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For: Martin-Loeches I, Povoa P, Rodríguez A, Curcio D, Suarez D, Mira JP, Cordero ML, Lepecq R, Girault C, Candeias C, Seguin P, Paulino C, Messika J, Castro AG, Valles J, Coelho L, Rabello L, Lisboa T, Collins D, Torres A, Salluh J, Nseir S. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med 2015;3:859-68. [PMID: 26472037 DOI: 10.1016/s2213-2600(15)00326-4] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022]

For:	Martin-Loeches I, Povoa P, Rodríguez A, Curcio D, Suarez D, Mira JP, Cordero ML, Lepecq R, Girault C, Candeias C, Seguin P, Paulino C, Messika J, Castro AG, Valles J, Coelho L, Rabello L, Lisboa T, Collins D, Torres A, Salluh J, Nseir S. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med 2015;3:859-68. [PMID: 26472037 DOI: 10.1016/s2213-2600(15)00326-4] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022]

Number

Cited by Other Article(s)

Kreitmann L, Helms J, Martin-Loeches I, Salluh J, Poulakou G, Pène F, Nseir S. ICU-acquired infections in immunocompromised patients. Intensive Care Med 2024;50:332-349. [PMID: 38197931 DOI: 10.1007/s00134-023-07295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/25/2023] [Indexed: 01/11/2024]

Abstract

Immunocompromised patients account for an increasing proportion of the typical intensive care unit (ICU) case-mix. Because of the increased availability of new drugs for cancer and auto-immune diseases, and improvement in the care of the most severely immunocompromised ICU patients (including those with hematologic malignancies), critically ill immunocompromised patients form a highly heterogeneous patient population. Furthermore, a large number of ICU patients with no apparent immunosuppression also harbor underlying conditions altering their immune response, or develop ICU-acquired immune deficiencies as a result of sepsis, trauma or major surgery. While infections are associated with significant morbidity and mortality in immunocompromised critically ill patients, little specific data are available on the incidence, microbiology, management and outcomes of ICU-acquired infections in this population. As a result, immunocompromised patients are usually excluded from trials and guidelines on the management of ICU-acquired infections. The most common ICU-acquired infections in immunocompromised patients are ventilator-associated lower respiratory tract infections (which include ventilator-associated pneumonia and tracheobronchitis) and bloodstream infections. Recently, several large observational studies have shed light on some of the epidemiological specificities of these infections-as well as on the dynamics of colonization and infection with multidrug-resistant bacteria-in these patients, and these will be discussed in this review. Immunocompromised patients are also at higher risk than non-immunocompromised hosts of fungal and viral infections, and the diagnostic and therapeutic management of these infections will be covered. Finally, we will suggest some important areas of future investigation.

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Nesseler N, Mansour A, Schmidt M, Para M, Porto A, Falcoz PE, Mongardon N, Fougerou C, Ross JT, Beurton A, Gaide-Chevronnay L, Guinot PG, Lebreton G, Flecher E, Vincentelli A, Massart N. Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study. Crit Care 2024;28:54. [PMID: 38374103 PMCID: PMC10877839 DOI: 10.1186/s13054-024-04832-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open

Affiliation(s)

Nicolas Nesseler Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France. Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France. Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, 35000, Rennes, France. Hôpital Pontchaillou, Pôle Anesthésie, SAMU, Urgences, Réanimations, Médecine Interne Et Gériatrie (ASUR-MIG), 2 Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
Alexandre Mansour Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France Univ Rennes, CHU Rennes, Inserm, IRSET, UMR_S 1085, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France
Matthieu Schmidt Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, PARIS, France Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France
Marylou Para Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France Laboratory of Vascular Translational Science, University of Paris, UMR 1148, Paris, France
Alizée Porto Department of Cardiac Surgery, Timone Hospital, APHM, 13005, Marseille, France
Pierre-Emmanuel Falcoz INSERM, UMR 1260, Regenerative Nanomedicine (RNM), FMTS, 67000, Strasbourg, France Faculté de Médecine et Pharmacie, Université de Strasbourg, 67000, Strasbourg, France Hôpitaux Universitaire de Strasbourg, Service de Chirurgie Thoracique - Nouvel Hôpital Civil, Strasbourg, France
Nicolas Mongardon Service d'anesthésie-Réanimation, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France Faculté de Santé, Univ Paris Est Créteil, 94010, Créteil, France U955-IMRB, Equipe 03 « Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT), Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), 94700, Maisons-Alfort, France
Claire Fougerou Department of Clinical Pharmacology, University Hospital, Rennes 1 University, 35033, Rennes, France Inserm CIC 1414, Clinical Investigation Centre, University Hospital, Rennes 1 University, 35033, Rennes, France
James T Ross Department of Surgery, University Hospitals Cleveland and Case Western Reserve University, Cleveland, USA
Antoine Beurton Department of Anaesthesia and Critical Care, CHU Bordeaux, Magellan Medico-Surgical Centre, 33000, Bordeaux, France UMR 1034, Biology of Cardiovascular Diseases, Univ. Bordeaux, INSERM, 33600, Pessac, France
Lucie Gaide-Chevronnay Department of Anesthesiology and Critical Care Medicine, University Hospital of Grenoble, Grenoble, France
Pierre-Grégoire Guinot Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, France
Guillaume Lebreton Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
Erwan Flecher Department of Thoracic and Cardiovascular Surgery, Signal and Image Treatment Laboratory (LTSI), Pontchaillou University Hospital, University of Rennes 1, Inserm U1099, Rennes, France
André Vincentelli Cardiac Surgery, Univ. Lille, CHU Lille, 59000, Lille, France Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000, Lille, France
Nicolas Massart Intensive Care Unit, Centre Hospitalier Yves Le Foll, Saint-Brieuc, France

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Rodríguez A, Gómez F, Sarvisé C, Gutiérrez C, Giralt MG, Guerrero-Torres MD, Pardo-Granell S, Picó-Plana E, Benavent-Bofill C, Trefler S, Berrueta J, Canadell L, Claverias L, Esteve Pitarch E, Olona M, García Pardo G, Teixidó X, Bordonado L, Sans MT, Bodí M. Clinical and Microbiological Impact of Implementing a Decision Support Algorithm through Microbiologic Rapid Diagnosis in Critically Ill Patients: An Epidemiological Retrospective Pre-/Post-Intervention Study. Biomedicines 2023;11:3330. [PMID: 38137551 PMCID: PMC10741655 DOI: 10.3390/biomedicines11123330] [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: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open

Affiliation(s)

Alejandro Rodríguez Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain; Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain
Frederic Gómez Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain Centre for Biomedical Research in Infectious Diseases Network (CIBERINFEC), 28220 Madrid, Spain
Carolina Sarvisé Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Cristina Gutiérrez Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Montserrat Galofre Giralt Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
María Dolores Guerrero-Torres Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Sergio Pardo-Granell Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Ester Picó-Plana Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Clara Benavent-Bofill Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Sandra Trefler Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
Julen Berrueta Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Tarragona Health Data Research Working Group (THeDaR), Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Laura Canadell Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain; Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Laura Claverias Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
Erika Esteve Pitarch Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Montserrat Olona Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Graciano García Pardo Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Xavier Teixidó ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
Laura Bordonado ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
María Teresa Sans Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
María Bodí Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain

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Young PJ. Ventilator-associated pneumonia: A problematic outcome for clinical trials. CRIT CARE RESUSC 2023;25:159-160. [PMID: 38234327 PMCID: PMC10790014 DOI: 10.1016/j.ccrj.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 01/19/2024]

Benítez-Cano A, Bermejo S, Luque S, Sorlí L, Carazo J, Zaragoza I, Ramos I, Vallès J, Horcajada JP, Adalia R. Clinical, Microbiological and Treatment Characteristics of Severe Postoperative Respiratory Infections: An Observational Cohort Study. J Pers Med 2023;13:1482. [PMID: 37888093 PMCID: PMC10608667 DOI: 10.3390/jpm13101482] [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: 09/12/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open

Affiliation(s)

Adela Benítez-Cano Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.) Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (S.L.); (L.S.); (J.P.H.)
Silvia Bermejo Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
Sonia Luque Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (S.L.); (L.S.); (J.P.H.) Pharmacy Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
Luisa Sorlí Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (S.L.); (L.S.); (J.P.H.) Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
Jesús Carazo Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
Irene Zaragoza Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
Isabel Ramos Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
Jordi Vallès Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
Juan P. Horcajada Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (S.L.); (L.S.); (J.P.H.) Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
Ramón Adalia Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)

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Lopinto J, Arrestier R, Peiffer B, Gaillet A, Voiriot G, Urbina T, Luyt CE, Bellaïche R, Pham T, Ait-Hamou Z, Roux D, Clere-Jehl R, Azoulay E, Gaudry S, Mayaux J, Mekontso Dessap A, Canoui-Poitrine F, de Prost N. High-Dose Steroids for Nonresolving Acute Respiratory Distress Syndrome in Critically Ill COVID-19 Patients Treated With Dexamethasone: A Multicenter Cohort Study. Crit Care Med 2023;51:1306-1317. [PMID: 37199534 DOI: 10.1097/ccm.0000000000005930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]

Abstract

OBJECTIVES

To determine the impact of high doses of corticosteroids (HDCT) in critically ill COVID-19 patients with nonresolving acute respiratory distress syndrome (ARDS) who had been previously treated with dexamethasone as a standard of care.

DESIGN

Prospective observational cohort study. Eligible patients presented nonresolving ARDS related to severe acute respiratory syndrome coronavirus 2 infection and had received initial treatment with dexamethasone. We compared patients who had received or not HDCT during ICU stay, consisting of greater than or equal to 1 mg/kg of methylprednisolone or equivalent for treatment of nonresolving ARDS. The primary outcome was 90-day mortality. We assessed the impact of HDCT on 90-day mortality using univariable and multivariable Cox regression analysis. Further adjustment for confounding variables was performed using overlap weighting propensity score. The association between HDCT and the risk of ventilator-associated pneumonia was estimated using multivariable cause-specific Cox proportional hazard model adjusting for pre-specified confounders.

