Mortality of nosocomial pneumonia in ventilated patients: influence of diagnostic tools.

Timsit, J. F.; Chevret, Sylvie; Valcke, Judith; Misset, Benoît; Renaud, Bertrand; Goldstein, F. W.; Vaury, P; Carlet, Jean

doi:10.1164/ajrccm.154.1.8680666

Cited by 142 publications

(68 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regarding the etiologic diagnosis, we observed concordance with the agents typically isolated in late-onset VAP. (16)(17) In the present study, 92 cases of late-onset VAP (87%) occurred. A total of 43% of the patients with VAP presented infection with multidrugresistant organisms, a statistically higher value than that found for the group without VAP (p < 0.001).…”

Section: Discussionsupporting

confidence: 47%

“…of VAP cases/1000 MV days). (16) The microbiological diagnosis was performed through quantitative cultures of the BALF and tracheal fluid aspirate, as well as through blood cultures and lung biopsies. The following complications were also reported during MV: acute respiratory distress syndrome (ARDS); tracheobronchitis; acute sinusitis; atelectasis; pneumothorax; pneumomediastinum; and accidental extubation.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário

Guimaraes

Rocco

2006

J. bras. pneumol.

View full text Add to dashboard Cite

Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. Methods: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. Results: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases/1000 ventilator-days: 45.3% were caused by gram-negative agents (Pseudomonas aeruginosa accounting for 22%); and multidrug resistant organisms were identified in 43.4%. In the ventilator-associated pneumonia group, time on mechanical ventilation, time to mechanical ventilation weaning, hospital stays and intensive care unit stays were all longer (p < 0.001). In addition, atelectasis, acute respiratory distress syndrome, pneumothorax, sinusitis, tracheobronchitis and infection with multidrug resistant organisms were more common in the ventilator-associated pneumonia group (p < 0.05). Mortality rates in the intensive care unit were comparable to those observed in the hospital infirmary. Associations between ventilator-associated pneumonia and various factors are expressed as odds ratios and 95% confidence intervals: acute sinusitis (38.8; 3.4-441); > 10 days on mechanical ventilation (7.7; 4.1-14.2); immunosuppression (4.3; 1.3-14.3); acute respiratory distress syndrome (3.5; 1.4-9.0); atelectasis (3.0; 1.2-7.3); cardiac arrest (0.18; 0.05-0.66); and upper gastrointestinal tract bleeding (0.07; 0.009-0.62). The variables found to be associated with in-hospital death were as follows: chronic renal failure (26.1; 1.9-350.7); previous intensive care unit admission (15.6; 1.6-152.0); simplified acute physiologic score II > 50 (11.9; 3.4-42.0); and age > 55 years (4.4; 1.6-12.3). Conclusion: Ventilator-associated pneumonia increased the time on mechanical ventilation and the number of complications, as well as the length of intensive care unit and hospital stays, but did not affect mortality rates.

show abstract

Section: Discussionsupporting

confidence: 47%

Section: Methodsmentioning

confidence: 99%

Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário

Guimaraes

Rocco

2006

J. bras. pneumol.

View full text Add to dashboard Cite

show abstract

“…However, the use of a clinical, poorly specific definition of nosocomial pneumonia mimics the real clinical situation, in which decisions must be made on an empirical basis (27), and several recent studies have stressed the importance of appropriate initial antibiotic coverage (1,18,22,25). The two study drugs have shown comparable efficacies in this setting.…”

Section: Discussionmentioning

confidence: 99%

Cefepime versus Imipenem-Cilastatin for Treatment of Nosocomial Pneumonia in Intensive Care Unit Patients: a Multicenter, Evaluator-Blind, Prospective, Randomized Study

