Bacteremic Nosocomial Pneumonia

Taylor, Geoffrey; Buchanan-Chell, Maureen; Kirkland, Teresa; McKenzie, Marg; Wiens, Rhoda

doi:10.1378/chest.108.3.786

Cited by 47 publications

(8 citation statements)

References 15 publications

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“…A. baumannii exhibits an intrinsic resistance to multiple antimicrobial agents and generates a continuing controversy about whether VAP caused by this microorganism increases morbidity and mortality independently of the effect of other confounding factors in the ICU setting [22-25]. In contrast to other studies [14,15], our data show A. baumannii is an important pathogen isolated in respiratory samples of B-NP patients and is also an independent risk factor for bacteremia. A. baumannii has a high level of antibiotic resistance, but with a low virulence [25,26].…”

Section: Discussioncontrasting

confidence: 76%

“…The present study reports that 14.6% of NP episodes in European ICUs have bacteremia. Our prevalence is within the range (8 to 20%) of previous studies that included all patients with NP not admitted to the ICU [14,15], but is lower than that (17.3%) shown in the study of Agbaht and colleagues that only included ICU patients with VAP diagnosis [6]. …”

Section: Discussionsupporting

confidence: 57%

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Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study

et al. 2011

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IntroductionSince positive blood cultures are uncommon in patients with nosocomial pneumonia (NP), the responsible pathogens are usually isolated from respiratory samples. Studies on bacteremia associated with hospital-acquired pneumonia (HAP) have reported fatality rates of up to 50%. The purpose of the study is to compare risk factors, pathogens and outcomes between bacteremic nosocomial pneumonia (B-NP) and nonbacteremic nosocomial pneumonia (NB-NP) episodes.MethodsThis is a prospective, observational and multicenter study (27 intensive care units in nine European countries). Consecutive patients requiring invasive mechanical ventilation for an admission diagnosis of pneumonia or on mechanical ventilation for > 48 hours irrespective of admission diagnosis were recruited.ResultsA total of 2,436 patients were evaluated; 689 intubated patients presented with NP, 224 of them developed HAP and 465 developed ventilation-acquired pneumonia. Blood samples were extracted in 479 (69.5%) patients, 70 (14.6%) being positive. B-NP patients had higher Simplified Acute Physiology Score (SAPS) II score (51.5 ± 19.8 vs. 46.6 ± 17.5, P = 0.03) and were more frequently medical patients (77.1% vs. 60.4%, P = 0.01). Mortality in the intensive care unit was higher in B-NP patients compared with NB-NP patients (57.1% vs. 33%, P < 0.001). B-NP patients had a more prolonged mean intensive care unit length of stay after pneumonia onset than NB-NP patients (28.5 ± 30.6 vs. 20.5 ± 17.1 days, P = 0.03). Logistic regression analysis confirmed that medical patients (odds ratio (OR) = 5.72, 95% confidence interval (CI) = 1.93 to 16.99, P = 0.002), methicillin-resistant Staphylococcus aureus (MRSA) etiology (OR = 3.42, 95% CI = 1.57 to 5.81, P = 0.01), Acinetobacter baumannii etiology (OR = 4.78, 95% CI = 2.46 to 9.29, P < 0.001) and days of mechanical ventilation (OR = 1.02, 95% CI = 1.01 to 1.03, P < 0.001) were independently associated with B-NP episodes. Bacteremia (OR = 2.01, 95% CI = 1.22 to 3.55, P = 0.008), diagnostic category (medical patients (OR = 3.71, 95% CI = 2.01 to 6.95, P = 0.02) and surgical patients (OR = 2.32, 95% CI = 1.10 to 4.97, P = 0.03)) and higher SAPS II score (OR = 1.02, 95% CI = 1.01 to 1.03, P = 0.008) were independent risk factors for mortality.ConclusionsB-NP episodes are more frequent in patients with medical admission, MRSA and A. baumannii etiology and prolonged mechanical ventilation, and are independently associated with higher mortality rates.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionsupporting

confidence: 57%

Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study

et al. 2011

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“…A survey of 59 US hospitals involving 4543 patients with culture-positive pneumonia between January 2002 and January 2004 identified MRSA as a potential pathogen in communityacquired pneumonia (CAP) (8.9%), healthcare-associated pneumonia (26.5%), HAP (22.9%) and VAP (14.6%) [2]. Bacteraemic nosocomial S. aureus pneumonia accounted for 8.4% of all bacteraemias, 30% of all nosocomial bacteraemias and 68% of bacteraemias in patients hospitalised in Intensive Care Units (ICUs) in large teaching hospitals [3][4][5]. Indeed, S. aureus was identified as the only pathogen independently associated with mortality.…”

Section: Pneumoniamentioning

confidence: 99%

Staphylococcus aureus bacteraemia with known sources

Rubinstein

2008

International Journal of Antimicrobial Agents

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“…One explanation for the poor prognosis associated with P . aeruginosa pneumonia is that some strains cause acute lung injury and disseminate into the circulation [13,15]. …”

Section: Introductionmentioning

confidence: 99%

Mice Survival and Plasmatic Cytokine Secretion in a “Two Hit” Model of Sepsis Depend on Intratracheal Pseudomonas Aeruginosa Bacterial Load

et al. 2016

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Sepsis is characterized by pro- and anti-inflammatory responses following infection. While inflammation is responsible for widespread organ damage, anti-inflammatory mediators lead to immunoparalysis increasing susceptibility to secondary infections (nosocomial pneumonia). We aimed to investigate the impact of bacterial load on survival and cytokine release in a two-hit murine (C57BL/6J) model of CLP followed by P. aeruginosa pneumonia. Plasmatic TNFα, IL-6, IL-10, sTNFr I and II were quantified until 13 days. At D5, splenocytes were processed for immunological assays or mice were intratracheally instilled with Pseudomonas aeruginosa (5.106, 2.107 and 108 CFU) to evaluate survival and cytokines production. TNFα, sTNFrs, IL-6 and IL-10 increased 2h post CLP. TNFα and sTNFrs declined respectively one and two days later. In CLP mice, IL-6 and IL-10 remained high for the whole experiment, as compared to Sham. At D5, for CLP mice, whereas total T cells population (CD3+) decreased, Treg fraction (CD4+/CD25+) increased. In parallel, T cells proliferation and LPS-stimulated splenocytes ability to release TNFα decreased. At D13, survival was 100% after 5.106 CFU, 50% for CLP mice after 2.107 CFU and 0% for CLP and Sham after 108 CFU. After instillation, IL-10 and IL-6 increased and appeared to be dose and time dependent. Pseudomonas was detected in all CLP and Sham’s lungs; in spleen and liver only in CLP at 2.107 CFU, and in CLP and Sham at 108 CFU. We demonstrated that post-CLP immunosuppression followed by Pseudomonas aeruginosa lung instillation increases mortality reactivates cytokines secretion and is associated with systemic dissemination in septic mice depending on bacterial load.

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Bacteremic Nosocomial Pneumonia

Cited by 47 publications

References 15 publications

Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study

Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study

Staphylococcus aureus bacteraemia with known sources

Mice Survival and Plasmatic Cytokine Secretion in a “Two Hit” Model of Sepsis Depend on Intratracheal Pseudomonas Aeruginosa Bacterial Load

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