SETTING

We included consecutive patients admitted in 11 ICUs of Great Paris area from September 2020 to February 2021.

PATIENTS

Three hundred eighty-three patients were included (59 in the HDCT group, 324 in the no HDCT group).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

At day 90, 30 of 59 patients (51%) in the HDCT group and 116 of 324 patients (35.8%) in the no HDCT group had died. HDCT was significantly associated with 90-day mortality in unadjusted (hazard ratio [HR], 1.60; 95% CI, 1.04-2.47; p = 0.033) and adjusted analysis with overlap weighting (adjusted HR, 1.65; 95% CI, 1.03-2.63; p = 0.036). HDCT was not associated with an increased risk of ventilator-associated pneumonia (adjusted cause-specific HR, 0.42; 95% CI, 0.15-1.16; p = 0.09).

CONCLUSIONS

In critically ill COVID-19 patients with nonresolving ARDS, HDCT result in a higher 90-day mortality.

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Affiliation(s)

Julien Lopinto Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
Romain Arrestier Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
Bastien Peiffer Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Créteil, France
Antoine Gaillet Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
Guillaume Voiriot Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
Tomas Urbina Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
Charles-Edouard Luyt Sorbonne University, INSERM, UMRS 1166, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France Service de médecine intensive-réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Pitié-Salpêtrière Hospital, Paris, France
Raphaël Bellaïche Département d'Anesthésie Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
Tái Pham Université Paris-Saclay, AP-HP, Service de Médecine Intensive Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Le Kremlin-Bicêtre, France
Zakaria Ait-Hamou Service de Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Hôpitaux universitaires Paris-Centre, Paris, France
Damien Roux Médecine intensive réanimation, Hôpital Louis Mourier, Assistance Publique - Hôpitaux de Paris, Colombes, France Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, Paris, France
Raphaël Clere-Jehl Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Hôpitaux universitaires Paris-Nord, Paris, France
Elie Azoulay Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Hôpitaux universitaires Paris-Nord, Paris, France
Stéphane Gaudry Réanimation médico-chirurgicale, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Sorbonne Paris Nord, Bobigny, France
Julien Mayaux Service de Médecine Intensive Réanimation et Pneumologie, Hôpital Pitié-Salpêtrière Assistance Publique - Hôpitaux de Paris, Paris, France
Armand Mekontso Dessap Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
Florence Canoui-Poitrine Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Créteil, France
Nicolas de Prost Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France

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Martin-Loeches I, Reyes LF, Nseir S, Ranzani O, Povoa P, Diaz E, Schultz MJ, Rodríguez AH, Serrano-Mayorga CC, De Pascale G, Navalesi P, Panigada M, Coelho LM, Skoczynski S, Esperatti M, Cortegiani A, Aliberti S, Caricato A, Salzer HJF, Ceccato A, Civljak R, Soave PM, Luyt CE, Ekren PK, Rios F, Masclans JR, Marin J, Iglesias-Moles S, Nava S, Chiumello D, Bos LD, Artigas A, Froes F, Grimaldi D, Taccone FS, Antonelli M, Torres A. European Network for ICU-Related Respiratory Infections (ENIRRIs): a multinational, prospective, cohort study of nosocomial LRTI. Intensive Care Med 2023;49:1212-1222. [PMID: 37812242 PMCID: PMC10562498 DOI: 10.1007/s00134-023-07210-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023]

Abstract

PURPOSE

Lower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes.

METHODS

A prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU hospital-acquired pneumonia (ICU-HAP), HAP that required invasive ventilation (VHAP), and HAP in patients transferred to the ICU without invasive mechanical ventilation were collected. The clinical diagnosis and treatments were per clinical practice and not per protocol. Descriptive statistics were used to compare the study groups.

RESULTS

1060 patients with LRTI (72.5% male sex, median age 64 [50-74] years) were included in the study; 160 (15.1%) developed VAT, 556 (52.5%) VAP, 98 (9.2%) ICU-HAP, 152 (14.3%) HAP, and 94 (8.9%) VHAP. Patients with VHAP had higher serum procalcitonin (PCT) and Sequential Organ Failure Assessment (SOFA) scores. Patients with VAP or VHAP developed acute kidney injury, acute respiratory distress syndrome, multiple organ failure, or septic shock more often. One thousand eight patients had microbiological samples, and 711 (70.5%) had etiological microbiology identified. The most common microorganisms were Pseudomonas aeruginosa (18.4%) and Klebsiella spp (14.4%). In 382 patients (36%), the causative pathogen shows some antimicrobial resistance pattern. ICU, hospital and 28-day mortality were 30.8%, 37.5% and 27.5%, respectively. Patients with VHAP had the highest ICU, in-hospital and 28-day mortality rates.

CONCLUSION

VHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study.

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Affiliation(s)

Ignacio Martin-Loeches St James's University Hospital, Trinity College, Dublin 8, D08 NHY, Ireland. Universidad de Barcelona, CIBERes, Barcelona, Spain.
Luis Felipe Reyes Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia Clinica Universidad de La Sabana, Chia, Colombia Pandemic Sciences Institute, University of Oxford, Oxford, UK
Saad Nseir University Hospital of Lille, Lille, France
Otavio Ranzani Hospital Clinic of Barcelona, Barcelona, Spain
Pedro Povoa Hospital de Sao Francisco Xavier, Lisbon, Portugal
Emili Diaz Corporacio Sanitaria Parc Tauli, Sabadell, Spain
Marcus J Schultz Academic Medical Center, Amsterdam, The Netherlands Department of Intensive Care Laboratory for Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam, The Netherlands Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
Alejandro H Rodríguez Hospital Joan XXIII de Tarragona, Tarragona, Spain
Cristian C Serrano-Mayorga Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia Clinica Universidad de La Sabana, Chia, Colombia
Gennaro De Pascale Department of Intensive Care Policlinico Gemelli, Rome, Italy
Paolo Navalesi Magna Graecia University, Catanzaro, Italy Sant'Andrea (ASL VC), Vercelli, Italy
Mauro Panigada Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Luis Miguel Coelho Hospital de Sao Francisco Xavier, Lisbon, Portugal
Szymon Skoczynski Medical University of Silesia, Katowice, Poland
Mariano Esperatti Hospital Privado de Comunidad, Mar del Plata, Argentina
Andrea Cortegiani Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
Stefano Aliberti Medical University of Silesia, Katowice, Poland Department of Biomedical Sciences, Humanitas University, Milan, Italy IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
Anselmo Caricato Sant'Andrea (ASL VC), Vercelli, Italy
Helmut J F Salzer Department of Internal Medicine 4-Pneumology, Kepler University Hospital, Linz, Austria Medical Faculty, Johannes Kepler University Linz, Linz, Austria Division of Infectious Diseases and Tropical Medicine, Kepler University Hospital, Linz, Austria
Adrian Ceccato Hospital Clinic of Barcelona, Barcelona, Spain
Rok Civljak "Dr. Fran Mihaljevic" University Hospital for Infectious Diseases, Zagreb, Croatia
Paolo Maurizio Soave Department of Surgical Intensive Care Policlinico Gemelli, Rome, Italy
Charles-Edouard Luyt Groupe Hospitalier Pitie-Salpitriere, Paris, France
Pervin Korkmaz Ekren Ege University Medical Faculty, Izmir, Turkey
Fernando Rios Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
Joan Ramon Masclans Hospital del Mar, Barcelona, Spain Intensive Care Medicine, Hospital del Mar & IMIM, Barcelona, Spain Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain
Judith Marin Intensive Care Medicine, Hospital del Mar & IMIM, Barcelona, Spain
Silvia Iglesias-Moles Hospital Arnau de Vilanova de Lleida, Lleida, Spain
Stefano Nava S. Orsola-Malpighi Hospital, Bologna, Italy Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
Davide Chiumello ASST Santi Paolo e Carlo, Milan, Italy
Lieuwe D Bos Academic Medical Center, Amsterdam, The Netherlands
Antoni Artigas Corporacio Sanitaria Parc Tauli, Sabadell, Spain
Filipe Froes Hospital Pulido Valente, Lisbon, Portugal
David Grimaldi Hospital Erasme Universit Libre de Bruxelles, Brussels, Belgium
Fabio Silvio Taccone Hospital Erasme Universit Libre de Bruxelles, Brussels, Belgium
Massimo Antonelli Department of Intensive Care Policlinico Gemelli, Rome, Italy
Antoni Torres Hospital Clinic of Barcelona, Barcelona, Spain.

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Dibos M, Haschka SJ, Abbassi R, Schneider J, Schmid RM, Rasch S, Lahmer T. Influence of a Structured Microbiological Endotracheal Monitoring Program on the Outcome of Critically Ill COVID-19 Patients: An Observational Study. J Clin Med 2023;12:5622. [PMID: 37685689 PMCID: PMC10488947 DOI: 10.3390/jcm12175622] [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: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open

Influence of a structured microbiological endotracheal monitoring on the outcome of critically ill COVID-19 patients: an observational study.. [DOI: 10.21203/rs.3.rs-2436406/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]

Martin-Loeches I, Povoa P, Nseir S. Dichotomy between ventilator associated-pneumonia/tracheobronchitis: did you ask the lung its opinion? Author's reply. Intensive Care Med 2023;49:1034-1035. [PMID: 37318521 DOI: 10.1007/s00134-023-07118-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]

Martin-Loeches I, Povoa P, Nseir S. Ventilator associated tracheobronchitis and pneumonia: one infection with two faces. Intensive Care Med 2023;49:996-999. [PMID: 37160828 PMCID: PMC10425498 DOI: 10.1007/s00134-023-07086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023]

Massart N, Plainfosse E, Julien G, Magalhaes E, Fillâtre P. Dichotomy between ventilator-associated pneumonia/-tracheobronchitis: did you ask the lung its opinion? Intensive Care Med 2023;49:1031-1033. [PMID: 37256342 PMCID: PMC10231292 DOI: 10.1007/s00134-023-07105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]

