Marin H Kollef1, Jean Chastre, Jean-Yves Fagon, Bruno François, Michael S Niederman, Jordi Rello, Antoni Torres, Jean-Louis Vincent, Richard G Wunderink, Kerry W Go, Christine Rehm. 1. 1Department of Medicine, Virginia E. and Sam J. Golman Chair in Respiratory Intensive Care Medicine, Washington University School of Medicine, St. Louis, MO. 2Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris and Faculté de Médecine Paris 6-Pierre et Marie Curie, Paris, France. 3Université Paris Descartes and Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France. 4Service de Réanimation Polyvalente and CIC-P 0801, CHU Limoges and INSERM, Limoges, France. 5Department of Medicine, Winthrop-University Hospital, Mineola, NY. 6Department of Medicine, SUNY at Stony Brook, Mineola, NY. 7Hospital Valle Hebron, Institut Recerca Vall D'Hebron-Universitat Autonoma, CIBERES, Barcelona, Spain. 8Cap de Secció UVIR, Servei de Pneumologia, Catedràtic de Medicina, Hospital Clínic, CIBERES, Barcelona, Spain. 9Department of Intensive Care, Erasme University Hospital, Brussels, Belgium. 10Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL. 11Sanofi Pasteur, Swiftwater, PA.
Abstract
OBJECTIVE: To estimate the prevalence of ventilator-associated pneumonia caused by Pseudomonas aeruginosa in patients at risk for ventilator-associated pneumonia and to describe risk factors for P. aeruginosa ventilator-associated pneumonia. DESIGN: Prospective, observational study. SETTING: ICUs at 56 sites in 11 countries across four regions: the United States (n = 502 patients), Europe (n = 495), Latin America (n = 500), and Asia Pacific (n = 376). PATIENTS: Adults intubated and mechanically ventilated for 48 hours to 7 days, inclusive. INTERVENTIONS: None (local standard of care). MEASUREMENTS AND MAIN RESULTS: Ventilator-associated pneumonia prevalence as defined by local investigators were 15.6% (293/1,873) globally, 13.5% in the United States, 19.4% in Europe, 13.8% in Latin America, and 16.0% in Asia Pacific (p = 0.04). Corresponding P. aeruginosa ventilator-associated pneumonia prevalences were 4.1%, 3.4%, 4.8%, 4.6%, and 3.2% (p = 0.49). Of 50 patients with P. aeruginosa ventilator-associated pneumonia who underwent surveillance testing, 19 (38%) had prior P. aeruginosa colonization and 31 (62%) did not (odds ratio, 7.99; 95% CI, 4.31-14.71). Of predefined risk factors for multidrug resistance (hereafter, risk factors), the most frequent in all patients were antimicrobial therapy within 90 days (51.9% of enrolled patients) and current hospitalization of more than or equal to 5 days (45.3%). None of these risk factors were significantly associated with P. aeruginosa ventilator-associated pneumonia by multivariate logistic regression. Risk factors associated with prior P. aeruginosa colonization were antimicrobial therapy within 90 days (odds ratio, 0.46; 95% CI, 0.29-0.73) and high proportion of antibiotic resistance in the community or hospital unit (odds ratio, 1.79; 95% CI, 1.14-2.82). CONCLUSIONS: Our findings suggest that ventilator-associated pneumonia remains a common ICU infection and that P. aeruginosa is one of the most common causative pathogens. The odds of developing P. aeruginosa ventilator-associated pneumonia were eight times higher in patients with prior P. aeruginosa colonization than in uncolonized patients, which in turn was associated with local resistance.
OBJECTIVE: To estimate the prevalence of ventilator-associated pneumonia caused by Pseudomonas aeruginosa in patients at risk for ventilator-associated pneumonia and to describe risk factors for P. aeruginosa ventilator-associated pneumonia. DESIGN: Prospective, observational study. SETTING: ICUs at 56 sites in 11 countries across four regions: the United States (n = 502 patients), Europe (n = 495), Latin America (n = 500), and Asia Pacific (n = 376). PATIENTS: Adults intubated and mechanically ventilated for 48 hours to 7 days, inclusive. INTERVENTIONS: None (local standard of care). MEASUREMENTS AND MAIN RESULTS: Ventilator-associated pneumonia prevalence as defined by local investigators were 15.6% (293/1,873) globally, 13.5% in the United States, 19.4% in Europe, 13.8% in Latin America, and 16.0% in Asia Pacific (p = 0.04). Corresponding P. aeruginosa ventilator-associated pneumonia prevalences were 4.1%, 3.4%, 4.8%, 4.6%, and 3.2% (p = 0.49). Of 50 patients with P. aeruginosa ventilator-associated pneumonia who underwent surveillance testing, 19 (38%) had prior P. aeruginosa colonization and 31 (62%) did not (odds ratio, 7.99; 95% CI, 4.31-14.71). Of predefined risk factors for multidrug resistance (hereafter, risk factors), the most frequent in all patients were antimicrobial therapy within 90 days (51.9% of enrolled patients) and current hospitalization of more than or equal to 5 days (45.3%). None of these risk factors were significantly associated with P. aeruginosa ventilator-associated pneumonia by multivariate logistic regression. Risk factors associated with prior P. aeruginosa colonization were antimicrobial therapy within 90 days (odds ratio, 0.46; 95% CI, 0.29-0.73) and high proportion of antibiotic resistance in the community or hospital unit (odds ratio, 1.79; 95% CI, 1.14-2.82). CONCLUSIONS: Our findings suggest that ventilator-associated pneumonia remains a common ICU infection and that P. aeruginosa is one of the most common causative pathogens. The odds of developing P. aeruginosa ventilator-associated pneumonia were eight times higher in patients with prior P. aeruginosa colonization than in uncolonized patients, which in turn was associated with local resistance.
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