patients (45.8%) developed VAP. The incidence of S. aureus VAP was significantly higher among carriers than non-carriers (40.5% vs. 10.1%; RR 3.99, 95% CI 1.70-9.53; p = 0.001). Early VAP, regardless of pathogen, occurred more frequently in carriers than in non-carriers (45.9% vs. 18.6%; p = 0.02). The overall incidence of VAP and other secondary outcomes did not differ significantly between groups.Conclusion
Nasal carriage of S. aureus at ICU admission could be associated with the occurrence of S. aureus VAP and overall early VAP in brain-injured patients.