Martin-Loeches I, Sganzerla Martinez G, Garduno A, Cusack R, Andaluz-Ojeda D, Lopez-Campos G, Kelvin D, Ramirez P, Lomas Lorenzo LT, Socias Crespi L, Bermejo-Martín JF. Transcriptomics reveals shared immunosuppressive landscapes in ventilator-associated lower respiratory tract infections (VA-LRTI) patients. Expert Rev Anti Infect Ther 2023;21:1135-1141. [PMID: 37676034 DOI: 10.1080/14787210.2023.2256979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/02/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]

Affiliation(s)

Ignacio Martin-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland CIBER de Enfermedades Respiratorias, CB22/06/00035, Instituto de Salud Carlos III, Madrid, Spain
Gustavo Sganzerla Martinez Laboratory of Immunity, Department of Immunology, Shantou University Medical College, Shantou, China Laboratory of Emerging and Infectious Diseases, Department of Immunology and Microbiology, Dalhousie University, Halifax, Nova Scotia, Canada
Alexis Garduno Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland
Rachel Cusack Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland
David Andaluz-Ojeda Servicio de Medicina Intensiva, Hospital Universitario HM Sanchinarro, Hospitales Madrid, Madrid, Spain Intensive Care Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain Scientific Coordination, Fundación de Investigación HM, Madrid, Spain
Guillermo Lopez-Campos Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
David Kelvin Laboratory of Immunity, Department of Immunology, Shantou University Medical College, Shantou, China Laboratory of Emerging and Infectious Diseases, Department of Immunology and Microbiology, Dalhousie University, Halifax, Nova Scotia, Canada
Paula Ramirez Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Valencia, Spain
Luis Tamayo Lomas Lorenzo Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
Lorenzo Socias Crespi Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
Jesús F Bermejo-Martín Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Gerencia Regional de Salud de Castilla y León, Salamanca, Spain School of Medicine, Universidad de Salamanca, Salamanca, Spain Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, CIBERes, Barcelona, Spain

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Saura O, Luyt CE. Procalcitonin as a biomarker to guide treatments for patients with lower respiratory tract infections. Expert Rev Respir Med 2023;17:651-661. [PMID: 37639716 DOI: 10.1080/17476348.2023.2251394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]

Utsumi S, Ohshimo S, Ishii J, Nishikimi M, Shime N. Lung Abscess and Pyothorax in Critically Ill COVID-19 Patients: A Single-Center Retrospective Study. Crit Care Explor 2023;5:e0919. [PMID: 37197587 PMCID: PMC10184985 DOI: 10.1097/cce.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open

Myrianthefs P, Zakynthinos GE, Tsolaki V, Makris D. Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review. Antibiotics (Basel) 2023;12:antibiotics12050801. [PMID: 37237704 DOI: 10.3390/antibiotics12050801] [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: 04/03/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open

Abstract

BACKGROUND

Ventilator-associated lower respiratory tract infectious complications in critically ill patients cover a wide spectrum of one disease process (respiratory infection), initiating from tracheal tube and/or tracheobronchial colonization, to ventilator associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP). VAP occurence has been associated with increased intensive care unit (ICU) morbidity (ventilator days, as well as length of ICU and hospital stay) and ICU mortality. Therefore, treatments that aim at VAP/VAT incidence reduction are a high priority.

AIM

The aim of the present review is to discuss the current literature concerning two major aspects: (a) can aerosolized antibiotics (AA) administered in a pre-emptive way prevent the occurrence of ventilator-associated infections? and (b) can VAT treatment with aerosolized avert the potential evolution to VAP?

RESULTS

There were identified eight studies that provided data on the use of aerosolized antibiotics for the prevention of VAT/VAP. Most of them report favorable data on reducing the colonisation rate and the progression to VAP/VAT. Another four studies dealt with the treatment of VAT/VAP. The results support the decrease in the incidence to VAP transition and/or the improvement in signs and symptoms of VAP. Moreover, there are concise reports on higher cure rates and microbiological eradication in patients treated with aerosolized antibiotics. Yet, differences in the delivery modality adopted and resistance emergence issues preclude the generalisability of the results.

CONCLUSION

Aerosolized antibiotic therapy can be used to manage ventilator-associated infections, especially those with difficult to treat resistance. The limited clinical data raise the need for large randomized controlled trials to confirm the benefits of AA and to evaluate the impact on antibiotic selection pressure.

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Roquilly A, Francois B, Huet O, Launey Y, Lasocki S, Weiss E, Petrier M, Hourmant Y, Bouras M, Lakhal K, Le Bel C, Flattres Duchaussoy D, Fernández-Barat L, Ceccato A, Flet L, Jobert A, Poschmann J, Sebille V, Feuillet F, Koulenti D, Torres A. Interferon gamma-1b for the prevention of hospital-acquired pneumonia in critically ill patients: a phase 2, placebo-controlled randomized clinical trial. Intensive Care Med 2023;49:530-544. [PMID: 37072597 PMCID: PMC10112824 DOI: 10.1007/s00134-023-07065-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]

Abstract

PURPOSE

We aimed to determine whether interferon gamma-1b prevents hospital-acquired pneumonia in mechanically ventilated patients.

METHODS

In a multicenter, placebo-controlled, randomized trial conducted in 11 European hospitals, we randomly assigned critically ill adults, with one or more acute organ failures, under mechanical ventilation to receive interferon gamma-1b (100 µg every 48 h from day 1 to 9) or placebo (following the same regimen). The primary outcome was a composite of hospital-acquired pneumonia or all-cause mortality on day 28. The planned sample size was 200 with interim safety analyses after enrolling 50 and 100 patients.

RESULTS

The study was discontinued after the second safety analysis for potential harm with interferon gamma-1b, and the follow-up was completed in June 2022. Among 109 randomized patients (median age, 57 (41-66) years; 37 (33.9%) women; all included in France), 108 (99%) completed the trial. Twenty-eight days after inclusion, 26 of 55 participants (47.3%) in the interferon-gamma group and 16 of 53 (30.2%) in the placebo group had hospital-acquired pneumonia or died (adjusted hazard ratio (HR) 1.76, 95% confidence interval (CI) 0.94-3.29; P = 0.08). Serious adverse events were reported in 24 of 55 participants (43.6%) in the interferon-gamma group and 17 of 54 (31.5%) in the placebo group (P = 0.19). In an exploratory analysis, we found that hospital-acquired pneumonia developed in a subgroup of patients with decreased CCL17 response to interferon-gamma treatment.

CONCLUSIONS

Among mechanically ventilated patients with acute organ failure, treatment with interferon gamma-1b compared with placebo did not significantly reduce the incidence of hospital-acquired pneumonia or death on day 28. Furthermore, the trial was discontinued early due to safety concerns about interferon gamma-1b treatment.

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Affiliation(s)

Antoine Roquilly Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France. Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France.
Bruno Francois ICU Department and Inserm CIC 1435 & UMR 1092, University Hospital of Limoges, Limoges, France
Olivier Huet Département d'anesthésie réanimation et medecine peri-operatoire, CHRU de Brest, Université de Bretagne Occidentale, 29000, Brest, France
Yoann Launey Department of Anaesthesia, Critical Care and Perioperative Medicine, Univ Rennes, CHU Rennes, 35000, Rennes, France
Sigismond Lasocki Department of Anesthesiology and Critical Care Medicine, University Hospital of Angers, 49000, Angers, France
Emmanuel Weiss Department of Anesthesiology and Critical Care, Université Paris Cité, INSERM UMR_S1149, and AP-HP Nord, Hôpital Beaujon, Clichy, France
Melanie Petrier Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
Yannick Hourmant Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
Marwan Bouras Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
Karim Lakhal Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
Cecilia Le Bel Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
Delphine Flattres Duchaussoy Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
Laia Fernández-Barat CELLEX research laboratories, CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, CIBERES, Icrea, IDIBAPS, Barcelona, Spain
Adrian Ceccato Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, CIBERES, Icrea, IDIBAPS, Barcelona, Spain
Laurent Flet Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
Alexandra Jobert Nantes Université, CHU Nantes, DRI, Département promotion, cellule vigilances recherche, Nantes, France Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
Jeremie Poschmann Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
Veronique Sebille Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, 44000, Nantes, France Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
Fanny Feuillet Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, 44000, Nantes, France Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
Despoina Koulenti 2nd Critical Care Department, Attikon University Hospital, Athens, Greece Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
Antoni Torres CELLEX research laboratories, CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

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Caceres E, Olivella JC, Yanez M, Viñan E, Estupiñan L, Boada N, Martin-Loeches I, Reyes LF. Risk factors and outcomes of lower respiratory tract infections after traumatic brain injury: a retrospective observational study. Front Med (Lausanne) 2023;10:1077371. [PMID: 37138738 PMCID: PMC10150376 DOI: 10.3389/fmed.2023.1077371] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open

Abstract

Background

Traumatic brain injury (TBI) is a public health problem with a high burden in terms of disability and death. Infections are a common complication, with respiratory infections being the most frequent. Most available studies have addressed the impact of ventilator-associated pneumonia (VAP) after TBI; therefore, we aim to characterize the hospital impact of a broader entity, lower respiratory tract infections (LRTIs).

Methods

This observational, retrospective, single-center cohort study describes the clinical features and risk factors associated with LRTIs in patients with TBI admitted to an intensive care unit (ICU). We used bivariate and multivariate logistic regressions to identify the risk factors associated with developing LRTI and determine its impact on hospital mortality.

