Intensive care unit patients with lower respiratory tract nosocomial infections: the ENIRRIs project

Pascale, Gennaro De; Ranzani, Otávio T.; Nseir, Saad; Chastre, Jean; Welte, Tobias; Antonelli, Massimo; Navalesi, Paolo; Garofalo, Eugenio; Bruni, Andrea; Coelho, Luís; Skoczyński, Szymon; Longhini, Federico; Taccone, Fabio Silvio; Grimaldi, David; Salzer, Helmut J. F.; Lange, Christoph; Froes, Filipe; Artigas, A.; Dı́az, Emili; Vallès, Jordi; Rodríguez, Alejandro; Panigada, Mauro; Comellini, Vittoria; Fasano, Luca; Soave, Paolo; Spinazzola, Giorgia; Luyt, Charles Edouard; Álvarez-Lerma, Francisco; Marín, José Eduardo Oliva; Masclans, Joan Ramón; Chiumello, Davide; Pezzi, Annalisa; Schultz, Marcus J.; Mohamed, Hafiz Ahmed E; Eerden, Menno van der; Hoek, R.A.S.; Gommers, Diederik; Pasquale, Marta Di; Čivljak, Rok; Kutleša, Marko; Bassetti, Matteo; Dimοpoulos, George; Nava, Stefano; Ríos, Fernando; Zampieri, Fernando Godinho; Póvoa, Pedro; Bos, Lieuwe D. J.; Aliberti, Stefano; Torres, Antoni; Martín‐Loeches, Ignacio

doi:10.1183/23120541.00092-2017

Cited by 23 publications

(16 citation statements)

References 18 publications

(15 reference statements)

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“…Specifically, >50% of HAP cases required mechanical ventilation. Mortality and outcomes vary significantly between the different subtypes of nosocomial pneumonia [14]. In 2016, MICEK et al [15] observed that patients with HAP presented an 8.4-fold increased risk of death, an eight-fold increase in mechanical ventilation and a longer hospital length of stay compared with those not affected by HAP.…”

Section: Epidemiologymentioning

confidence: 99%

Is ventilated hospital-acquired pneumonia a worse entity than ventilator-associated pneumonia?

et al. 2020

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IntroductionNosocomial pneumonia develops after ≥48 h of hospitalisation and is classified as ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP); the latter may require mechanical ventilation (V-HAP) or not (NV-HAP).Main findingsVAP and HAP affect a significant proportion of hospitalised patients and are characterised by poor clinical outcomes. Among them, V-HAP has the greatest 28-day mortality rate followed by VAP and NV-HAP (27.8% versus 18% versus 14.5%, respectively). However, no differences in terms of pathophysiology, underlying microbiological pathways and subsequent therapy have been identified. International guidelines suggest specific flow charts to help clinicians in the therapeutic management of such diseases; however, there are no specific recommendations beyond VAP and HAP classification. HAP subtypes are scarcely considered as different entities and the lack of data from the clinical scenario limits any final conclusion. Hopefully, recent understanding of the pathophysiology of such diseases, as well as the discovery of new therapies, will improve the outcome associated with such pulmonary infections.ConclusionNosocomial pneumonia is a multifaced disease with features of pivotal interest in critical care medicine. Due to the worrisome data on mortality of patients with nosocomial pneumonia, further prospective studies focused on this topic are urgently needed.

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Section: Epidemiologymentioning

confidence: 99%

Is ventilated hospital-acquired pneumonia a worse entity than ventilator-associated pneumonia?

et al. 2020

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“…The clinical course of ICU patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by different clinical and microbiological aspects [ 3 ]. Interestingly, patients admitted to an ICU that require invasive mechanical ventilation after developing pneumonia in the ward (ventilated Hospital acquired pneumonia) are on the rise [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

Martín‐Loeches

2020

Antibiotics

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It is widely known that pneumonia (either community acquired or hospital acquired, as like ventilator associated pneumonia (VAP)), is the most frequent type of severe infection and continues to pose a significant burden on healthcare services worldwide. Despite new diagnostic developments, most pneumonia cases continue to be difficult to diagnose clinically, partly due to acquired antibiotic resistance and the lack of a ‘gold standard’ method of diagnosis. In other words, the lack of a rapid, accurate diagnostic test, as well as the uncertainty of the initial etiologic diagnosis and the risk stratification, results in empirical antibiotic treatments. There are significant changes in the aetiology of patients with ventilator associated lower respiratory tract infections (VA-LRTI), which are characterised by a higher incidence of multi drug resistant organisms. Evidence suggests that when patients with VA-LRTI develop organ failure, the associated mortality can be exceptionally high with frequent complications, including acute respiratory distress syndrome, acute kidney injury, and septic shock. Appropriate antibiotic treatments must consider that the present cardiovascular failure seen in patients has a different association with the patient’s mortality. Unlike patients with less severe clinical presentations, who have a higher chance of survival when the appropriate antibiotics are administered promptly, for patients with a severe subtype of the disease, the appropriateness of antibiotic treatment will impact the patient’s outcome to a lesser extent. The present review highlights certain factors detectable at the time of admission that could indicate patients who are at a high risk of bacteraemia and who, therefore, merit more intense therapy and stratified care.

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“…The ENIRRIs CRC started with the aim of supporting experienced research groups in the fields of epidemiology, aetiology, microbiology, pathophysiology, clinical management and prognosis of respiratory infections affecting critically ill patients. In 2017, the ENIRRIs became a more global network, including countries in Latin America [13].…”

Section: Aims and Challengesmentioning

confidence: 99%

The European Network for ICU-Related Respiratory Infections (ENIRRIs) ERS Clinical Research Collaboration

Martín‐Loeches

Torres

2019

Eur Respir J

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Intensive care unit patients with lower respiratory tract nosocomial infections: the ENIRRIs project

Cited by 23 publications

References 18 publications

Is ventilated hospital-acquired pneumonia a worse entity than ventilator-associated pneumonia?

Is ventilated hospital-acquired pneumonia a worse entity than ventilator-associated pneumonia?

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

The European Network for ICU-Related Respiratory Infections (ENIRRIs) ERS Clinical Research Collaboration

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