Prevalence, Risk Factors, and Mortality for Ventilator-Associated Pneumonia in Middle-Aged, Old, and Very Old Critically III Patients
Identifieur interne : 004004 ( Main/Exploration ); précédent : 004003; suivant : 004005Prevalence, Risk Factors, and Mortality for Ventilator-Associated Pneumonia in Middle-Aged, Old, and Very Old Critically III Patients
Auteurs : Stijn Blot [Belgique] ; Despoina Koulenti [Grèce, Australie] ; George Dimopoulos [Grèce] ; Claude Martin [France] ; Apostolos Komnos [Grèce] ; Wolfgang A. Krueger [Allemagne] ; Giuseppe Spina [Italie] ; Apostolos Armaganidis [Grèce] ; Jordi Rello [Espagne]Source :
- Critical care medicine [ 0090-3493 ] ; 2014.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Association, Mortalité, Homme, Personne âgée.
English descriptors
- KwdEn :
Abstract
Objective: We investigated the epidemiology of ventilator-associated pneumonia in elderly ICU patients. More precisely, we assessed prevalence, risk factors, signs and symptoms, causative bacterial pathogens, and associated outcomes. Design: Secondary analysis of a multicenter prospective cohort (EU-VAP project). Setting: Twenty-seven European ICUs. Patients: Patients who were mechanically ventilated for greater than or equal to 48 hours. We compared middle-aged (45-64 yr; n = 670), old (65-74 yr; n = 549), and very old patients (≥ 75 yr; n = 516). Measurements and Main Results: Ventilator-associated pneumonia occurred in 103 middle-aged (14.6%), 104 old (17.0%), and 73 very old patients (12.8%). The prevalence (n ventilator-associated pneumonia/1,000 ventilation days) was 13.7 in middle-aged patients, 16.6 in old patients, and 13.0 in very old patients. Logistic regression analysis could not demonstrate older age as a risk factor for ventilator-associated pneumonia. Ventilator-associated pneumonia in elderly patients was more frequently caused by Enterobacteriaceae (24% in middle-aged, 32% in old, and 43% in very old patients; p = 0.042). Regarding clinical signs and symptoms at ventilator-associated pneumonia onset, new temperature rise was less frequent among very old patients (59% vs 76% and 74% for middle-aged and old patients, respectively; p = 0.035). Mortality among patients with ventilator-associated pneumonia was higher among elderly patients: 35% in middle-aged patients versus 51% in old and very old patients (p = 0.036). Logistic regression analysis confirmed the importance of older age in the risk of death (adjusted odds ratio for old age, 2.1; 95% CI, 1.2-3.9 and adjusted odds ratio for very old age, 2.3; 95% CI, 1.2-4.4). Other risk factors for mortality in ventilator-associated pneumonia were diabetes mellitus, septic shock, and a high-risk pathogen as causative agent. Conclusions: In this multicenter cohort study, ventilator-associated pneumonia did not occur more frequently among elderly, but the associated mortality in these patients was higher. New temperature rise was less common in elderly patients with ventilator-associated pneumonia, whereas more episodes among elderly patients were caused by Enterobacteriaceae.