Results

We included 291 patients, of whom 77% (225/291) were men. The median (IQR) age was 38 years (28-52 years). The most common cause of injury was road traffic accidents 72% (210/291), followed by falls 18% (52/291) and assault at 3% (9/291). The median (IQR) Glasgow Coma Scale (GCS) score on admission was 9 (6-14), and 47% (136/291) were classified as severe TBI, 13% (37/291) as moderate TBI, and 40% (114/291) as mild TBI. The median (IQR) injury severity score (ISS) was 24 (16-30). Nearly 48% (141/291) of patients presented at least one infection during hospitalization, and from those, 77% (109/141) were classified as LRTIs, which included tracheitis 55% (61/109), ventilator-associated pneumonia (VAP) 34% (37/109), and hospital-acquired pneumoniae (HAP) 19% (21/109). After multivariable analysis, the following variables were significantly associated with LRTIs: age (OR 1.1, 95% CI 1.01-1.2), severe TBI (OR 2.7, 95% CI 1.1-6.9), AIS thorax (OR 1.4, 95 CI 1.1-1.8), and mechanical ventilation on admission (OR 3.7, 95% CI 1.1-13.5). At the same time, hospital mortality did not differ between groups (LRTI 18.6% vs. No LRTI 20.1%, p = 0.7), and ICU and hospital length of stay (LOS) were longer in the LRTI group (median [IQR] 12 [9-17] vs. 5 [3-9], p < 0.01) and (median [IQR] 21 [13-33] vs. 10 [5-18], p = 0.01), respectively. Time on the ventilator was longer for those with LRTIs.

Conclusion

The most common site/location of infection in patients with TBI admitted to ICU is respiratory. Age, severe TBI, thoracic trauma, and mechanical ventilation were identified as potential risk factors. LRTI was associated with prolonged ICU, hospital stay, and more days on a ventilator, but not with mortality.

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Ventilator-Associated Pneumonia in Immunosuppressed Patients. Antibiotics (Basel) 2023;12:antibiotics12020413. [PMID: 36830323 PMCID: PMC9952186 DOI: 10.3390/antibiotics12020413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open

Abstract

Immunocompromised patients-including patients with cancer, hematological malignancies, solid organ transplants and individuals receiving immunosuppressive therapies for autoimmune diseases-account for an increasing proportion of critically-ill patients. While their prognosis has improved markedly in the last decades, they remain at increased risk of healthcare- and intensive care unit (ICU)-acquired infections. The most frequent of these are ventilator-associated lower respiratory tract infections (VA-LTRI), which include ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Recent studies have shed light on some of the specific features of VAP and VAT in immunocompromised patients, which is the subject of this narrative review. Contrary to previous belief, the incidence of VAP and VAT might actually be lower in immunocompromised than non-immunocompromised patients. Further, the relationship between immunosuppression and the incidence of VAP and VAT related to multidrug-resistant (MDR) bacteria has also been challenged recently. Etiological diagnosis is essential to select the most appropriate treatment, and the role of invasive sampling, specifically bronchoscopy with bronchoalveolar lavage, as well as new molecular syndromic diagnostic tools will be discussed. While bacteria-especially gram negative bacteria-are the most commonly isolated pathogens in VAP and VAT, several opportunistic pathogens are a special concern among immunocompromised patients, and must be included in the diagnostic workup. Finally, the impact of immunosuppression on VAP and VAT outcomes will be examined in view of recent papers using improved statistical methodologies and treatment options-more specifically empirical antibiotic regimens-will be discussed in light of recent findings on the epidemiology of MDR bacteria in this population.

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Airway and Respiratory Devices in the Prevention of Ventilator-Associated Pneumonia. MEDICINA (KAUNAS, LITHUANIA) 2023;59:medicina59020199. [PMID: 36837404 PMCID: PMC9965501 DOI: 10.3390/medicina59020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/04/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]

Ribeiro ILA, Bellissimo-Rodrigues WT, Mussolin MG, Innocentini LMAR, Marangoni ATD, Macedo LD, Barbosa-Júnior F, de Souza HCC, Menegueti MG, Pereira APS, Gaspar GG, Schmidt A, Miranda CH, Lovato WJ, Puga ML, Auxiliadora-Martins M, Basile-Filho A, Bellissimo-Rodrigues F. Impact of a dental care intervention on the hospital mortality of critically ill patients admitted to intensive care units: A quasi-experimental study. Am J Infect Control 2022;50:1156-1161. [PMID: 35108582 DOI: 10.1016/j.ajic.2022.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 01/25/2023]

Affiliation(s)

Isabella Lima Arrais Ribeiro Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Wanessa Teixeira Bellissimo-Rodrigues Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Mariama Gentil Mussolin Graduate Program in Public Health/Clinical Oncology, Stem Cells and Cell Therapy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Lara Maria Alencar Ramos Innocentini Dentistry Service. University Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Adriano Tadeu Dias Marangoni Dentistry Service. University Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Leandro Dorigan Macedo Dentistry Service. University Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Francisco Barbosa-Júnior Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Hayala Cristina Cavenague de Souza Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Mayra Gonçalves Menegueti School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
Ana Paula Sulino Pereira School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
Gilberto Gambero Gaspar Infection Control and Prevention Service. University Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
André Schmidt Cardiology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Carlos Henrique Miranda Cardiology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Wilson José Lovato Intensive Care Unit, University Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Marcelo Lourencini Puga Intensive Care Medicine Division, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Maria Auxiliadora-Martins Intensive Care Medicine Division, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Anibal Basile-Filho Intensive Care Medicine Division, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Fernando Bellissimo-Rodrigues Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.

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Saura O, Rouzé A, Martin-Loeches I, Povoa P, Kreitmann L, Torres A, Metzelard M, Du Cheyron D, Lambiotte F, Tamion F, Labruyere M, Boulle Geronimi C, Luyt CE, Nyunga M, Pouly O, Thille AW, Megarbane B, Saade A, Magira E, Llitjos JF, Ioannidou I, Pierre A, Reignier J, Garot D, Baudel JL, Voiriot G, Plantefeve G, Morawiec E, Asfar P, Boyer A, Mekontso-Dessap A, Bardaka F, Diaz E, Vinsonneau C, Floch PE, Weiss N, Ceccato A, Artigas A, Nora D, Duhamel A, Labreuche J, Nseir S, Bouchereau M, Boyd S, Coelho L, Maizel J, Cuchet P, Zarrougui W, Boyer D, Quenot JP, Imouloudene M, Pineton de Chambrun M, Van der Linden T, Arrive F, Voicu S, Azoulay E, Moglia E, Pene F, Cilloniz C, Thevenin D, Larrat C, Argaud L, Guidet B, Contou D, Beurton A, Meguerditchian D, Razazi K, Tsolaki V, Marzouk M, Brunin G, Marois C, Morales L. Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study. Crit Care 2022;26:292. [PMID: 36167550 PMCID: PMC9513297 DOI: 10.1186/s13054-022-04170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022] Open

Abstract Abstract Background Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. Methods Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox’s proportional hazard models with adjustment on pre-specified confounders. Results Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17–1.31) at day 2, 0.95 (0.63–1.42) at day 7, 1.48 (1.01–2.16) at day 14 and 1.94 (1.09–3.46) at day 21. Conclusions No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up. Collapse

Massart N, Reizine F, Fillatre P, Seguin P, La Combe B, Frerou A, Egreteau PY, Hourmant B, Kergoat P, Lorber J, Souchard J, Canet E, Rieul G, Fedun Y, Delbove A, Camus C. Multiple-site decontamination regimen decreases acquired infection incidence in mechanically ventilated COVID-19 patients. Ann Intensive Care 2022;12:84. [PMID: 36053369 PMCID: PMC9438389 DOI: 10.1186/s13613-022-01057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022] Open

Abstract

Background

Among strategies that aimed to prevent acquired infections (AIs), selective decontamination regimens have been poorly studied in the COVID-19 setting. We assessed the impact of a multiple-site decontamination (MSD) regimen on the incidence of bloodstream infections (BSI) and ventilator-associated pneumonia (VAP) in COVID-19 patients receiving mechanical ventilation.

Methods

We performed an ancillary analysis of a multicenter retrospective observational study in 15 ICUs in western France. In addition to standard-care (SC), 3 ICUs used MSD, a variant of selective digestive decontamination, which consists of the administration of topical antibiotics four times daily in the oropharynx and the gastric tube, chlorhexidine body wash and a 5-day nasal mupirocin course. AIs were compared between the 3 ICUs using MSD (MSD group) and the 12 ICUs using SC.

Results

During study period, 614 of 1158 COVID-19 patients admitted in our ICU were intubated for at least 48 h. Due to missing data in 153 patients, 461 patients were finally included of whom 89 received MSD. There were 34 AIs in the MSD group (2117 patient-days), as compared with 274 AIs in the SC group (8957 patient-days) (p < 0.001). MSD was independently associated with a lower risk of AI (IRR = 0.56 [0.38–0.83]; p = 0.004) (Table 2). When the same model was used for each site of infection, MSD remained independently associated with a lower risk of VAP (IRR = 0.52 [0.33–0.89]; p = 0.005) but not of BSI (IRR = 0.58, [0.25–1.34], p = 0.21). Hospital mortality was lower in the MSD group (16.9% vs 30.1%, p = 0.017).

Conclusions

In ventilated COVID-19 patients, MSD was independently associated with lower AI incidence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-022-01057-x.

