Ventilator-Associated Pneumonia Due to Pseudomonas Aeruginosa

Brewer, Susan C.; Wunderink, Richard G.; Jones, Carol; Leeper, Kenneth V.

doi:10.1378/chest.109.4.1019

Cited by 328 publications

(209 citation statements)

References 38 publications

(4 reference statements)

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“…A common complication of sepsis syndrome is adult respiratory distress syndrome, which occurs in 25-45% of patients with sepsis associated with bacteremia (2)(3)(4). In addition, sepsis syndrome with or without adult respiratory distress syndrome is frequently complicated by the development of nosocomial pneumonia, which results in a mortality rate of 55-75% in mechanically ventilated patients (5)(6)(7)(8)(9).…”

Section: Intrapulmonary Tnf Gene Therapy Reverses Sepsis-inducedmentioning

confidence: 99%

Intrapulmonary TNF Gene Therapy Reverses Sepsis-Induced Suppression of Lung Antibacterial Host Defense

Chen

Reddy

Newstead

et al. 2000

The Journal of Immunology

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Sepsis syndrome is frequently complicated by the development of nosocomial infections, particularly Gram-negative pneumonia. Although TNF-α (TNF) has been shown to mediate many of the pathophysiologic events in sepsis, this cytokine is a critical component of innate immune response within the lung. Therefore, we hypothesized that the transient transgenic expression of TNF within the lung during the postseptic period could augment host immunity against nosocomial pathogens. To test this, mice underwent 26-gauge cecal ligation and puncture (CLP) as a model of abdominal sepsis, followed 24 h later by intratracheal (i.t.) administration of Pseudomonas aeruginosa. In animals undergoing sham surgery followed by bacterial challenge, Pseudomonas were nearly completely cleared from the lungs by 24 h. In contrast, mice undergoing CLP were unable to clear P. aeruginosa and rapidly developed bacteremia. Alveolar macrophages (AM) recovered from mice 24 h after CLP produced significantly less TNF ex vivo, as compared with AM from sham animals. Furthermore, the adenoviral mediated transgenic expression of TNF within the lung increased survival in CLP animals challenged with Pseudomonas from 25% in animals receiving control vector to 91% in animals administered recombinant murine TNF adenoviral vector. Improved survival in recombinant murine TNF adenoviral vector-treated mice was associated with enhanced lung bacterial clearance and proinflammatory cytokine expression, as well as enhanced AM phagocytic activity and cytokine expression when cultured ex vivo. These observations suggest that intrapulmonary immunostimulation with TNF can reverse sepsis-induced impairment in antibacterial host defense.

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Section: Intrapulmonary Tnf Gene Therapy Reverses Sepsis-inducedmentioning

confidence: 99%

Intrapulmonary TNF Gene Therapy Reverses Sepsis-Induced Suppression of Lung Antibacterial Host Defense

Chen

Reddy

Newstead

et al. 2000

The Journal of Immunology

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“…[6][7][8][9][10] Mortality associated with P. aeruginosa NP (Pa-NP) is among the highest of any bacteria owing to both the virulence of P. aeruginosa as well as the administration of inappropriate initial antibiotic therapy (IIAT) in MDR isolates. [11][12][13][14][15] The escalating prevalence of antibiotic resistance in P. aeruginosa, along with the development and availability of novel antimicrobial therapies, requires a precise understanding of how the various categories of Pa-NP influence outcome. A comparison of mortality of Pa-NP, as well as risk factors for mortality, according to pneumonia classification has not previously been performed.…”

mentioning

confidence: 99%

Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

Micek

Kollef

Torres

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo describe and compare the mortality associated with nosocomial pneumonia due to Pseudomonas aeruginosa (Pa-NP) according to pneumonia classification (community-onset pneumonia [COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP]).DESIGNWe conducted a retrospective cohort study of adults with Pa-NP. We compared mortality for Pa-NP among patients with COP, HAP, and VAP and used logistic regression to identify risk factors for hospital mortality and inappropriate initial antibiotic therapy (IIAT).SETTINGTwelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3).PATIENTS/PARTICIPANTSA total of 742 patients with Pa-NP.RESULTSHospital mortality was greater for those with VAP (41.9%) and HAP (40.1%) compared with COP (24.5%) (P<.001). In multivariate analyses, independent predictors of hospital mortality differed by pneumonia classification (COP: need for mechanical ventilation and intensive care; HAP: multidrug-resistant isolate; VAP: IIAT, increasing age, increasing Charlson comorbidity score, bacteremia, and use of vasopressors). Presence of multidrug resistance was identified as an independent predictor of IIAT for patients with COP and HAP, whereas recent antibiotic administration was protective in patients with VAP.CONCLUSIONSAmong patients with Pa-NP, pneumonia classification identified patients with different risks for hospital mortality. Specific risk factors for hospital mortality also differed by pneumonia classification and multidrug resistance appeared to be an important risk factor for IIAT. These findings suggest that pneumonia classification for P. aeruginosa identifies patients with different mortality risks and specific risk factors for outcome and IIAT.Infect Control Hosp Epidemiol 2015;36(10):1190–1197

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“…morbidity and mortality rates (4,5). When serious P. aeruginosa infections are suspected, early and appropriate antimicrobial drug therapy is crucial because inadequate drug selection has been associated with increased mortality rates (6,7).…”

mentioning

confidence: 99%

Cefepime-ResistantPseudomonas aeruginosa

Akhabue¹,

Synnestvedt²,

Weiner³

et al. 2011

Emerg. Infect. Dis.

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Resistance to extended-spectrum cephalosporins complicates treatment of Pseudomonas aeruginosa infections. To elucidate risk factors for cefepime-resistant P. aeruginosa and determine its association with patient death, we conducted a case-control study in Philadelphia, Pennsylvania. Among 2,529 patients hospitalized during 2001-2006, a total of 213 (8.4%) had cefepime-resistant P. aeruginosa infection. Independent risk factors were prior use of an extended-spectrum cephalosphorin (p<0.001), prior use of an extended-spectrum penicillin (p = 0.005), prior use of a quinolone (p<0.001), and transfer from an outside facility (p = 0.01). Among those hospitalized at least 30 days, mortality rates were higher for those with cefepimeresistant than with cefepime-susceptible P. aeruginosa infection (20.2% vs. 13.2%, p = 0.007). Cefepime-resistant P. aeruginosa was an independent risk factor for death only for patients for whom it could be isolated from blood (p = 0.001). Strategies to counter its emergence should focus on optimizing use of antipseudomonal drugs.P seudomonas aeruginosa is one of the most common gram-negative bacterial causes of health careacquired infections (1-3). These infections result in high Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s) TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.All other clinicians completing this activity will be issued a certifi cate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscape.org/journal/eid; (4) view/print certifi cate. Learning Objectives Upon completion of this activity, participants will be able to:• Distinguish the prevalence of cefepime-resistant P. aeruginosa• Analyze risk factors for the development of cefepime-resistant P. aeruginosa• Evaluate the effects of cefepime-resistant P. aeruginosa on the risk for mortality.

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Ventilator-Associated Pneumonia Due to Pseudomonas Aeruginosa

Cited by 328 publications

References 38 publications

Intrapulmonary TNF Gene Therapy Reverses Sepsis-Induced Suppression of Lung Antibacterial Host Defense

Intrapulmonary TNF Gene Therapy Reverses Sepsis-Induced Suppression of Lung Antibacterial Host Defense

Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

Cefepime-ResistantPseudomonas aeruginosa

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