Affiliations:
- Allemagne, Australie, Belgique, Espagne, France, Grèce, Italie
- Attique (région), Catalogne, Piémont, Provence-Alpes-Côte d'Azur, Province de Flandre-Orientale, Région flamande
- Athènes, Barcelone, Gand, Marseille, Turin
- Université de Gand
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14-0095847 INIST</idno><idno type="RBID">Pascal:14-0095847</idno><idno type="wicri:Area/PascalFrancis/Corpus">000494</idno><idno type="wicri:Area/PascalFrancis/Curation">005967</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000140</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000140</idno><idno type="wicri:doubleKey">0090-3493:2014:Blot S:prevalence:risk:factors</idno><idno type="wicri:Area/Main/Merge">004064</idno><idno type="wicri:Area/Main/Curation">004004</idno><idno type="wicri:Area/Main/Exploration">004004</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Prevalence, Risk Factors, and Mortality for Ventilator-Associated Pneumonia in Middle-Aged, Old, and Very Old Critically III Patients</title><author><name sortKey="Blot, Stijn" sort="Blot, Stijn" uniqKey="Blot S" first="Stijn" last="Blot">Stijn Blot</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Internal Medicine, Ghent University</s1><s2>Ghent</s2><s3>BEL</s3><sZ>1 aut.</sZ></inist:fA14><country>Belgique</country><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName><orgName type="university">Université de Gand</orgName></affiliation></author><author><name sortKey="Koulenti, Despoina" sort="Koulenti, Despoina" uniqKey="Koulenti D" first="Despoina" last="Koulenti">Despoina Koulenti</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Attikon University Hospital</s1><s2>Athens</s2><s3>GRC</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Grèce</country><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Critical Care Department, The Burns, Trauma, and Critical Care Research Center, The University of Queensland</s1><s2>Brisbane, QLD</s2><s3>AUS</s3><sZ>2 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Brisbane, QLD</wicri:noRegion></affiliation></author><author><name sortKey="Dimopoulos, George" sort="Dimopoulos, George" uniqKey="Dimopoulos G" first="George" last="Dimopoulos">George Dimopoulos</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Attikon University Hospital</s1><s2>Athens</s2><s3>GRC</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Grèce</country><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Martin, Claude" sort="Martin, Claude" uniqKey="Martin C" first="Claude" last="Martin">Claude Martin</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Critical Care Department, Nord University Hospital</s1><s2>Marseille</s2><s3>FRA</s3><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Komnos, Apostolos" sort="Komnos, Apostolos" uniqKey="Komnos A" first="Apostolos" last="Komnos">Apostolos Komnos</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Critical Care Department, General Hospital of Larisa</s1><s2>Larisa</s2><s3>GRC</s3><sZ>5 aut.</sZ></inist:fA14><country>Grèce</country><wicri:noRegion>Larisa</wicri:noRegion></affiliation></author><author><name sortKey="Krueger, Wolfgang A" sort="Krueger, Wolfgang A" uniqKey="Krueger W" first="Wolfgang A." last="Krueger">Wolfgang A. Krueger</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Critical Care Department, Clinics of Constance</s1><s2>Constance</s2><s3>DEU</s3><sZ>6 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Constance</wicri:noRegion><wicri:noRegion>Clinics of Constance</wicri:noRegion><wicri:noRegion>Constance</wicri:noRegion></affiliation></author><author><name sortKey="Spina, Giuseppe" sort="Spina, Giuseppe" uniqKey="Spina G" first="Giuseppe" last="Spina">Giuseppe Spina</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Department of Intensive Care, Mauriziano Hospital</s1><s2>Turin</s2><s3>ITA</s3><sZ>7 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="Armaganidis, Apostolos" sort="Armaganidis, Apostolos" uniqKey="Armaganidis A" first="Apostolos" last="Armaganidis">Apostolos Armaganidis</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Attikon University Hospital</s1><s2>Athens</s2><s3>GRC</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Grèce</country><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Critical Care Department, Vall d'Hebron University Hospital, CIBERES, Universitat Autonoma de Barcelona</s1><s2>Barcelona</s2><s3>ESP</s3><sZ>9 aut.</sZ></inist:fA14><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Critical care medicine</title><title level="j" type="abbreviated">Crit. care med.</title><idno type="ISSN">0090-3493</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Critical care medicine</title><title level="j" type="abbreviated">Crit. care med.