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Affiliation(s)

Nicolas Massart Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France.
Florian Reizine Service de Réanimation Médicale CHU de Rennes, 2, rue Henri le Guilloux, 35000 , Rennes, France.,Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
Pierre Fillatre Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France
Philippe Seguin Service de Réanimation Chirugicale, CHU de Rennes, 2, rue Henri le Guilloux, 35000, Rennes, France
Béatrice La Combe Service de Réanimation, CH Bretagne SUD, LORIENT, 5 avenue de Choiseul, 56322, Lorient, France
Aurélien Frerou Service de Réanimation, Centre Hospitalier de Saint-Malo, 1 rue de la Marne, 35400, Saint-Malo, France
Pierre-Yves Egreteau Service de Réanimation, Centre Hospitalier de Morlaix, 15 rue de kersaint gilly, 29600, Morlaix, France
Baptiste Hourmant Service de Réanimation Médicale CHU de Brest, 2 avenue Foch, 29200, Brest, France
Pierre Kergoat Service de Réanimation, CH de QUIMPER, 14bis Avenue Yves Thépot, 29107, Quimper , France
Julien Lorber Service de Médecine Intensive Réanimation, CH de Saint-Nazaire, 11 bd Georges Charpak, 44600, Saint-Nazaire, France
Jerome Souchard Service de Réanimation Médicale CHU de Rennes, 2, rue Henri le Guilloux, 35000 , Rennes, France.,Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
Emmanuel Canet Service de Réanimation médicale, CHU de nantes, 1 place Alexis Ricordeau, 44093, Nantes , France
Guillaume Rieul Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
Yannick Fedun Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
Agathe Delbove Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
Christophe Camus Service de Réanimation Médicale CHU de Rennes, 2, rue Henri le Guilloux, 35000 , Rennes, France

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Ranzani OT, Niederman MS, Torres A. Ventilator-associated pneumonia. Intensive Care Med 2022;48:1222-1226. [PMID: 35771252 PMCID: PMC9245883 DOI: 10.1007/s00134-022-06773-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]

Duszynska W, Idziak M, Smardz K, Burkot A, Grotowska M, Rojek S. Frequency, Etiology, Mortality, Cost, and Prevention of Respiratory Tract Infections—Prospective, One Center Study. J Clin Med 2022;11:jcm11133764. [PMID: 35807049 PMCID: PMC9267472 DOI: 10.3390/jcm11133764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open

Blot S, Ruppé E, Harbarth S, Asehnoune K, Poulakou G, Luyt CE, Rello J, Klompas M, Depuydt P, Eckmann C, Martin-Loeches I, Povoa P, Bouadma L, Timsit JF, Zahar JR. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs 2022;70:103227. [PMID: 35249794 PMCID: PMC8892223 DOI: 10.1016/j.iccn.2022.103227] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Abstract

Patients in intensive care units (ICUs) are at high risk for healthcare-acquired infections (HAI) due to the high prevalence of invasive procedures and devices, induced immunosuppression, comorbidity, frailty and increased age. Over the past decade we have seen a successful reduction in the incidence of HAI related to invasive procedures and devices. However, the rate of ICU-acquired infections remains high. Within this context, the ongoing emergence of new pathogens, further complicates treatment and threatens patient outcomes. Additionally, the SARS-CoV-2 (COVID-19) pandemic highlighted the challenge that an emerging pathogen provides in adapting prevention measures regarding both the risk of exposure to caregivers and the need to maintain quality of care. ICU nurses hold a special place in the prevention and management of HAI as they are involved in basic hygienic care, steering and implementing quality improvement initiatives, correct microbiological sampling, and aspects antibiotic stewardship. The emergence of more sensitive microbiological techniques and our increased knowledge about interactions between critically ill patients and their microbiota are leading us to rethink how we define HAIs and best strategies to diagnose, treat and prevent these infections in the ICU. This multidisciplinary expert review, focused on the ICU setting, will summarise the recent epidemiology of ICU-HAI, discuss the place of modern microbiological techniques in their diagnosis, review operational and epidemiological definitions and redefine the place of several controversial preventive measures including antimicrobial-impregnated medical devices, chlorhexidine-impregnated washcloths, catheter dressings and chlorhexidine-based mouthwashes. Finally, general guidance is suggested that may reduce HAI incidence and especially outbreaks in ICUs.

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Affiliation(s)

Stijn Blot Dept. of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium.
Etienne Ruppé INSERM, IAME UMR 1137, University of Paris, France; Department of Bacteriology, Bichat-Claude Bernard Hospital, APHP, Paris, France
Stephan Harbarth Infection Control Program, Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Karim Asehnoune Department of Anesthesiology and Surgical Intensive Care, Hôtel-Dieu, University Hospital of Nantes, Nantes, France
Garyphalia Poulakou 3(rd) Department of Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital of Athens, Greece
Charles-Edouard Luyt Médecine Intensive Réanimation, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
Jordi Rello Vall d'Hebron Institut of Research (VHIR) and Centro de Investigacion Biomedica en Red de Enferemedades Respiratorias (CIBERES), Instituto Salud Carlos III, Barcelona, Spain
Michael Klompas Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, United States; Department of Medicine, Brigham and Women's Hospital, Boston, United States
Pieter Depuydt Intensive Care Department, Ghent University Hospital, Gent, Belgium
Christian Eckmann Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Medical University Hannover, Germany
Ignacio Martin-Loeches Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland; Hospital Clinic, Universidad de Barcelona, CIBERes, Barcelona, Spain
Pedro Povoa Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal; NOVA Medical School, Comprehensive Health Research Center, CHRC, New University of Lisbon, Lisbon Portugal; Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
Lila Bouadma INSERM, IAME UMR 1137, University of Paris, France; Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, Paris, France
Jean-Francois Timsit INSERM, IAME UMR 1137, University of Paris, France; Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, Paris, France
Jean-Ralph Zahar INSERM, IAME UMR 1137, University of Paris, France; Microbiology, Infection Control Unit, GH Paris Seine Saint-Denis, APHP, Bobigny, France

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Jongers B, Hotterbeekx A, Bielen K, Vervliet P, Boddaert J, Lammens C, Fransen E, Baggerman G, Covaci A, Goossens H, Malhotra-Kumar S, Jorens PG, Kumar-Singh S. Identification of Potential Urinary Metabolite Biomarkers of Pseudomonas aeruginosa Ventilator-Associated Pneumonia. Biomark Insights 2022;17:11772719221099131. [PMID: 35592849 PMCID: PMC9112676 DOI: 10.1177/11772719221099131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open

Abstract

Introduction:

Ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa is a major cause of morbidity and mortality in hospital intensive care units (ICU). Rapid identification of P. aeruginosa-derived markers in easily accessible patients’ samples can enable an early detection of P. aeruginosa VAP (VAP-PA), thereby stewarding antibiotic use and improving clinical outcomes.

Methods:

Metabolites were analysed using liquid chromatography-mass spectrometry (LC-MS) in prospectively collected urine samples from mechanically ventilated patients admitted to the Antwerp University Hospital ICU. Patients were followed from the start of mechanical ventilation (n = 100 patients) till the time of clinical diagnosis of VAP (n = 13). Patients (n = 8) in whom diagnosis of VAP was further confirmed by culturing respiratory samples and urine samples were studied for semi-quantitative metabolomics.

Results:

We first show that multivariate analyses highly discriminated VAP-PA from VAP–non-PA as well as from the pre-infection groups (R² = .97 and .98, respectively). A further univariate analysis identified 58 metabolites that were significantly elevated or uniquely present in VAP-PA compared to the VAP–non-PA and pre-infection groups (P < .05). These comprised both a known metabolite of histidine as well as a novel nicotine metabolite. Most interestingly, we identified 3 metabolites that were not only highly upregulated for, but were also highly specific to, VAP-PA, as these metabolites were completely absent in all pre-infection timepoints and in VAP–non-PA group.

Conclusions:

Considerable differences exist between urine metabolites in VAP-PA compared to VAP due to other bacterial aetiologies as well to non-VAP (pre-infection) timepoints. The unique urinary metabolic biomarkers we describe here, if further validated, could serve as highly specific diagnostic biomarkers of VAP-PA.

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Affiliation(s)

Bart's Jongers Molecular Pathology Group, Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, Wilrijk, Belgium
An Hotterbeekx Molecular Pathology Group, Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, Wilrijk, Belgium
Kenny Bielen Molecular Pathology Group, Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, Wilrijk, Belgium.,Laboratory of Medical Microbiology - Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
Philippe Vervliet Toxicological Centre, University of Antwerp, Wilrijk, Belgium
Jan Boddaert Molecular Pathology Group, Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, Wilrijk, Belgium
Christine Lammens Laboratory of Medical Microbiology - Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
Erik Fransen StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
Geert Baggerman CEPROMA - Centre for proteomics and mass spectrometry, Department of Biology, University of Antwerp, Antwerp, Belgium
Adrian Covaci Toxicological Centre, University of Antwerp, Wilrijk, Belgium
Herman Goossens Laboratory of Medical Microbiology - Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
Surbhi Malhotra-Kumar Laboratory of Medical Microbiology - Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
Philippe G Jorens Department of Critical Care Medicine, Antwerp University Hospital and University of Antwerp, LEMP, Edegem, Belgium
Samir Kumar-Singh Molecular Pathology Group, Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, Wilrijk, Belgium.,Laboratory of Medical Microbiology - Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

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Bergin SP, Calvert SB, Farley J, Sun JL, Chiswell K, Dieperink W, Kluytmans J, Lopez-Delgado JC, Leon-Lopez R, Zervos MJ, Kollef MH, Sims M, Kabchi BA, Rubin D, Santiago J, Natarajan M, Tenaerts P, Fowler VG, Holland TL, Bonten MJ, Hullegie SJ. PROPHETIC EU: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit in European and United States Cohorts. Open Forum Infect Dis 2022;9:ofac231. [PMID: 35836748 PMCID: PMC9274438 DOI: 10.1093/ofid/ofac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open

Abstract Abstract Background The prospective identification of patients at high risk for hospital-acquired/ventilator-associated bacterial pneumonia may improve clinical trial feasibility and foster antibacterial development. In a prior study conducted in the United States, clinical criteria were used to prospectively identify these patients; however, these criteria have not been applied in a European population. Methods Adults considered high risk for pneumonia (treatment with ventilation or high levels of supplemental oxygen) in the intensive care units of seven European hospitals were prospectively enrolled from June 12-December 27, 2017. We estimated the proportion of high-risk patients developing pneumonia according to United States Food and Drug Administration guidance and a subset potentially eligible for antibacterial trial enrollment. We compared patient characteristics, treatment exposures, and pneumonia incidence in the European and previously described United States cohorts. Results Of 888 high-risk patients, 211/888 (24%) were treated for possible pneumonia and 150/888 (17%) met the Food and Drug Administration definition for hospital-acquired/ventilator-associated bacterial pneumonia. A higher proportion of European patients treated for possible pneumonia met the pneumonia definition (150/211 [71%] versus 537/1464 [37%], p<0.001). Among patients developing pneumonia, a higher proportion of European patients met antibacterial trial eligibility criteria (124/150 [83%] versus 371/537 [69%], p<0.001). Conclusions Clinical criteria prospectively identified high-risk patients with high rates of pneumonia in the European cohort. Despite higher rates of established risk factors and incident pneumonia, European patients were significantly less likely to receive antibiotics for possible pneumonia than United States patients. Different treatment practices may contribute to lower rates of antibacterial trial enrollment in the United States. Collapse

Inhaled antibiotics in critical care: state of the art and future perspectives. Infect Dis Now 2022;52:327-333. [DOI: 10.1016/j.idnow.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 12/15/2022]

Smith CJ, Sierra CM, Robbins J, Cobbina E. Enteral antipseudomonal fluoroquinolones for ventilator-associated tracheobronchitis in children with pre-existing tracheostomy. Pediatr Pulmonol 2022;57:1064-1071. [PMID: 34989477 DOI: 10.1002/ppul.25816] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/08/2022]

Abstract

INTRODUCTION

Pseudomonas aeruginosa is the most commonly isolated organism in tracheostomy-dependent children with ventilator-associated tracheobronchitis (VAT). Enteral treatment with an antipseudomonal fluoroquinolone such as ciprofloxacin or levofloxacin is sometimes employed, but supportive data are limited. The purpose of this study was to evaluate the effectiveness and safety of enteral antipseudomonal fluoroquinolones for VAT in children with pre-existing tracheostomy.

