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Huang F, Shen T, Hai X, Xiu H, Zhang K, Huang T, Chen J, Guan Z, Zhou H, Cai J, Cai Z, Cui W, Zhang S, Zhang G. Clinical characteristics of and risk factors for secondary bloodstream infection after pneumonia among patients infected with methicillin-resistant Staphylococcus aureus. Heliyon 2022; 8:e11978. [PMID: 36506352 PMCID: PMC9732304 DOI: 10.1016/j.heliyon.2022.e11978] [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: 06/15/2022] [Revised: 10/29/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To investigate the clinical features and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia (MP) with secondary MRSA bloodstream infections (MRSA-BSI) (termed MP-BSI) compared with MP alone and to study the incidence of MP-BSI among patients with MP. Methods This was a retrospective, single-center study with clinical data derived from previous medical records. The cases were divided into groups: MP alone and MP-BSI. The determination of independent risk factors for MP-BSI relied on logistic regression analysis. Additionally, the crude outcomes were compared. Results A total of 435 patients with MP were recruited, with 18.9% (82/435) having MP-BSI. The median age was 62 (interquartile range, 51,72) years, and 74.5% of the patients were male. Multivariate analysis revealed that immunosuppression, community-acquired MP (CA-MP), time from initial to targeted antibiotic use, high Sequential Organ Failure Assessment (SOFA) score, increased respiratory rate, and elevated γ-GT level (all p < 0.05) were independent risk factors for MP-BSI, while targeted treatment with linezolid was a protective factor. Patients with MP-BSI had a longer duration of hospitalization (median days, 27.5 vs. 19, p = 0.001), a higher 28-day mortality rate (24.4% vs. 11.0%, p = 0.001), and a higher in-hospital mortality rate (26.8% vs. 14.7%, p = 0.009) than those with MP alone. Conclusion Secondary MRSA-BSI among patients with MP is not rare. Immunosuppression, CA-MP, time from initial to targeted antibiotic use, high SOFA score, increased respiratory rate and elevated γ-GT level are all independent risk factors for MP-BSI; however, linezolid, as a targeted antibiotic, is a protective factor. Moreover, patients with MP may have worse clinical outcomes when they develop MRSA-BSI.
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Affiliation(s)
- Fangfang Huang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China,Department of Critical Care Medicine, Yuyao People's Hospital, Yuyao 315400, China
| | - Ting Shen
- Department of Critical Care Medicine, Yuyao People's Hospital, Yuyao 315400, China
| | - Xin Hai
- Department of Pharmacy, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China
| | - Huiqing Xiu
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Tiancha Huang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Juan Chen
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China,Department of Intensive Care Unit, Ningbo Fourth Hospital Ningbo, Zhejiang 315700, China
| | - Zhihui Guan
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China,Department of Critical Care Medicine, Taizhou First People's Hospital, Taizhou 318020, China
| | - Hongwei Zhou
- Clinical Microbiology Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jiachang Cai
- Clinical Microbiology Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Zhijian Cai
- Institute of Immunology, and Department of Orthopaedics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wei Cui
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China,Corresponding author.
| | - Shufang Zhang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China,Corresponding author.
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China,Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, China,Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, China,Corresponding author.
