It has been demonstrated that VAP related mortality is restricted mainly to patients with late-onset VAP; it is only marginally reduced with appropriate empirical antibiotic treatment [ 14].
Considering VAP as a time-dependent covariate, univariate analysis (Table 2) revealed that VAP is not associated with 1-year mortality (HR 1.41; 95% CI 0.98 2.03; P = 0.06).
Hence, our data do not support that VAP due to Acinetobacter baumannii carries a worse prognosis than other causes of VAP.
In two studies by Garnacho-Montero and colleagues [ 11, 25], one of which was included in our review, the authors suggested that VAP due to A. baumannii was not associated with a poorer prognosis than other causes of VAP.
Further, the percentage of patients with VAP diagnosed using BAL was similar in patients with appropriate or inappropriate antibiotic treatment, suggesting that VAP episodes were not misdiagnosed because of the low specificity of tracheal aspirate.
It is noteworthy that VAP incidence could be underestimated in the intervention group because fever is a clinical sign of VAP; consequently, the difference in VAP occurrence between the two groups could be minimized.
However, all the patients included were prospectively followed in order to determine that VAP correctly diagnosed.
Jovanovic et al. [8] found that VAP was associated with higher and earlier mortality in comatose patients with TBI.
One possible reason to omit it might derive from the fact that VAP is intrinsically associated with the stay in the ICU, whatever the underlying condition of the patient.
On the contrary, by considering VAP as a time-dependent variable and estimating survival from the time of VAP diagnosis, we showed that VAP was significantly associated with 1-year mortality.
Investigators previously have shown that VAP associates with microtubules [10], [12].