METHODS

This was a retrospective review of electronic medical records for tracheostomy-dependent children <18 years of age who received an enteral antipseduomonal fluoroquinolone for the treatment of presumed VAT from January 2013 through January 2020 at an academic children's hospital.

RESULTS

Seventy-six treatment courses representing 60 children (median age: 9.5, interquartile range [IQR]: 3.6-13.1 years) received an antipseudomonal fluoroquinolone for VAT treatment during the study period. Median treatment duration was 8 (range: 7-10) days. Most tracheostomy cultures (n = 70/82, 85%) were polymicrobial, with P. aeruginosa most commonly isolated (n = 67/224 organisms, 30%). Sixty-five courses (86%) were successfully treated with an enteral fluoroquinolone. Antibiotics were changed or extended for two (3%) children. Antibiotics were prescribed for 10 (13%) courses and eight (11%) required hospitalization for a respiratory infection within 30 days of fluoroquinolone completion. Six (8%) courses received a seizure rescue medication, seven (9%) experienced emesis, and one (1%) had elevated transaminases. Tendonitis and tendon rupture were not observed.

CONCLUSIONS

The results of this study suggest enteral antipseudomonal fluoroquinolones may be effective for the treatment of VAT in children with tracheostomy. Further study is warranted to clarify the role of these agents in pediatric VAT.

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Le Pape M, Besnard C, Acatrinei C, Guinard J, Boutrot M, Genève C, Boulain T, Barbier F. Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study. Ann Intensive Care 2022;12:24. [PMID: 35290537 PMCID: PMC8922395 DOI: 10.1186/s13613-022-00998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/27/2022] [Indexed: 12/15/2022] Open

Abstract

Background

The clinical impact and outcomes of ventilator-associated pneumonia (VAP) have been scarcely investigated in patients with the acute respiratory distress syndrome (ARDS).

Methods

Patients admitted over an 18-month period in two intensive care units (ICU) of a university-affiliated hospital and meeting the Berlin criteria for ARDS were retrospectively included. The association between VAP and the probability of death at day 90 (primary endpoint) was appraised through a Cox proportional hazards model handling VAP as a delay entry variable. Secondary endpoints included (i) potential changes in the PaO₂/FiO₂ ratio and SOFA score values around VAP (linear mixed modelling), and (ii) mechanical ventilation (MV) duration, numbers of ventilator- and vasopressor-free days at day 28, and length of stay (LOS) in patients with and without VAP (median or absolute risk difference calculation). Subgroup analyses were performed in patients with COVID-19-related ARDS and those with ARDS from other causes.

Results

Among the 336 included patients (101 with COVID-19 and 235 with other ARDS), 176 (52.4%) experienced a first VAP. VAP induced a transient and moderate decline in the PaO₂/FiO₂ ratio without increase in SOFA score values. VAP was associated with less ventilator-free days (median difference and 95% CI, − 19 [− 20; − 13.5] days) and vasopressor-free days (− 5 [− 9; − 2] days) at day 28, and longer ICU (+ 13 [+ 9; + 15] days) and hospital (+ 11.5 [+ 7.5; + 17.5] days) LOS. These effects were observed in both subgroups. Overall day-90 mortality rates were 35.8% and 30.0% in patients with and without VAP, respectively (P = 0.30). In the whole cohort, VAP (adjusted HR 3.16, 95% CI 2.04–4.89, P < 0.0001), the SAPS-2 value at admission, chronic renal disease and an admission for cardiac arrest predicted death at day 90, while the COVID-19 status had no independent impact. When analysed separately, VAP predicted death in non-COVID-19 patients (aHR 3.43, 95% CI 2.11–5.58, P < 0.0001) but not in those with COVID-19 (aHR 1.19, 95% CI 0.32–4.49, P = 0.80).

Conclusions

VAP is an independent predictor of 90-day mortality in ARDS patients. This condition exerts a limited impact on oxygenation but correlates with extended MV duration, vasoactive support, and LOS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-022-00998-7.

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Ventilator-Associated Lower Respiratory Tract Bacterial Infections in COVID-19 Compared With Non-COVID-19 Patients. Crit Care Med 2022;50:825-836. [PMID: 35148524 PMCID: PMC9005099 DOI: 10.1097/ccm.0000000000005462] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Wicky PH, Martin-Loeches I, Timsit JF. "HAP and VAP after Guidelines". Semin Respir Crit Care Med 2022;43:248-254. [PMID: 35042265 DOI: 10.1055/s-0041-1740246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]

Abstract

Nosocomial pneumonia is associated with worsened prognosis when diagnosed in intensive care unit (ICU), ranging from 12 to 48% mortality. The incidence rate of ventilation-acquired pneumonia tends to decrease below 15/1,000 intubation-day. Still, international guidelines are heterogeneous about diagnostic criteria because of inaccuracy of available methods. New entities have thus emerged concerning lower respiratory tract infection, namely ventilation-acquired tracheobronchitis (VAT), or ICU-acquired pneumonia (ICUAP), eventually requiring invasive ventilation (v-ICUAP), according to the type of ventilation support. The potential discrepancy with non-invasive methods could finally lead to underdiagnosis in almost two-thirds of non-intubated patients. Delayed diagnostic could explain in part the 2-fold increase in mortality of penumonia when invasive ventilation is initiated. Here we discuss the rationale underlying this new classification.Many situations can lead to misdiagnosis, even more when the invasive mechanical ventilation is initiated. The chest radiography lacks sntivity and specificity for diagnosing pneumonia. The place of chest computed tomography and lung ultrasonography for routine diagnostic of new plumonary infiltrate remain to be evaluated.Microbiological methods used to confirm the diagnostic can be heterogeneous. The development of molecular diagnostic tools may improve the adequacy of antimicrobial therapies of ventilated patients with pneumonia, but we need to further assess its impact in non-ventilated pneumonia.In this review we introduce distinction between hospital-acquired pneumonia according to the localization in the hospital and the oxygenation/ventilation mode. A clarification of definition is the first step to develop more accurate diagnostic strategies and to improve the patients' prognosis.

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Cusack R, Garduno A, Elkholy K, Martín-Loeches I. Novel investigational treatments for ventilator-associated pneumonia and critically ill patients in the intensive care unit. Expert Opin Investig Drugs 2022;31:173-192. [PMID: 35040388 DOI: 10.1080/13543784.2022.2030312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]

Rouzé A, Nseir S. Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia and Ventilator-Associated Tracheobronchitis in COVID-19. Semin Respir Crit Care Med 2022;43:243-247. [PMID: 35042264 DOI: 10.1055/s-0041-1740334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]

Ershova K, Savin I, Khomenko O, Wong D, Danilov G, Shifrin M, Sokolova E, O'Reilly-Shah VN, Lele AV, Ershova O. The incidence and outcomes of healthcare-associated respiratory tract infections in non-ventilated neurocritical care patients: Results of a 10-year cohort study. J Clin Neurosci 2022;97:32-41. [PMID: 35033779 DOI: 10.1016/j.jocn.2021.12.035] [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: 08/24/2021] [Revised: 11/25/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022]

Li Q, Tong Y, Wang H, Ren J, Liu S, Liu T, Qu K, Liu C, Zhang J. Origin of Sepsis Associated with the Short-Term Mortality of Patients: A Retrospective Study Using the eICU Collaborative Research Database. Int J Gen Med 2022;14:10293-10301. [PMID: 34992444 PMCID: PMC8714464 DOI: 10.2147/ijgm.s345050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open

Study of risk factors for healthcare-associated infections in acute cardiac patients using categorical principal component analysis (CATPCA). Sci Rep 2022;12:28. [PMID: 34996993 PMCID: PMC8742031 DOI: 10.1038/s41598-021-03970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open

Wang Q, Liu Y, Fu Y, Liu C, Li J, Dang H. Analysis of predictors of mortality and clinical outcomes of different subphenotypes for moderate-to-severe pediatric acute respiratory distress syndrome: A prospective single-center study. Front Pediatr 2022;10:1019314. [PMID: 36389387 PMCID: PMC9665116 DOI: 10.3389/fped.2022.1019314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open

Abstract

BACKGROUND

This study aimed to observe the prognosis of patients with moderate-to-severe pediatric acute respiratory distress syndrome (PARDS) admitted to the Pediatric Intensive Care Unit (PICU) as a function of underlying conditions and available treatment strategies, and to investigate the risk factors for death and the outcomes of different clinical subphenotypes.

METHODS

Patients were divided into non-survivors and survivors according to the prognosis 28 days after the diagnosis. The risk factors for death and the predictive value of relevant factors for mortality were analyzed. Latent class analysis was used to identify different clinical subphenotypes.

