Impact of Chronic Obstructive Pulmonary Disease on Incidence, Microbiology and Outcome of Ventilator-Associated Lower Respiratory Tract Infections

Microorganisms

Pauline Boddaert¹  Saad Nseir¹  Anahita Rouzé¹  Marion Houard¹  Nassima Ramdane²  Ignacio Martin-Loeches³  Alejandro Rodriguez⁴  Jorge Salluh⁵  Pedro Povoa⁶ 

[1] Centre Hospitalier Universitaire Lille, Critical Care Center, F-59000 Lille, France;Centre Hospitalier Universitaire Lille, University of Lille, EA 2694—Santé Publique, Epidémiologie et Qualité des Soins, Département de Biostatistiques, F-59000 Lille, France;Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, St. James Street, Dublin 8, D08 NHY1 Dublin, Ireland;ICU, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain;Institute for Research and Education, D’Or, Rio de Janeiro 22281-100, Brazil;Nova Medical School, New University of Lisbon, 1099-085 Lisbon, Portugal;

关键词: chronic obstructive pulmonary disease;    ventilator-associated;    lower respiratory tract infections;    pneumonia;    tracheobronchitis;    mechanical ventilation;    intensive care;   

DOI  :  10.3390/microorganisms8020165

来源: DOAJ

【 摘 要 】

Objectives: To determine the impact of chronic obstructive pulmonary disease (COPD) on incidence, microbiology, and outcomes of ventilator-associated lower respiratory tract infections (VA-LRTI). Methods: Planned ancillary analysis of TAVeM study, including 2960 consecutive adult patients who received invasive mechanical ventilation (MV) > 48 h. COPD patients (n = 494) were compared to non-COPD patients (n = 2466). The diagnosis of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) was based on clinical, radiological and quantitative microbiological criteria. Results: No significant difference was found in VAP (12% versus 13%, p = 0.931), or VAT incidence (13% versus 10%, p = 0.093) between COPD and non-COPD patients. Among patients with VA-LRTI, Escherichia coli and Stenotrophomonas maltophilia were significantly more frequent in COPD patients as compared with non-COPD patients. However, COPD had no significant impact on multidrug-resistant bacteria incidence. Appropriate antibiotic treatment was not significantly associated with progression from VAT to VAP among COPD patients who developed VAT, unlike non-COPD patients. Among COPD patients, patients who developed VAT or VAP had significantly longer MV duration (17 days (9−30) or 15 (8−27) versus 7 (4−12), p < 0.001) and intensive care unit (ICU) length of stay (24 (17−39) or 21 (14−40) versus 12 (8−19), p < 0.001) than patients without VA-LRTI. ICU mortality was also higher in COPD patients who developed VAP (44%), but not VAT(38%), as compared to no VA-LRTI (26%, p = 0.006). These worse outcomes associated with VA-LRTI were similar among non-COPD patients. Conclusions: COPD had no significant impact on incidence or outcomes of patients who developed VAP or VAT.

【 授权许可】

Unknown