COPD patients with ventilator-associated pneumonia: implications for management.
Identifieur interne : 003093 ( Main/Merge ); précédent : 003092; suivant : 003094COPD patients with ventilator-associated pneumonia: implications for management.
Auteurs : D. Koulenti [Grèce] ; S. Blot [Australie] ; J M Dulhunty [Australie] ; L. Papazian [France] ; I. Martin-Loeches [Espagne] ; G. Dimopoulos [Grèce] ; C. Brun-Buisson [France] ; M. Nauwynck [Belgique] ; C. Putensen [Allemagne] ; J. Sole-Violan [Espagne] ; A. Armaganidis [Grèce] ; J. Rello [Espagne]Source :
- European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology [ 1435-4373 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Analyse de survie, Antibactériens (usage thérapeutique), Broncho-pneumopathie chronique obstructive (), Europe (épidémiologie), Femelle, Humains, Mâle, Pneumopathie infectieuse sous ventilation assistée (microbiologie), Pneumopathie infectieuse sous ventilation assistée (mortalité), Pneumopathie infectieuse sous ventilation assistée (traitement médicamenteux), Pneumopathie infectieuse sous ventilation assistée (épidémiologie), Pseudomonas aeruginosa (isolement et purification), Résultat thérapeutique, Sujet âgé, Sujet âgé de 80 ans ou plus, Unités de soins intensifs, Études prospectives.
- MESH :
- isolement et purification : Pseudomonas aeruginosa.
- microbiologie : Pneumopathie infectieuse sous ventilation assistée.
- mortalité : Pneumopathie infectieuse sous ventilation assistée.
- traitement médicamenteux : Pneumopathie infectieuse sous ventilation assistée.
- usage thérapeutique : Antibactériens.
- épidémiologie : Europe, Pneumopathie infectieuse sous ventilation assistée.
- Adulte, Adulte d'âge moyen, Analyse de survie, Broncho-pneumopathie chronique obstructive, Femelle, Humains, Mâle, Résultat thérapeutique, Sujet âgé, Sujet âgé de 80 ans ou plus, Unités de soins intensifs, Études prospectives.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents (therapeutic use), Europe (epidemiology), Female, Humans, Intensive Care Units, Male, Middle Aged, Pneumonia, Ventilator-Associated (drug therapy), Pneumonia, Ventilator-Associated (epidemiology), Pneumonia, Ventilator-Associated (microbiology), Pneumonia, Ventilator-Associated (mortality), Prospective Studies, Pseudomonas aeruginosa (isolation & purification), Pulmonary Disease, Chronic Obstructive (complications), Survival Analysis, Treatment Outcome.
- MESH :
- chemical , therapeutic use : Anti-Bacterial Agents.
- geographic , epidemiology : Europe.
- complications : Pulmonary Disease, Chronic Obstructive.
- drug therapy : Pneumonia, Ventilator-Associated.
- epidemiology : Pneumonia, Ventilator-Associated.
- isolation & purification : Pseudomonas aeruginosa.
- microbiology : Pneumonia, Ventilator-Associated.
- mortality : Pneumonia, Ventilator-Associated.
- Adult, Aged, Aged, 80 and over, Female, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Survival Analysis, Treatment Outcome.
Abstract
Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.
DOI: 10.1007/s10096-015-2495-6
PubMed: 26407622
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pubmed:26407622Le document en format XML
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<term>Analyse de survie</term>
<term>Broncho-pneumopathie chronique obstructive</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Résultat thérapeutique</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Unités de soins intensifs</term>
<term>Études prospectives</term>
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<front><div type="abstract" xml:lang="en">Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.</div>
</front>
</TEI>
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