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Watson K, Reoch J, Heales LJ, Fernando J, Tan E, Smith K, Austin D, Divanoglou A. The incidence and characteristics of ventilator-associated pneumonia in a regional nontertiary Australian intensive care unit: A retrospective clinical audit study. Aust Crit Care 2021; 35:294-301. [PMID: 34144862 DOI: 10.1016/j.aucc.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation in the intensive care unit. The incidence, patient characteristics, and outcomes have not been described in a regional Australian setting. OBJECTIVES Τhe primary objective was to establish the incidence of VAP in a regional intensive care unit using predetermined diagnostic criteria. The secondary objective was to compare the agreement between criteria-based and physician-based diagnostic processes. The tertiary objectives were to compare patient characteristics and clinical outcomes of cases with and without VAP. METHODS A retrospective clinical audit was performed of adult patients admitted to Rockhampton Intensive Care Unit, Australia, between 2013 and 2016. We included all patients ventilated for ≥72 h and not diagnosed with a pneumonia before or during the first 72 h of ventilation. RESULTS A total of 170 cases met the inclusion criteria. The incidence of VAP as per the criteria-based diagnosis was 27.3 cases per 1000 ventilator days (95% confidence interval [CI]: 18.4-36.2) and as per the physician-based diagnosis was 25.8 cases per 1000 ventilator days (95% CI: 17.1-34.4). There was a moderate chance-corrected agreement between the criteria- and physician-based diagnosis. Very obese cases (body mass index [BMI] ≥40) were nearly four times more likely to develop VAP than cases with normal BMI (BMI <30) (odds ratio: 3.664; 95% CI: 1.394-9.634; p = 0.008). After controlling for sex, BMI category, comorbidities, and Acute Physiology and Chronic Health Evaluation II scores, there was a trend (p = 0.283) for higher adjusted mortality rate for cases with VAP (10.1%, 95% CI: 4.8-21.5) than for those without VAP (6.1%, 95% CI: 3.0-12.4). Cases with VAP had a higher total hospital cost ($123,223 AUD vs $66,425 AUD, p < 0.001), than cases without VAP. CONCLUSIONS This is the first study reporting incidence of VAP in an Australian regional intensive care unit setting. An increased length of stay and significantly higher hospital costs warrant research investigating reliable and valid clinical prediction rules to forecast those at risk of VAP.
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Affiliation(s)
- Kirsty Watson
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia; Allied Health, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - Josephine Reoch
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - Luke J Heales
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.
| | - Jeremy Fernando
- Rural Clinical School, Rockhampton, University of Queensland, Australia.
| | - Elise Tan
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - Karen Smith
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - David Austin
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - Anestis Divanoglou
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Park C, Na SJ, Chung CR, Cho YH, Suh GY, Jeon K. Community versus hospital-acquired pneumonia in patients requiring extracorporeal membrane oxygenation. Ther Adv Respir Dis 2019; 13:1753466618821038. [PMID: 30803350 PMCID: PMC6327342 DOI: 10.1177/1753466618821038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Bacterial pneumonia is a major cause of acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) support. However, it is unknown whether the type of pneumonia, community-acquired pneumonia (CAP) versus hospital-acquired pneumonia (HAP), should be considered when predicting outcomes for ARDS patients treated with ECMO. Methods: We divided a sample of adult patients receiving ECMO for acute respiratory distress syndrome caused by bacterial pneumonia between January 2012 and December 2016 into CAP (n = 21) and HAP (n = 35) groups and compared clinical and bacteriological characteristics and outcomes. Results: The median acute physiology and chronic health evaluation II and sequential organ failure assessment scores were 22 and 8, respectively, in the CAP and HAP groups. The most commonly identified organism in the CAP group was Streptococcus pneumonia (n = 12, 57.1%), while Acinectobacter baumanii was the most commonly identified in the HAP group (n = 13, 37.1%). However, the incidence of multidrug resistant bacteria was not different between groups (57.1% versus 74.3%, p = 0.125). Of the 56 patients in the study, 26 were successfully weaned from ECMO, and 20 were discharged from the hospital. There were no significant differences in ECMO weaning rate (47.6% versus 45.7%, p > 0.999) or survival to discharge rate (33.3% versus 37.1%, p > 0.999) between the two groups. The 30-day and 90-day mortality rates were also similar. Conclusion: Patients with CAP and HAP who received ECMO for respiratory support had similar characteristics and clinical outcomes.
