Clinically suspected nosocomial pneumonia was routinely documented using cultures of protected distal specimens, protected brushing, or BAL, as previously described. Antibiotic treatment of nosocomial pneumonia was in compliance with current guide-lines. Invasive candidiasis was defined as recommended. Recovery of Candida spp from the lungs (protected or unprotected specimens), urine, stool, upper digestive tract (mouth, pharynx, or stomach), drainage systems, or postoperative sites was interpreted as colonization, regardless of organism counts. When Candida was documented at one body site, specimens were collected routinely from other sites to look for additional Candida colonization. Antifungal therapy was at the discretion of the physician in charge. buy ventolin inhaler
Data were collected daily on computers by ICU physicians closely involved in establishing the database. All codes and definitions were written before data collection. For each patient, the ICU physician completed a case report form on a computer using data capture software (Vigirea; manufactured by author’s group) and then imported all records to the database. The following information was recorded prospectively: demographic characteristics (age, sex, weight, height); underlying diseases using the McCabe score and Knaus classification; presence of diabetes mellitus (with the type and complications); admission category (medical, scheduled surgery, or unscheduled surgery); admission diagnosis (cardiac, respiratory, or neurologic failure, infection, and other); invasive procedures (arterial or venous central catheter, Swan-Ganz catheter, endotracheal intubation); and treatment of organ failures (inotropic support, hemodialysis, and mechanical ventilation). Location of the patient prior to ICU admission was recorded, with transfer from wards defined as being in the same hospital or another hospital before ICU admission. Severity of illness was recorded at admission and on each day. Day 1 was defined as the interval from admission to 8:00 am on the next day; all other days were calendar days from 8:00 am to 8:00 am. The simplified acute physiology score (SAPS II) at hospital admission was computed using the worse physical and laboratory data recorded during the first 24 h in the ICU. The SAPS II and logistic organ dysfunction (LOD) score were computed daily. Duration of stays in the ICU and acute-care hospital and vital status at ICU and hospital discharge were recorded.