Pathogens in Early-Onset and Late-Onset Intensive Care Unit–Acquired Pneumonia

Verhamme, Katia; Coster, W. De; Roo, L. de; Beenhouwer, H. De; Nollet, G.; Verbeke, Justine; Demeyer, Ignace; Jordens, Paul

doi:10.1086/511702

Cited by 44 publications

(36 citation statements)

References 18 publications

(12 reference statements)

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“…Giantsou et al investigated this question, focusing on pneumonia cases diagnosed by BAL, and came to the same conclusion (11). Hedrick et al did find some differences in the distribution of organisms in early-onset (predominantly gram-positive bacteria) and late-onset (predominantly gram-negative bacteria) VAP among trauma surgical patients, but they were unable to detect any significant differences among nontrauma surgical patients, and no differences in mortality between early-and late onset pneumonia were found either in trauma patients or in nontrauma patients (13 pathogens potentially resistant to multiple drugs were isolated in more than half (52%) of cases of early-onset ICU-acquired pneumonia (26). However, all these authors used data from individual institutions, and their data may not be representative of all intensive-care patients.…”

Section: Discussionmentioning

confidence: 95%

Early- and Late-Onset Pneumonia: Is This Still a Useful Classification?

Gastmeier

Sohr

Geffers

et al. 2009

Antimicrob Agents Chemother

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The choice of empirical treatment of nosocomial pneumonia in the intensive-care unit (ICU) used to rely on the interval after the start of mechanical ventilation. Nowadays, however, the question of whether in fact there is a difference in the distribution of causative pathogens is under debate. Data from 308 ICUs from the German National Nosocomial Infection Surveillance System, including information on relevant pathogens isolated in 11,285 cases of nosocomial pneumonia from 1997 to 2004, were used for our evaluation. Each individual pneumonia case was allocated either to early-or to late-onset pneumonia, with three differentiation criteria: onset on the 4th day, the 5th day, or the 7th day in the ICU. The frequency of pathogens was evaluated according to these categories.

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Section: Discussionmentioning

confidence: 95%

Early- and Late-Onset Pneumonia: Is This Still a Useful Classification?

Gastmeier

Sohr

Geffers

et al. 2009

Antimicrob Agents Chemother

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“…Combination therapy can increase the success of empiric therapy in up to 20% of patients [17, 18]. A high C max is therefore likely necessary given that P. aeruginosa is one of the most frequently isolated micro-organisms, even in cases of early-onset sepsis [19, 20]. …”

Section: Discussionmentioning

confidence: 99%

Impact of a high loading dose of amikacin in patients with severe sepsis or septic shock

Allou

Bouteau

Allyn

et al. 2016

Ann. Intensive Care

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BackgroundThe therapeutic effect of aminoglycosides is highest and optimal when the peak plasma concentration (C max)/minimal inhibitory concentration (MIC) ratio is between 8 and 10. The French guidelines recommend to use high doses of aminoglycosides for empiric antibiotic therapy in patients suffering from severe sepsis or septic shock. In clinical practice, the recommended target is an amikacin C max between 60 and 80 mg/L, which corresponds to approximately 8 times the MIC breakpoint, as defined by the European Committee on Antimicrobial Susceptibility Testing. The aim of this study was to assess the incidence and impact on mortality of an amikacin concentration between 60 and 80 mg/L in patients suffering from severe sepsis or septic shock.MethodsThis was a prospective observational cohort study conducted in two intensive care units (ICU). Patients receiving amikacin at a loading dose of 30 mg/kg for severe sepsis or septic shock were enrolled in the cohort. The target C max for amikacin was between 60 and 80 mg/L, as recommended by French guidelines (i.e. C max/MIC breakpoint = 8–10).ResultsOver the study period, the amikacin C max was <60 mg/L, between 60 and 80 mg/L, and >80 mg/L in 20 (18.2%), 46 (41.8%) and 44 (40%) of the 110 selected patients, respectively. Mortality rate was 40, 28.3 and 56.8% in the groups of patients with C max < 60 mg/L, 60 mg/L < C max < 80 mg/L and C max > 80 mg/L, respectively. Following multivariate analysis, mortality rate was significantly lower in the group of patients with amikacin C max between 60 and 80 mg/L than in the group of patients with amikacin C max > 80 mg/L (P = 0.004). The multivariate analysis also revealed that the factors independently associated with a higher in-ICU mortality rate were age (P = 0.02) and norepinephrine dose (P = 0.0001).Conclusions With a loading dose of 30 mg/kg of amikacin, concentration was potentially suboptimal (C max < 60 mg/L) in only 18.2% of patients. The pharmacodynamic target (60 mg/L < C max < 80 mg/L) recommended by French guidelines was reached in 41.8% of patients and was associated with reduced in-ICU mortality. But amikacin overexposure (i.e. C max > 80 mg/L) was frequent and potentially associated with increased mortality.

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“…were considered community-acquired pathogens, whereas hospital-acquired pathogens included MRSA, ampC-producing Enterobacteriaceae, and nonfermentative gram-negative bacilli. 21 The most frequently used empirical antibiotic therapy regimen consisted of piperacillin-tazobactam (PIP-TAZ) with or without gentamicin (GTC) according to the severity. Vancomycin was added when MRSA carriage was preoperatively known.…”

Section: Perioperative Managementmentioning

confidence: 99%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum b-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed. Orthotopic liver transplantation (LT) is a widely accepted treatment for patients with end-stage liver disease. Despite global improvements in survival over the last few decades, sepsis remains the leading cause of early postoperative mortality. 1,2 Lower respiratory tract infections are a major concern in this context.

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Pathogens in Early-Onset and Late-Onset Intensive Care Unit–Acquired Pneumonia

Cited by 44 publications

References 18 publications

Early- and Late-Onset Pneumonia: Is This Still a Useful Classification?

Early- and Late-Onset Pneumonia: Is This Still a Useful Classification?

Impact of a high loading dose of amikacin in patients with severe sepsis or septic shock

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

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