To investigate the risk factors and one-year prognosis of ventilator-associated pneumonia (VAP) infected by multidrug-resistant organism (MDRO) in patients treated in severe neurological rehabilitation ward.

Total of 248 patients with severe neurological rehabilitation who were hospitalized in the neurological intensive care rehabilitation unit of Beijing Rehabilitation Hospital, Capital Medical University from December 2020 to September 2022 were collected. There were no obvious systemic infection at admission. They were divided into case group (80 cases) and control group (168 cases) according to whether diagnosed with VAP infected by MDRO during hospitalization. Two independent sample t tests were taken for the measurement data with normal distribution and Mann-Whitney U tests were taken for the measurement data with non-normal distribution. The classified data were analyzed by Chi-square analysis. The indicators with significant differences in univariate analysis were independent variables, and the diagnosis of VAP infected by MDRO during hospitalization was the dependent variable. Multivariate Logistic regression analysis was performed to find the risk factors of VAP infected by MDRO in patients with severe neurological rehabilitation. Receiver operating characteristic (ROC) curves were plotted to assess the value of risk factors to predict the acquisition of VAP caused by MDRO during hospitalization. Survival curves were drawn to compare one-year survival rates between VAP group and control group.

Among the 248 patients with severe neurological conditions eligible for enrollment, 80 patients (32.26%) were confirmed of VAP with MDRO during hospitalization (case group), and 168 patients (67.74%) were undiagnosed (control group). The age (Z = 0.221, P = 0.026), GCS score (Z = 3.153, P = 0.002), time from onset to admission (Z = 2.238, P = 0.025), hemochrome at admission (Z = 2.502, P = 0.012), use of mechanical ventilation (χ² = 18.750, P < 0.001), history of chronic renal insufficiency (χ² = 7.394, P = 0.007), intravenous use of acid inhibitors (χ² = 8.556, P = 0.003), use of central vein catheter (CVC) (χ² = 15.262, P < 0.001) and single drainage volume of subglottic secretion (DVSS) (χ² = 17.908, P < 0.001) between the two groups were all significantly different. Multivariate Logistic regression analysis indicated: mechanical ventilation (MV) (OR = 2.514, 95%CI: 1.326-4.767, P = 0.005), use of CVC (OR = 2.400, 95%CI: 1.210-4.759, P = 0.012), GCS score (OR = 0.845, 95%CI: 0.766-0.932, P = 0.001), and DVSS (OR = 2.323, 95%CI: 1.494-3.613, P = 0.032) were independent risk factors for VAP infected by MDRO in patients with severe neurological conditions. ROC curves showed the predicting risk factors for MDRO infection with VAP: the sensitivity of time of MV, time of CVC, GCS and DVSS were 43.7%, 37.5%, 68.7% and 86.2%; and the specificity of them were 94.0%, 91.1%, 54.8% and 53.0%; the areas under the curve of them were 0.687, 0.632, 0.623 and 0.728; and the optimal cut-off values were 96 h, 16 d, 8 min and 2.8 ml, respectively. Comparative survival analysis by Log-rank test displayed that the VAP group infected by MDRO had a lower one-year survival rate than the control group, with significant differences (χ² = 39.004, P < 0.001).

Shortening the time of mechanical ventilation, reducing unnecessary catheter days, promoting wakefulness and reducing DVSS could effectively prevent VAP infected by MDRO in patients with severe neurological conditions.