Ventilator-Associated Tracheobronchitis: To Treat or Not to Treat?

Koulenti, Despoina; Arvaniti, Kostoula; Judd, Mathew; Lalos, Natasha; Tjoeng, Iona; Xu, Elena; Armaganidis, Apostolos; Lipman, Jeffrey

doi:10.3390/antibiotics9020051

Cited by 17 publications

(25 citation statements)

References 42 publications

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“…Ventilator-associated lower respiratory tract infection (VA-LRTI) comprises ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP). Because VAT represents a continuum of colonization and VAP, with overlap between the two conditions, antibiotic therapy in patients with VAT remains controversial [1][2][3]. Furthermore, the increasing emergence of multidrug-resistant PA has become a global problem [4].…”

Section: Introductionmentioning

confidence: 99%

Airway Pseudomonas aeruginosa density in mechanically ventilated patients: clinical impact and relation to therapeutic efficacy of antibiotics

et al. 2021

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Background The bacterial density of Pseudomonas aeruginosa is closely related to its pathogenicity. We evaluated the effect of airway P. aeruginosa density on the clinical course of mechanically ventilated patients and the therapeutic efficacy of antibiotics. Methods We retrospectively analyzed data of mechanically ventilated ICU patients with P. aeruginosa isolated from endotracheal aspirates. Patients were divided into three groups according to the peak P. aeruginosa density during ICU stay: low (≤ 104 cfu/mL), moderate (105‒106 cfu/mL), and high (≥ 107 cfu/mL) peak density groups. The relationship between peak P. aeruginosa density and weaning from mechanical ventilation, risk factors for isolation of high peak density of P. aeruginosa, and antibiotic efficacy were investigated using multivariate and propensity score-matched analyses. Results Four-hundred-and-sixty-one patients were enrolled. Patients with high peak density of P. aeruginosa had higher inflammation and developed more severe respiratory infections. High peak density of P. aeruginosa was independently associated with few ventilator-free days on day 28 (P < 0.01) and increased ICU mortality (P = 0.047). Risk factors for high peak density of P. aeruginosa were prolonged mechanical ventilation (odd ratio [OR] 3.07 95% confidence interval [CI] 1.35‒6.97), non-antipseudomonal cephalosporins (OR 2.17, 95% CI 1.35‒3.49), hyperglycemia (OR 2.01, 95% CI 1.26‒3.22) during ICU stay, and respiratory diseases (OR 1.9, 95% CI 1.12‒3.23). Isolation of commensal colonizer was associated with lower risks of high peak density of P. aeruginosa (OR 0.43, 95% CI 0.26‒0.73). Propensity score-matched analysis revealed that antibiotic therapy for patients with ventilator-associated tracheobronchitis improved weaning from mechanical ventilation only in the high peak P. aeruginosa group. Conclusions Patients with high peak density of P. aeruginosa had worse ventilator outcome and ICU mortality. In patients with ventilator-associated tracheobronchitis, antibiotic therapy was associated with favorable ventilator weaning only in the high peak P. aeruginosa density group, and bacterial density could be a good therapeutic indicator for ventilator-associated tracheobronchitis due to P. aeruginosa.

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Section: Introductionmentioning

confidence: 99%

Airway Pseudomonas aeruginosa density in mechanically ventilated patients: clinical impact and relation to therapeutic efficacy of antibiotics

et al. 2021

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“…Ventilator-associated lower respiratory tract infection (VA-LRTI) comprises ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP). Because VAT represents a continuum of colonization and VAP, with overlap between the two conditions, antibiotic therapy in patients with VAT remains controversial [1][2][3]. Furthermore, the increasing emergence of multidrugresistant PA has become a global problem [4].…”

Section: Introductionmentioning

confidence: 99%

Airway Pseudomonas aeruginosa Density in Mechanically Ventilated Patients: Clinical Impact and Relation to Therapeutic Efficacy of Antibiotics