</title><idno type="ISSN">0090-3493</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Artificial ventilation</term><term>Association</term><term>Elderly</term><term>Epidemiology</term><term>Evolution</term><term>Geriatrics</term><term>Human</term><term>Intensive care</term><term>Middle age</term><term>Mortality</term><term>Nosocomial infection</term><term>Patient</term><term>Pneumonia</term><term>Prevalence</term><term>Prognosis</term><term>Resuscitation</term><term>Risk factor</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Pneumonie</term><term>Prévalence</term><term>Facteur risque</term><term>Association</term><term>Mortalité</term><term>Epidémiologie</term><term>Infection nosocomiale</term><term>Ventilation artificielle</term><term>Age mûr</term><term>Homme</term><term>Malade</term><term>Personne âgée</term><term>Gériatrie</term><term>Soin intensif</term><term>Pronostic</term><term>Evolution</term><term>Réanimation</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Association</term><term>Mortalité</term><term>Homme</term><term>Personne âgée</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective: We investigated the epidemiology of ventilator-associated pneumonia in elderly ICU patients. More precisely, we assessed prevalence, risk factors, signs and symptoms, causative bacterial pathogens, and associated outcomes. Design: Secondary analysis of a multicenter prospective cohort (EU-VAP project). Setting: Twenty-seven European ICUs. Patients: Patients who were mechanically ventilated for greater than or equal to 48 hours. We compared middle-aged (45-64 yr; n = 670), old (65-74 yr; n = 549), and very old patients (≥ 75 yr; n = 516). Measurements and Main Results: Ventilator-associated pneumonia occurred in 103 middle-aged (14.6%), 104 old (17.0%), and 73 very old patients (12.8%). The prevalence (n ventilator-associated pneumonia/1,000 ventilation days) was 13.7 in middle-aged patients, 16.6 in old patients, and 13.0 in very old patients. Logistic regression analysis could not demonstrate older age as a risk factor for ventilator-associated pneumonia. Ventilator-associated pneumonia in elderly patients was more frequently caused by Enterobacteriaceae (24% in middle-aged, 32% in old, and 43% in very old patients; p = 0.042). Regarding clinical signs and symptoms at ventilator-associated pneumonia onset, new temperature rise was less frequent among very old patients (59% vs 76% and 74% for middle-aged and old patients, respectively; p = 0.035). Mortality among patients with ventilator-associated pneumonia was higher among elderly patients: 35% in middle-aged patients versus 51% in old and very old patients (p = 0.036). Logistic regression analysis confirmed the importance of older age in the risk of death (adjusted odds ratio for old age, 2.1; 95% CI, 1.2-3.9 and adjusted odds ratio for very old age, 2.3; 95% CI, 1.2-4.4). Other risk factors for mortality in ventilator-associated pneumonia were diabetes mellitus, septic shock, and a high-risk pathogen as causative agent. Conclusions: In this multicenter cohort study, ventilator-associated pneumonia did not occur more frequently among elderly, but the associated mortality in these patients was higher. New temperature rise was less common in elderly patients with ventilator-associated pneumonia, whereas more episodes among elderly patients were caused by Enterobacteriaceae.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Belgique</li><li>Espagne</li><li>France</li><li>Grèce</li><li>Italie</li></country><region><li>Attique (région)</li><li>Catalogne</li><li>Piémont</li><li>Provence-Alpes-Côte d'Azur</li><li>Province de Flandre-Orientale</li><li>Région flamande</li></region><settlement><li>Athènes</li><li>Barcelone</li><li>Gand</li><li>Marseille</li><li>Turin</li></settlement><orgName><li>Université de Gand</li></orgName></list><tree><country name="Belgique"><region name="Région flamande"><name sortKey="Blot, Stijn" sort="Blot, Stijn" uniqKey="Blot S" first="Stijn" last="Blot">Stijn Blot</name></region></country><country name="Grèce"><region name="Attique (région)"><name sortKey="Koulenti, Despoina" sort="Koulenti, Despoina" uniqKey="Koulenti D" first="Despoina" last="Koulenti">Despoina Koulenti</name></region><name sortKey="Armaganidis, Apostolos" sort="Armaganidis, Apostolos" uniqKey="Armaganidis A" first="Apostolos" last="Armaganidis">Apostolos Armaganidis</name><name sortKey="Dimopoulos, George" sort="Dimopoulos, George" uniqKey="Dimopoulos G" first="George" last="Dimopoulos">George Dimopoulos</name><name sortKey="Komnos, Apostolos" sort="Komnos, Apostolos" uniqKey="Komnos A" first="Apostolos" last="Komnos">Apostolos Komnos</name></country><country name="Australie"><noRegion><name sortKey="Koulenti, Despoina" sort="Koulenti, Despoina" uniqKey="Koulenti D" first="Despoina" last="Koulenti">Despoina Koulenti</name></noRegion></country><country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Martin, Claude" sort="Martin, Claude" uniqKey="Martin C" first="Claude" last="Martin">Claude Martin</name></region></country><country name="Allemagne"><noRegion><name sortKey="Krueger, Wolfgang A" sort="Krueger, Wolfgang A" uniqKey="Krueger W" first="Wolfgang A." last="Krueger">Wolfgang A. Krueger</name></noRegion></country><country name="Italie"><region name="Piémont"><name sortKey="Spina, Giuseppe" sort="Spina, Giuseppe" uniqKey="Spina G" first="Giuseppe" last="Spina">Giuseppe Spina</name></region></country><country name="Espagne"><region name="Catalogne"><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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