RESULTS

A total of 213 patients with moderate-to-severe PARDS were enrolled, of which 98 (46.0%) died. Higher PELOD2 scores (OR = 1.082, 95% CI 1.004-1.166, p < 0.05), greater organ failure (OR = 1.617, 95% CI 1.130-2.313, p < 0.05), sepsis (OR = 4.234, 95% CI 1.773-10.111, p < 0.05), any comorbidity (OR = 3.437, 95% CI 1.489-7.936, p < 0.05), and higher infiltration area grade (IAG) (OR = 1.980, 95% CI 1.028-3.813, p < 0.05) were associated with higher mortality. The combination of these five indicators had the largest area under the curve (sensitivity 89.79%, specificity 94.78%). Patients were classified into higher-risk and lower-risk phenotype group according to the latent class analysis. Compared to the lower-risk phenotype, more patients with higher-risk phenotype suffered from sepsis (24.40% vs. 12.20%, p < 0.05), inherited metabolic diseases (45.80% vs. 25.60%, p < 0.05), positive respiratory pathogens (48.10% vs. 26.80%, p < 0.05), and higher IAG (p < 0.05); they also had significantly higher PIM3 and PELOD2 scores (p < 0.05), with an extremely high mortality rate (61.1% vs. 22.0%, p < 0.05).

CONCLUSIONS

Moderate-to-severe PARDS has high morbidity and mortality in PICU; a higher PELOD2 score, greater organ failure, sepsis, any comorbidity, and higher IAG were risk factors for death, and the combination of these five indicators had the greatest value in predicting prognosis. More patients with sepsis, positive respiratory pathogens, higher PIM3 and PELOD2 scores, and higher IAG were in higher-risk phenotype group, which had worse outcomes. Clear classification facilitates targeted treatment and prognosis determination.

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Affiliation(s)

Qingyue Wang Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
Yanling Liu Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
Yueqiang Fu Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
Chengjun Liu Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
Jing Li Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
Hongxing Dang Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China

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Estella Á, Vidal-Cortés P, Rodríguez A, Andaluz Ojeda D, Martín-Loeches I, Díaz E, Suberviola B, Gracia Arnillas MP, Catalán González M, Álvarez-Lerma F, Ramírez P, Nuvials X, Borges M, Zaragoza R. [Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU]. Med Intensiva 2021;45:485-500. [PMID: 33994616 PMCID: PMC8086823 DOI: 10.1016/j.medin.2021.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 12/29/2022]

Povoa P, Martin-Loeches I, Nseir S. Secondary pneumonias in critically ill patients with COVID-19: risk factors and outcomes. Curr Opin Crit Care 2021;27:468-473. [PMID: 34321415 PMCID: PMC8452245 DOI: 10.1097/mcc.0000000000000860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]

Póvoa P, Coelho L. Which Biomarkers Can Be Used as Diagnostic Tools for Infection in Suspected Sepsis? Semin Respir Crit Care Med 2021;42:662-671. [PMID: 34544183 DOI: 10.1055/s-0041-1735148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

Abstract

The diagnosis of infection in patients with suspected sepsis is frequently difficult to achieve with a reasonable degree of certainty. Currently, the diagnosis of infection still relies on a combination of systemic manifestations, manifestations of organ dysfunction, and microbiological documentation. In addition, the microbiologic confirmation of infection is obtained only after 2 to 3 days of empiric antibiotic therapy. These criteria are far from perfect being at least in part responsible for the overuse and misuse of antibiotics, in the community and in hospital, and probably the main drive for antibiotic resistance. Biomarkers have been studied and used in several clinical settings as surrogate markers of infection to improve their diagnostic accuracy as well as in the assessment of response to antibiotics and in antibiotic stewardship programs. The aim of this review is to provide a clear overview of the current evidence of usefulness of biomarkers in several clinical scenarios, namely, to diagnose infection to prescribe antibiotics, to exclude infection to withhold antibiotics, and to identify the causative pathogen to target antimicrobial treatment. In recent years, new evidence with "old" biomarkers, like C-reactive protein and procalcitonin, as well as new biomarkers and molecular tests, as breathomics or bacterial DNA identification by polymerase chain reaction, increased markedly in different areas adding useful information for clinical decision making at the bedside when adequately used. The recent evidence shows that the information given by biomarkers can support the suspicion of infection and pathogen identification but also, and not less important, can exclude its diagnosis. Although the ideal biomarker has not yet been found, there are various promising biomarkers that represent true evolutions in the diagnosis of infection in patients with suspected sepsis.

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Estella Á, Vidal-Cortés P, Rodríguez A, Andaluz Ojeda D, Martín-Loeches I, Díaz E, Suberviola B, Gracia Arnillas MP, Catalán González M, Álvarez-Lerma F, Ramírez P, Nuvials X, Borges M, Zaragoza R. Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU. Med Intensiva 2021;45:485-500. [PMID: 34475008 PMCID: PMC8382590 DOI: 10.1016/j.medine.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/17/2021] [Indexed: 12/29/2022]

Effect of 0.12% Chlorhexidine Use for Oral Care on Ventilator-Associated Respiratory Infections: A Randomized Controlled Trial. J Trauma Nurs 2021;28:228-234. [PMID: 34210941 DOI: 10.1097/jtn.0000000000000590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Andrade TR, Salluh JIF, Garcia R, Farah D, Silva PSLD, Bastos DF, Fonseca MCM. A cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit. Rev Bras Ter Intensiva 2021;33:428-433. [PMID: 35107554 PMCID: PMC8555397 DOI: 10.5935/0103-507x.20210068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open

van Oort PM, Nijsen TM, White IR, Knobel HH, Felton T, Rattray N, Lawal O, Bulut M, Ahmed W, Artigas A, Povoa PR, Martin-Loeches I, Weda H, Goodacre R, Schultz MJ, Dark PM, Fowler SJ, Bos LD. Untargeted Molecular Analysis of Exhaled Breath as a Diagnostic Test for Ventilator-Associated Lower Respiratory Tract Infections (BreathDx). Thorax 2021;77:79-81. [PMID: 34088787 PMCID: PMC8685633 DOI: 10.1136/thoraxjnl-2021-217362] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]

Affiliation(s)

Pouline Mp van Oort Intensive Care, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
Tamara M Nijsen Philips Research, Eindhoven, The Netherlands
Iain R White Laboratory for Environmental and Life Sciences, University of Nova Gorica, Nova Gorica, Slovenia.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
Hugo H Knobel Materials Analysis, Eurofins Materials Science Netherlands BV, Eindhoven, The Netherlands
Timothy Felton Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
Nicholas Rattray Department of Pharmacy, University of Strathclyde, Glasgow, UK
Oluwasola Lawal Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
Murtaza Bulut Philips Research, Eindhoven, The Netherlands
Waqar Ahmed Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
Antonio Artigas Critical Care Centre, Corporació Sanitària I Universitaria Parc Taulí-Hospital De Sabadell-Ciber Enfermedades Respiratorias, Sabadell, Barcelona, Spain
Pedro R Povoa Intensive Care, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Ignacio Martin-Loeches Department of Clinical Medicine, University of Dublin Trinity College, Dublin, Ireland
Hans Weda Orikami, Nijmegen, The Netherlands
Royston Goodacre Department of Biochemistry, University of Liverpool, Liverpool, UK
Marcus J Schultz Intensive Care, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
Paul M Dark Intensive care, University of Manchester, Manchester, UK
Stephen J Fowler Manchester University NHS Foundation Trust - Wythenshawe Hospital, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, NIHR's Manchester Biomedical Research Centre (BRC), the University of Manchester, Manchester, UK
Lieuwe D Bos Intensive Care, Amsterdam UMC Location AMC, Amsterdam, The Netherlands .,Respiratory Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands

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Nseir S, Martin-Loeches I, Povoa P, Metzelard M, Du Cheyron D, Lambiotte F, Tamion F, Labruyere M, Makris D, Boulle Geronimi C, Pinetonde Chambrun M, Nyunga M, Pouly O, Mégarbane B, Saade A, Gomà G, Magira E, Llitjos JF, Torres A, Ioannidou I, Pierre A, Coelho L, Reignier J, Garot D, Kreitmann L, Baudel JL, Voiriot G, Contou D, Beurton A, Asfar P, Boyer A, Thille AW, Mekontso-Dessap A, Tsolaki V, Vinsonneau C, Floch PE, Le Guennec L, Ceccato A, Artigas A, Bouchereau M, Labreuche J, Duhamel A, Rouzé A. Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021;25:177. [PMID: 34034777 PMCID: PMC8146175 DOI: 10.1186/s13054-021-03588-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022]

Abstract

Background

Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients.

Methods

Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event.

Findings

Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11–2.46), p = 0.013), but not in influenza (1.74 (0.99–3.06), p = 0.052), or no viral infection groups (1.13 (0.68–1.86), p = 0.63). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups.

Interpretation

VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality.

Clinical trial registration

The study was registered at ClinicalTrials.gov, number NCT04359693.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-021-03588-4.

