Attributable mortality of ventilator-associated pneumonia: a meta-analysis

Agrafiotis, Michalis; Siempos, Ilias I.; Ntaidou, Theodora K.; Falagas, Matthew E.

doi:10.5588/ijtld.10.0498

Cited by 56 publications

(27 citation statements)

References 60 publications

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“…In this context, A . baumannii VAP has been associated to higher mortality and longer LOS in ICU than VAP caused by other pathogens [21, 26–28]. For instance, in a cohort of 163 patients with VAP, A .…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis on 24,186 patients from 44 observational studies [28] found that VAP was associated with higher mortality (OR 1.96, 95%CI 1.26–3.04) than their comparative groups; notwithstanding, this association was not found in VAP patients with appropriate initial treatment. The higher mortality of VAP caused by more resistant strains is probably related to the less likelihood of receiving appropriate therapy [21].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin

et al. 2016

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ObjectivesThis study aims to analyze the mortality and the length of ICU stay (LOS) of A. baumannii VAP compared to respiratory colonization in patients with mechanical ventilation (MV).MethodsA prospective cohort study was performed in an ICU of adult patients (February 2010–June 2011). One hundred patients on MV with A. baumannii in lower respiratory airways were recruited, and classified as VAP or airways colonization according to CPIS criteria, with a punctuation ≥6. LOS, 30-days mortality, A. baumannii bacteremia, and clinical features including antibiotic therapy were recorded. Multivariate analysis (linear and Cox regression) and survival analysis (Kaplan-Meier curves) were performed.ResultsFifty-seven VAP and 43 colonized A. baumannii patients were analyzed. Among the A. baumannii strains, 99% were non-susceptible to carbapenems and the MIC90 of colistin was 0.12 mg/l. Therapy was appropriate in 94.6% of VAP patients, most of them with colistin 6 MIU/day, although in 13 (23.6%) cases colistin was started 48 hours after the onset of VAP. Mortality was similar in both groups (VAP 24.6% vs. colonized 27.9%, p = 0.7). Bacteremia and acute kidney insufficiency were associated with decreased survival (p = 0.02 and p = 0.04, respectively) in VAP patients. LOS was 21.5 (11.5–42.75) vs. 9 (6–22) days for VAP and colonized patients (p = 0.004). VAP (p = 0.003) and age (p = 0.01) were independently related to a longer LOS.ConclusionsMultidrug-resistant A. baumannii VAP treated with colistin does not have a different mortality compared to lower airways colonization, among patients on mechanical-ventilation, in a setting of high susceptibility to colistin of A. baumannii.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin

et al. 2016

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“…espiratory tract infections caused by multidrug-resistant (MDR) bacteria, in particular Pseudomonas aeruginosa, are difficult to treat and often associated with high rates of recurrence, mortality, and morbidity (1)(2)(3). For respiratory infections caused by MDR P. aeruginosa, inhalational and intravenous colistin (polymyxin E) is often the only effective option (4,5).…”

mentioning

confidence: 99%

Pharmacokinetics/Pharmacodynamics of Pulmonary Delivery of Colistin against Pseudomonas aeruginosa in a Mouse Lung Infection Model

Lin

Zhou

Cheah

et al. 2017

Antimicrob Agents Chemother

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Colistin is often administered by inhalation and/or the parenteral route for the treatment of respiratory infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa. However, limited pharmacokinetic (PK) and pharmacodynamic (PD) data are available to guide the optimization of dosage regimens of inhaled colistin. In the present study, PK of colistin in epithelial lining fluid (ELF) and plasma was determined following intratracheal delivery of a single dose of colistin solution in neutropenic lung-infected mice. The antimicrobial efficacy of intratracheal delivery of colistin against three P. aeruginosa strains (ATCC 27853, PAO1, and FADDI-PA022; MIC of 1 mg/liter for all strains) was examined in a neutropenic mouse lung infection model. Dose fractionation studies were conducted over 2.64 to 23.8 mg/kg of body weight/day. The inhibitory sigmoid model was employed to determine the PK/PD index that best described the antimicrobial efficacy of pulmonary delivery of colistin. In both ELF and plasma, the ratio of the area under the unbound concentration-time profile to MIC (fAUC/MIC) was the PK/PD index that best described the antimicrobial effect in mouse lung infection (R 2 ϭ 0.60 to 0.84 for ELF and 0.64 to 0.83 for plasma). The fAUC/MIC targets required to achieve stasis against the three strains were 684 to 1,050 in ELF and 2.15 to 3.29 in plasma. The histopathological data showed that pulmonary delivery of colistin reduced infection-caused pulmonary inflammation and preserved the integrity of the lung epithelium, although colistin introduced mild pulmonary inflammation in healthy mice. This study showed pulmonary delivery of colistin provides antimicrobial effects against MDR P. aeruginosa lung infections superior to those of parenteral administrations. For the first time, our results provide important preclinical PK/PD information for optimization of inhaled colistin therapy.

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“…11 A meta-analysis found that the average attributable mortality to VAP is 32.5% in the ICU, 12 supported by another study 13 that found 33%. VAP increases the ICU and hospital length of stay, as well as the time the patient requires ventilatory support.…”

Section: Introductionmentioning

confidence: 81%

Prevention of ventilator-associated pneumonia

Oliveira

Zagalo

Cavaco‐Silva

2014

Revista Portuguesa de Pneumologia (English Edition)

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Attributable mortality of ventilator-associated pneumonia: a meta-analysis

Abstract: Presence, compared to absence, of VAP seems to be associated with higher mortality in critically ill patients. Appropriateness of initial antimicrobial treatment in such patients may moderate this association.

Cited by 56 publications

References 60 publications

Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin

Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin

Pharmacokinetics/Pharmacodynamics of Pulmonary Delivery of Colistin against Pseudomonas aeruginosa in a Mouse Lung Infection Model

Prevention of ventilator-associated pneumonia

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