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Crit Care Med. 2019 Mar;47(3):345-352. doi: 10.1097/CCM.0000000000003553.

A Comparison of the Mortality Risk Associated With Ventilator-Acquired Bacterial Pneumonia and Nonventilator ICU-Acquired Bacterial Pneumonia.

Author information

1
UMR 1137, IAME, Université Paris Diderot, Paris, France.
2
Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Diderot University, Paris, France.
3
Intensive Care Unit, AP-HP, Avicenne Hospital, Paris, France.
4
Intensive Care Unit, Medicine University, Paris 13 University, Bobigny, France.
5
Outcomerea Research Network, Aulnay sous Bois, France.
6
Medical Intensive Care Unit and University Hospital Centre, Nantes, France.
7
Surgical Intensive Care Unit and Lyon University Hospital, Lyon, France.
8
Critical Care Medicine Unit, CH Etampes-Dourdan, Etampes, France.
9
Medical Intensive Care Unit, Saint Etienne University Hospital, Saint-Etienne, France.
10
Intensive Care Unit, Jacques Lisfranc Medicine University, Jean Monnet University, Saint-Etienne, France.
11
CH de Saint-Denis - Hôpital Delafontaine Service de Réanimation Polyvalente, Saint-Denis, Cedex, France.
12
Medical ICU, Edouard Herriot University Hospital, Lyon, France.
13
Medical Surgical ICU, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
14
Intensive Care Unit, Saint Joseph Hospital Network, Paris, France.
15
Intensive Care Unit, Medicine University, Paris Descartes University, Sorbonne Cite, Paris, France.
16
Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, La Tronche, France.
17
Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
18
Medical-Surgical Intensive Care Unit, Le Raincy-Montfermeil General hospital, France.
19
Respiratory and infectious diseases ICU, APHM Hôpital Nord, Aix Marseille University, Marseille, France.

Abstract

OBJECTIVES:

To investigate the respective impact of ventilator-associated pneumonia and ICU-hospital-acquired pneumonia on the 30-day mortality of ICU patients.

DESIGN:

Longitudinal prospective studies.

SETTING:

French ICUs.

PATIENTS:

Patients at risk of ventilator-associated pneumonia and ICU-hospital-acquired pneumonia.

INTERVENTIONS:

The first three episodes of ventilator-associated pneumonia or ICU-hospital-acquired pneumonia were handled as time-dependent covariates in Cox models. We adjusted using the case-mix, illness severity, Simplified Acute Physiology Score II score at admission, and procedures and therapeutics used during the first 48 hours before the risk period. Baseline characteristics of patients with regard to the adequacy of antibiotic treatment were analyzed, as well as the Sequential Organ Failure Assessment score variation in the 2 days before the occurrence of ventilator-associated pneumonia or ICU-hospital-acquired pneumonia. Mortality was also analyzed for Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species(ESKAPE) and P. aeruginosa pathogens.

MEASUREMENTS AND MAIN RESULTS:

Of 14,212 patients who were admitted to the ICUs and who stayed for more than 48 hours, 7,735 were at risk of ventilator-associated pneumonia and 9,747 were at risk of ICU-hospital-acquired pneumonia. Ventilator-associated pneumonia and ICU-hospital-acquired pneumonia occurred in 1,161 at-risk patients (15%) and 176 at-risk patients (2%), respectively. When adjusted on prognostic variables, ventilator-associated pneumonia (hazard ratio, 1.38 (1.24-1.52); p < 0.0001) and even more ICU-hospital-acquired pneumonia (hazard ratio, 1.82 [1.35-2.45]; p < 0.0001) were associated with increased 30-day mortality. The early antibiotic therapy adequacy was not associated with an improved prognosis, particularly for ICU-hospital-acquired pneumonia. The impact was similar for ventilator-associated pneumonia and ICU-hospital-acquired pneumonia mortality due to P. aeruginosa and the ESKAPE group.

CONCLUSIONS:

In a large cohort of patients, we found that both ICU-hospital-acquired pneumonia and ventilator-associated pneumonia were associated with an 82% and a 38% increase in the risk of 30-day mortality, respectively. This study emphasized the importance of preventing ICU-hospital-acquired pneumonia in nonventilated patients.

PMID:
30407949
DOI:
10.1097/CCM.0000000000003553
[Indexed for MEDLINE]

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