Jean-Baptiste Denis1, Samuel Lehingue2, Vanessa Pauly3, Nadim Cassir4, Marc Gainnier5, Marc Léone6, Florence Daviet7, Benjamin Coiffard8, Sophie Baron9, Christophe Guervilly7, Jean-Marie Forel7, Antoine Roch7, Laurent Papazian7. 1. Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France. Electronic address: jean-baptiste.denis@ap-hm.fr. 2. Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France. 3. Aix-Marseille Université, School of Medicine - La Timone Medical Campus, CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Service d'Information Médicale, Public Health Department, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France. 4. Service des Maladies Infectieuses et Tropicales, CHU Nord, chemin des Bourrely, Marseille, France. 5. Aix-Marseille Université, School of Medicine - La Timone Medical Campus, CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Assistance Publique - Hôpitaux de Marseille, La Timone Hospital, Réanimation des Urgences, Marseille, France. 6. Aix-Marseille Université, Faculté de médecine, Marseille, France; Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation Polyvalente, Marseille, France. 7. Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France; Aix-Marseille Université, School of Medicine - La Timone Medical Campus, CEReSS - Health Service Research and Quality of Life Center, Marseille, France. 8. Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France; Aix-Marseille Université, Faculté de médecine, Marseille, France. 9. Aix-Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Faculté de Médecine et de Pharmacie, Marseille, France.
Abstract
BACKGROUND: The link between bacterial resistance and prognosis remains controversial. Predominant pathogen causing ventilator-associated pneumonia (VAP) is Pseudomonas aeruginosa (Pa), which has increasingly become multidrug resistant (MDR). The aim of this study was to evaluate the relationship between MDR VAP Pa episodes and 30-day mortality. METHODS: From a longitudinal prospective French multicenter database (2010-2016), Pa VAP onset and physiological data were recorded. MDR was defined as non-susceptibility to at least 1 agent in 3 or more antimicrobial categories. To analyze if MDR episodes were associated with greater in-hospital 30-day mortality, we performed a multivariate survival analysis using the multivariate nonlinear frailty model. RESULTS: A total of 230 patients presented 286 Pa VAP. A maximum of 3 episodes per patient was observed; 73 episodes were MDR and 213 were susceptible. In the multivariate model, factors independently associated with 30-day mortality included hospitalization in the 6 months preceding the first episode (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.50-3.60; P = .0002), chronic renal failure (HR, 2.34; 95% CI, 1.15-4.77; P = .0196), and Pa VAP recurrence (HR, 2.29; 95% CI, 1.79-4.87; P = .032). Finally, MDR Pa VAP was not associated with death (HR, 0.87; 95% CI; 0.52-1.45; P = .59). CONCLUSIONS: This study did not identify a relationship between the resistance profile of Pseudomonas aeruginosa and mortality.
BACKGROUND: The link between bacterial resistance and prognosis remains controversial. Predominant pathogen causing ventilator-associated pneumonia (VAP) is Pseudomonas aeruginosa (Pa), which has increasingly become multidrug resistant (MDR). The aim of this study was to evaluate the relationship between MDR VAP Pa episodes and 30-day mortality. METHODS: From a longitudinal prospective French multicenter database (2010-2016), Pa VAP onset and physiological data were recorded. MDR was defined as non-susceptibility to at least 1 agent in 3 or more antimicrobial categories. To analyze if MDR episodes were associated with greater in-hospital 30-day mortality, we performed a multivariate survival analysis using the multivariate nonlinear frailty model. RESULTS: A total of 230 patients presented 286 Pa VAP. A maximum of 3 episodes per patient was observed; 73 episodes were MDR and 213 were susceptible. In the multivariate model, factors independently associated with 30-day mortality included hospitalization in the 6 months preceding the first episode (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.50-3.60; P = .0002), chronic renal failure (HR, 2.34; 95% CI, 1.15-4.77; P = .0196), and Pa VAP recurrence (HR, 2.29; 95% CI, 1.79-4.87; P = .032). Finally, MDR Pa VAP was not associated with death (HR, 0.87; 95% CI; 0.52-1.45; P = .59). CONCLUSIONS: This study did not identify a relationship between the resistance profile of Pseudomonas aeruginosa and mortality.
Authors: Emma R Brannon; William J Kelley; Michael W Newstead; Alison L Banka; Kathryn E Uhrich; Colleen E O'Connor; Theodore J Standiford; Omolola Eniola-Adefeso Journal: Adv Healthc Mater Date: 2021-12-17 Impact factor: 11.092