Zanetti

Bally

Greub

et al. 2003

Antimicrob Agents Chemother

161

124

View full text Add to dashboard Cite

In a randomized, evaluator-blind, multicenter trial, we compared cefepime (2 g three times a day) with imipenem-cilastatin (500 mg four times a day) for the treatment of nosocomial pneumonia in 281 intensive care unit patients from 13 centers in six European countries. Of 209 patients eligible for per-protocol analysis of efficacy, favorable clinical responses were achieved in 76 of 108 (70%) patients treated with cefepime and 75 of 101 (74%) patients treated with imipenem-cilastatin. The 95% confidence interval (CI) for the difference between these response rates (؊16 to 8%) failed to exclude the predefined lower limit for noninferiority of ؊15%. In addition, therapy of pneumonia caused by an organism producing an extendedspectrum ␤-lactamase (ESBL) failed in 4 of 13 patients in the cefepime group but in none of 10 patients in the imipenem group. However, the clinical efficacies of both treatments appeared to be similar in a secondary intent-to-treat analysis (95% CI for difference, ؊9 to 14%) and a multivariate analysis (95% CI for odds ratio, 0.47 to 1.75). Furthermore, the all-cause 30-day mortality rates were 28 of 108 (26%) patients in the cefepime group and 19 of 101 (19%) patients in the imipenem group (P ‫؍‬ 0.25). Rates of documented or presumed microbiological eradication of the causative organism were similar with cefepime (61%) and imipenem-cilastatin (54%) (95% CI, ؊23 to 8%). Primary or secondary resistance of Pseudomonas aeruginosa was detected in 19% of the patients treated with cefepime and 44% of the patients treated with imipenem-cilastatin (P ‫؍‬ 0.05). Adverse events were reported in 71 of 138 (51%) and 62 of 141 (44%) patients eligible for safety analysis in the cefepime and imipenem groups, respectively (P ‫؍‬ 0.23). Although the primary end point for this study does not exclude the possibility that cefepime was inferior to imipenem, some secondary analyses showed that the two regimens had comparable clinical and microbiological efficacies. Cefepime appeared to be less active against organisms producing an ESBL, but primary and secondary resistance to imipenem was more common for P. aeruginosa. Selection of a single agent for therapy of nosocomial pneumonia should be guided by local resistance patterns.

show abstract

“…HAP infections occur in 0.5 to 2% of hospitalized patients (30,33) and are associated with mortality rates of approximately 30% (6,13,41,54). HAP is usually caused by bacterial pathogens, and in 26 to 67% of cases the etiology is polymicrobial (3,8,39).…”

mentioning

confidence: 99%

Pseudomonas aeruginosa Induces Localized Immunosuppression during Pneumonia

et al. 2008

View full text Add to dashboard Cite

Hospital-acquired bacterial pneumonia is a common and serious complication of modern medical care. Many aspects of such infections remain unclear, including the mechanisms by which invading pathogens resist clearance by the innate immune response and the tendency of the infections to be polymicrobial. Here, we used a mouse model of infection to show that Pseudomonas aeruginosa, a leading cause of hospital-acquired pneumonia, interferes with the ability of recruited phagocytic cells to eradicate bacteria from the lung. Early in infection, phagocytic cells, predominantly neutrophils, are recruited to the lungs but are incapacitated when they enter the airways by the P. aeruginosa toxin ExoU. The resulting paucity of functioning phagocytes allows P. aeruginosa to persist within the lungs and results in local immunosuppression that facilitates superinfection with less-pathogenic bacteria. Together, our results provide explanations for previous reports linking ExoU-secreting P. aeruginosa with more severe pulmonary infections and for the tendency of hospital-acquired pneumonia to be polymicrobial.Hospital-acquired pneumonia (HAP) is a common and frequently lethal complication of admission to an acute medical care facility. HAP infections occur in 0.5 to 2% of hospitalized patients (30,33) and are associated with mortality rates of approximately 30% (6,13,41,54). HAP is usually caused by bacterial pathogens, and in 26 to 67% of cases the etiology is polymicrobial (3,8,39). While the reasons for this are unclear, the coexistence of multiple species of bacteria within the lungs of patients may contribute to the high mortality associated with this disease.The gram-negative bacterium Pseudomonas aeruginosa is the leading cause of HAP in patients undergoing mechanical ventilation (referred to as ventilator-associated pneumonia [VAP]) (40). Interestingly, infection with P. aeruginosa, as opposed to infection with most other bacterial species, is an independent risk factor for death in patients with VAP (23). Although a high incidence of antibiotic resistance among P. aeruginosa strains contributes to the excess mortality associated with this bacterium, its intrinsic virulence also likely plays a role. Even VAP patients treated with antimicrobial agents to which their P. aeruginosa isolates were susceptible had a relapse rate of 18% (42). This suggests that P. aeruginosa elaborates potent virulence determinants that are adept at neutralizing the host immune response, resulting in persistent bacterial infections with poor outcomes.Despite the severity of HAP caused by P. aeruginosa, much remains unknown about the mechanisms by which this bacterium persists in the lungs and causes the tissue damage and inflammation associated with pneumonia. P. aeruginosa elaborates a number of virulence factors that may augment the disease process (12, 45), including a type III secretion system, which has been associated with more-severe disease in patients with HAP (18,44). Via a type III secretion system, some strains of P. aeruginosa injec...

show abstract

Mortality of nosocomial pneumonia in ventilated patients: influence of diagnostic tools.

Cited by 142 publications

References 24 publications

Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário

Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário

Cefepime versus Imipenem-Cilastatin for Treatment of Nosocomial Pneumonia in Intensive Care Unit Patients: a Multicenter, Evaluator-Blind, Prospective, Randomized Study

Pseudomonas aeruginosa Induces Localized Immunosuppression during Pneumonia

Contact Info

Product

Resources

About