Migiyama

Sakata

Iyama

et al. 2021

Preprint

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Background: The bacterial density of Pseudomonas aeruginosa is closely related to its pathogenicity. We evaluated the effect of airway P. aeruginosa density on the clinical course of mechanically ventilated patients and the therapeutic efficacy of antibiotics.Methods: We retrospectively analyzed data of mechanically ventilated ICU patients with P. aeruginosa isolated from endotracheal aspirates. Patients were divided into three groups according to the peak P. aeruginosa density during ICU stay: low (≤104 cfu/mL), moderate (105‒106 cfu/mL), and high (≥107 cfu/mL) peak density groups. The relationship between peak P. aeruginosa density and weaning from mechanical ventilation, risk factors for isolation of high peak density of P. aeruginosa, and antibiotic efficacy were investigated using multivariate and propensity score-matched analyses.Results: Four-hundred-and-sixty-one patients were enrolled. Patients with high peak density of P. aeruginosa had higher inflammation and developed more severe respiratory infections. High peak density of P. aeruginosa was independently associated with few ventilator-free days on day 28 (P < 0.01) and increased ICU mortality (P = 0.047). Risk factors for high peak density of P. aeruginosa were prolonged mechanical ventilation (odd ratio [OR] 3.07 95% confidence interval [CI] 1.35‒6.97), non-antipseudomonal cephalosporins (OR 2.17, 95% CI 1.35‒3.49), hyperglycemia (OR 2.01, 95% CI 1.26‒3.22) during ICU stay, and respiratory diseases (OR 1.9, 95% CI 1.12‒3.23). Isolation of commensal colonizer was associated with lower risks of high peak density of P. aeruginosa (OR 0.43, 95% CI 0.26‒0.73). Propensity score-matched analysis revealed that antibiotic therapy for patients with ventilator-associated tracheobronchitis improved weaning from mechanical ventilation only in the high peak P. aeruginosa group.Conclusions: Patients with high peak density of P. aeruginosa had worse ventilator outcome and ICU mortality. In patients with ventilator-associated tracheobronchitis, antibiotic therapy was associated with favorable ventilator weaning only in the high peak P. aeruginosa density group, and bacterial density could be a good therapeutic indicator for ventilator-associated tracheobronchitis due to P. aeruginosa.

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“…As culturas de aspirado traqueal colhido por técnica tradicional são inespecíficas e levam ao uso generalizado de antimicrobianos. Como alternativa aos antibióticos sistêmicos, sugere-se a aerossolização, (2) apesar da atual falta de evidências da redução da mortalidade ou do número de dias em ventilação mecânica (VM). (3) No presente número do Jornal Brasileiro de Pneumologia, Núñez et al (4) abordam a ocorrência de PAVM em pacientes traqueostomizados e em VM prolongada (mediana = 56 dias).…”

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“…A PAVM deve ser diferenciada da traqueobronquite associada à VM, (1) que é mais comum e representa uma etapa intermediária entre a disbiose das vias aéreas e o desenvolvimento de PAVM, (2) levando ao uso excessivo de antibióticos, que, por sua vez, aumenta o risco de surgimento de patógenos multirresistentes. (5,7,8) Além disso, a maioria dos pacientes em VM prolongada já teve um ou mais episódios de infecção ou de recidiva causados pelo mesmo patógeno.…”

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New insights into pneumonia in patients on prolonged mechanical ventilation: need for a new paradigm addressing dysbiosis

2021

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Ventilator-Associated Tracheobronchitis: To Treat or Not to Treat?

Cited by 17 publications

References 42 publications

Airway Pseudomonas aeruginosa density in mechanically ventilated patients: clinical impact and relation to therapeutic efficacy of antibiotics

Airway Pseudomonas aeruginosa density in mechanically ventilated patients: clinical impact and relation to therapeutic efficacy of antibiotics

Airway Pseudomonas aeruginosa Density in Mechanically Ventilated Patients: Clinical Impact and Relation to Therapeutic Efficacy of Antibiotics

New insights into pneumonia in patients on prolonged mechanical ventilation: need for a new paradigm addressing dysbiosis

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