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Villaamil A, Han L, Eloy P, Bachelet D, Gennequin M, Jeantrelle C, Moyer JD, Weiss E, Foucrier A. Risk factors of second ventilator-associated pneumonia in trauma patients: a retrospective cohort study. Eur J Trauma Emerg Surg 2023; 49:1981-1988. [PMID: 37031437 DOI: 10.1007/s00068-023-02269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/02/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Ventilator acquired pneumonia (VAP) is a frequent and serious complication in ICU. Second episodes of VAP are common in trauma patients and may be related to severity of underlying conditions, treatment or bacterial factors of the first VAP. The aim of this study was to identify risk factors of second VAP episodes in trauma injured patients (defined as the development of a new pulmonary infection during or remotely following the first episode). DESIGN This is a single-center, retrospective cohort study of trauma injured patients who underwent a first episode of VAP between January 1, 2013 and December 31, 2020 at Beaujon Hospital. RESULTS A total of 533 patients with a first episode of VAP were analyzed, mostly with head and/or thoracic traumatic injury. A second episode of VAP occurred in one hundred sixty-seven patients (31.3%). The main risk factors found was the degree of hypoxemia at the time of the first episode [PaO2/FiO2 ratio 100-200, OR 3.12 (1.77-5.69); < 100, OR 5.80 (2.70-12.8)] and severe traumatic brain injury characterized by an initial GCS ≤ 8 [OR 1.65 (1.01-2.74)]. CONCLUSION Depth of hypoxemia during the first VAP episode and severity of the initial brain injury are the main risk factors for VAP second episode in trauma injured patients.
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Affiliation(s)
- Alejandro Villaamil
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
| | - Lien Han
- Département d'épidémiologieBiostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France
| | - Philippine Eloy
- Département d'épidémiologieBiostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France
| | - Delphine Bachelet
- Département d'épidémiologieBiostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France
| | - Maël Gennequin
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Caroline Jeantrelle
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Jean-Denis Moyer
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
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Xie J, Meng Z, Han X, Li S, Ma X, Chen X, Liang Y, Deng X, Xia K, Zhang Y, Zhu H, Fu T. Cholesterol Microdomain Enhances the Biofilm Eradication of Antibiotic Liposomes. Adv Healthc Mater 2022; 11:e2101745. [PMID: 35037424 DOI: 10.1002/adhm.202101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/09/2022] [Indexed: 11/06/2022]
Abstract
Resistance and tolerance of biofilms to antibiotics is the greatest challenge in the treatment of bacterial infections. Therefore, developing an effective strategy against biofilms is a top priority. Liposomes are widely used as antibiotic drug carriers; however, common liposomes lack affinity for biofilms. Herein, biofilm-targeted antibiotic liposomes are created by simply adjusting their cholesterol content. The tailored liposomes exhibit significantly enhanced bacterial inhibition and biofilm eradication effects that are positively correlated with the cholesterol content of liposomes. The experiments further demonstrate that this enhanced effect can be ascribed to the effective drug release through the pores, which are formed by the combination of cholesterol microdomains in liposomal lipid bilayers with membrane-damaged toxins in biofilms. Consequently, liposome encapsulation with a high cholesterol concentration improves noticeably the pharmacodynamics and biocompatibility of antibiotics after pulmonary administration. This work may provide a new direction for the development of antibiofilm formulations that can be widely used for the treatment of infections caused by bacterial biofilms.
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Affiliation(s)
- Jianjun Xie
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Zhiping Meng
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Xingxing Han
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Sipan Li
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Xinai Ma
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Xuanyu Chen
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Yinmei Liang
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Xiaomin Deng
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Kexin Xia
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Yue Zhang
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Huaxu Zhu
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
| | - Tingming Fu
- School of Pharmacy Nanjing University of Chinese Medicine Nanjing 210023 China
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