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Affiliation(s)

Saad Nseir Médecine Intensive-Réanimation, CHU de Lille, F-59000, Lille, France. .,Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, Lille, France.
Ignacio Martin-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St. James Street, Dublin 8, Dublin, Eire, Ireland.,Hospital Clinic, IDIBAPS, Universided de Barcelona, CIBERes, Barcelona, Spain
Pedro Povoa Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
Matthieu Metzelard Medical ICU, Amiens University Hospital, Amiens, France
Damien Du Cheyron Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
Fabien Lambiotte Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
Fabienne Tamion Medical Intensive Care Unit, Rouen University Hospital, Normandie Université, UNIROUEN, Inserm U1096, FHU-REMOD-VHF, 76000, Rouen, France
Marie Labruyere Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
Demosthenes Makris Intensive Care Unit, University Hospital of Larissa, University of Thessaly, 41110, Biopolis Larissa, Greece
Claire Boulle Geronimi Service de Réanimation Et de Soins Intensifs, Centre Hospitalier de Douai, Route de Cambrai, Douai, France
Marc Pinetonde Chambrun Service de Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
Martine Nyunga ICU, Roubaix Hospital, Roubaix, France
Olivier Pouly Médecine Intensive Réanimation, Hôpital Saint Philibert GHICL, Université Catholique, Lille, France
Bruno Mégarbane Réanimation Médicale Et Toxicologique, Hôpital Lariboisière, Université de Paris, INSERM UMRS-1144, Paris, France
Anastasia Saade Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
Gemma Gomà Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
Eleni Magira 1St Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos Hospital, Athens, Greece
Jean-François Llitjos Medical Intensive Care Unit, Cochin Hospital, AP-HP. Centre, Université de Paris, Paris, France
Antoni Torres Department of Pulmonology, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERES, ICREA, Barcelona, Spain
Iliana Ioannidou 1St Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, "Sotiria" Chest Hospital, Athens, Greece
Alexandre Pierre Réanimation Polyvalente, CH Lens, Lens, France
Luis Coelho Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
Jean Reignier Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
Denis Garot Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau, 2 Bd Tonnellé, 37000, Tours, France
Louis Kreitmann Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5, place d'Arsonval, 69437, Lyon Cedex 03, France
Jean-Luc Baudel Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
Guillaume Voiriot Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
Damien Contou Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France
Alexandra Beurton Service de Pneumologie, Médecine Intensive - Réanimation (Département "R3S"), AP-HP, Sorbonne Université, Groupe Hospitalier Universitaire Pitié-Salpêtrière Charles Foix, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France
Pierre Asfar Département de Médecine Intensive-Réanimation, CHU D'Angers, Université D'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
Alexandre Boyer Intensive Care Unit, Pellegrin-Tripode Hospital, University Hospital of Bordeaux, Bordeaux, France
Arnaud W Thille CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers, Poitiers, France
Armand Mekontso-Dessap APHP, CHU Henri Mondor, Service de Médecine Intensive RéanimationUniversité Paris Est-Créteil, Faculté de Santé, Groupe de Recherche Clinique CARMASINSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
Vassiliki Tsolaki Intensive Care Unit, University Hospital of Larissa, University of Thessaly, 41110, Biopolis Larissa, Greece
Christophe Vinsonneau Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Réseau de Recherche Boréal, 62408, Béthune, France
Pierre-Edouard Floch Service de Réanimation, Hôpital Duchenne, Rue Monod, 62200, Boulogne-sur-Mer, France
Loïc Le Guennec Sorbonne Université, AP-HP, Hôpital de La Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Paris, France
Adrian Ceccato Intensive Care Unit, Hospital Universitari Sagrat Cor, and Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028)-Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
Antonio Artigas Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Parc Tauli 1, 08028, Sabadell, Spain
Mathilde Bouchereau Médecine Intensive-Réanimation, CHU de Lille, F-59000, Lille, France
Julien Labreuche Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
Alain Duhamel Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
Anahita Rouzé Médecine Intensive-Réanimation, CHU de Lille, F-59000, Lille, France.,Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, Lille, France

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Migiyama Y, Sakata S, Iyama S, Tokunaga K, Saruwatari K, Tomita Y, Saeki S, Okamoto S, Ichiyasu H, Sakagami T. Airway Pseudomonas aeruginosa density in mechanically ventilated patients: clinical impact and relation to therapeutic efficacy of antibiotics. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021;25:59. [PMID: 33573691 PMCID: PMC7876981 DOI: 10.1186/s13054-021-03488-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/04/2021] [Indexed: 01/31/2023]

Abstract

Background

The bacterial density of Pseudomonas aeruginosa is closely related to its pathogenicity. We evaluated the effect of airway P. aeruginosa density on the clinical course of mechanically ventilated patients and the therapeutic efficacy of antibiotics.

Methods

We retrospectively analyzed data of mechanically ventilated ICU patients with P. aeruginosa isolated from endotracheal aspirates. Patients were divided into three groups according to the peak P. aeruginosa density during ICU stay: low (≤ 10⁴ cfu/mL), moderate (10⁵‒10⁶ cfu/mL), and high (≥ 10⁷ cfu/mL) peak density groups. The relationship between peak P. aeruginosa density and weaning from mechanical ventilation, risk factors for isolation of high peak density of P. aeruginosa, and antibiotic efficacy were investigated using multivariate and propensity score-matched analyses.

Results

Four-hundred-and-sixty-one patients were enrolled. Patients with high peak density of P. aeruginosa had higher inflammation and developed more severe respiratory infections. High peak density of P. aeruginosa was independently associated with few ventilator-free days on day 28 (P < 0.01) and increased ICU mortality (P = 0.047). Risk factors for high peak density of P. aeruginosa were prolonged mechanical ventilation (odd ratio [OR] 3.07 95% confidence interval [CI] 1.35‒6.97), non-antipseudomonal cephalosporins (OR 2.17, 95% CI 1.35‒3.49), hyperglycemia (OR 2.01, 95% CI 1.26‒3.22) during ICU stay, and respiratory diseases (OR 1.9, 95% CI 1.12‒3.23). Isolation of commensal colonizer was associated with lower risks of high peak density of P. aeruginosa (OR 0.43, 95% CI 0.26‒0.73). Propensity score-matched analysis revealed that antibiotic therapy for patients with ventilator-associated tracheobronchitis improved weaning from mechanical ventilation only in the high peak P. aeruginosa group.

Conclusions

Patients with high peak density of P. aeruginosa had worse ventilator outcome and ICU mortality. In patients with ventilator-associated tracheobronchitis, antibiotic therapy was associated with favorable ventilator weaning only in the high peak P. aeruginosa density group, and bacterial density could be a good therapeutic indicator for ventilator-associated tracheobronchitis due to P. aeruginosa.

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Nseir S, Le Gouge A, Pouly O, Lascarrou JB, Lacherade JC, Mira JP, Mercier E, Declercq PL, Sirodot M, Piton G, Tinturier F, Coupez E, Gaudry S, Djibré M, Thevenin D, Balduyck M, Reignier J. Relationship Between Obesity and Ventilator-Associated Pneumonia: A Post Hoc Analysis of the NUTRIREA2 Trial. Chest 2021;159:2309-2317. [PMID: 33561455 DOI: 10.1016/j.chest.2021.01.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/05/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open

Abstract

BACKGROUND

Patients with obesity are at higher risk for community-acquired and nosocomial infections. However, no study has specifically evaluated the relationship between obesity and ventilator-associated pneumonia (VAP).

RESEARCH QUESTION

Is obesity associated with an increased incidence of VAP?

STUDY DESIGN AND METHODS

This study was a post hoc analysis of the Impact of Early Enteral vs Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA2) open-label, randomized controlled trial performed in 44 French ICUs. Adults receiving invasive mechanical ventilation and vasopressor support for shock and parenteral nutrition or enteral nutrition were included. Obesity was defined as BMI ≥ 30 kg/m² at ICU admission. VAP diagnosis was adjudicated by an independent blinded committee, based on all available clinical, radiologic, and microbiologic data. Only first VAP episodes were taken into account. Incidence of VAP was analyzed by using the Fine and Gray model, with extubation and death as competing risks.

RESULTS

A total of 699 (30%) of the 2,325 included patients had obesity; 224 first VAP episodes were diagnosed (60 and 164 in obese and nonobese groups, respectively). The incidence of VAP at day 28 was 8.6% vs 10.1% in the two groups (hazard ratio, 0.85; 95% CI 0.63-1.14; P = .26). After adjustment on sex, McCabe score, age, antiulcer treatment, and Sequential Organ Failure Assessment at randomization, the incidence of VAP remained nonsignificant between obese and nonobese patients (hazard ratio, 0.893; 95% CI, 0.66-1.2; P = .46). Although no significant difference was found in duration of mechanical ventilation and ICU length of stay, 90-day mortality was significantly lower in obese than in nonobese patients (272 of 692 [39.3%] patients vs 718 of 1,605 [44.7%]; P = .02). In a subgroup of patients (n = 123) with available pepsin and alpha-amylase measurements, no significant difference was found in rate of abundant microaspiration of gastric contents, or oropharyngeal secretions between obese and nonobese patients.

INTERPRETATION

Our results suggest that obesity has no significant impact on the incidence of VAP.

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Affiliation(s)

Saad Nseir Médecine Intensive-Réanimation, CHU Lille, Lille, France; Inserm U1285, Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France.
Amélie Le Gouge Inserm CIC 1415, CHU Tours, Tours, France
Olivier Pouly Médecine Intensive-Réanimation, CHU Lille, Lille, France
Jean-Baptiste Lascarrou Medecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes, France
Jean-Claude Lacherade Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche-sur-Yon, France
Jean-Paul Mira Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
Emmanuelle Mercier Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, Tours, France
Pierre-Louis Declercq Médecine Intensive Réanimation, Hôpital de Dieppe, Dieppe, France
Michel Sirodot Medical-Surgical Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
Gaël Piton Medical Intensive Care Unit, CHRU Besançon, Besançon, France; EA3920, Université de Franche Comté, Besançon, France
François Tinturier Surgical Intensive Care Unit, CHU Amiens Picardie, Amiens, France
Elisabeth Coupez Intensive Care Unit, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
Stéphane Gaudry Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France; INSERM, UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Paris, Paris, France
Michel Djibré Service de Médecine intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
Didier Thevenin Medical-Surgical Intensive Care Unit, Centre Hospitalier Docteur Schaffner, Lens, France
Malika Balduyck Centre de Biologie Pathologie, CHU Lille, Lille, France
Jean Reignier Medecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes, France

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Gaudet A, Devos M, Keignart S, Pouly O, Lecailtel S, Wallet F, Nseir S. Usefulness of Sepsis-3 in diagnosing and predicting mortality of ventilator-associated lower respiratory tract infections. PLoS One 2021;16:e0245552. [PMID: 33444395 PMCID: PMC7808583 DOI: 10.1371/journal.pone.0245552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/30/2020] [Indexed: 12/16/2022] Open