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Affiliation(s)
- Chul Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Xu Y, Lai C, Xu G, Meng W, Zhang J, Hou H, Pi H. Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation. Clin Interv Aging 2019; 14:1027-1038. [PMID: 31289438 PMCID: PMC6566835 DOI: 10.2147/cia.s197146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/26/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose: The aim of this study was to verify the potential risk factors of ventilator-associated pneumonia (VAP) in elderly Chinese patients receiving mechanical ventilation (MV). The secondary aim of this study was to present logistical regression prediction models of VAP occurrence in elderly Chinese patients receiving MV. Methods: Patients (aged 80 years or above) receiving MV for ≥48 h were enrolled from the Chinese People's Liberation Army (PLA) General Hospital from January 2011 to December 2015. A chi-squared test and Mann-Whitney U-test were used to compare the data between participants with VAP and without VAP. Univariate logistic regression models were performed to explore the relationship between risk factors and VAP. Results: A total of 901 patients were included in the study, of which 156 were diagnosed as VAP (17.3%). The incidence density of VAP was 4.25/1,000 ventilator days. Logistic regression analysis showed that the independent risk factors for elderly patients with VAP were COPD (OR =1.526, P < 0.05), intensive care unit (ICU) admission (OR=1.947, P < 0.01), the MV methods (P < 0.023), the number of antibiotics administered (OR=4.947, P < 0.01), the number of central venous catheters (OR=1.809, P < 0.05), the duration of indwelling urinary catheter (OR=1.805, P < 0.01) and the use of corticosteroids prior to MV (OR=1.618, P < 0.05). Logistic regression prediction model of VAP occurrence in the Chinese elderly patients with mechanical ventilation:L o g i t P = - 6 . 468 + 0 . 423 X 1 + 0 . 666 X 2 + 0 . 871 X 3 + - 0 . 501 X 5 + 0 . 122 X 6 + 0 . 593 X 7 + 0 . 590 X 8 + 1 . 599 X 9 . Conclusion: VAP occurrence is associated with a variety of controllable factors including the MV methods and the number of antibiotics administered. A model was established to predict VAP occurrence so that high-risk patients could be identified as early as possible.
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Affiliation(s)
- Yue Xu
- Department of Nursing, Chinese People’s Liberation Army (PLA) General Hospital, Chinese PLA Medical Academy, Beijing, People’s Republic of China
| | - Chunyun Lai
- Department of Respiratory, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Guogang Xu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Wenwen Meng
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jie Zhang
- Department of Nursing, Chinese People’s Liberation Army (PLA) General Hospital, Chinese PLA Medical Academy, Beijing, People’s Republic of China
| | - Huiru Hou
- Department of Nursing, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Hongying Pi
- Department of Nursing, Chinese People’s Liberation Army (PLA) General Hospital, Chinese PLA Medical Academy, Beijing, People’s Republic of China
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5
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van Vught LA, Scicluna BP, Wiewel MA, Hoogendijk AJ, Klein Klouwenberg PMC, Franitza M, Toliat MR, Nürnberg P, Cremer OL, Horn J, Schultz MJ, Bonten MMJ, van der Poll T. Comparative Analysis of the Host Response to Community-acquired and Hospital-acquired Pneumonia in Critically Ill Patients. Am J Respir Crit Care Med 2017; 194:1366-1374. [PMID: 27267747 DOI: 10.1164/rccm.201602-0368oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Preclinical studies suggest that hospitalized patients are susceptible to infections caused by nosocomial respiratory pathogens at least in part because of immune suppression caused by the condition for which they were admitted. OBJECTIVES We aimed to characterize the systemic host response in hospital-acquired pneumonia (HAP) when compared with community-acquired pneumonia (CAP). METHODS We performed a prospective study in two intensive care units (ICUs) in 453 patients with HAP (n = 222) or CAP (n = 231). Immune responses were determined on ICU admission by measuring 19 plasma biomarkers reflecting organ systems implicated in infection pathogenesis (in 192 patients with HAP and 183 patients with CAP) and by applying genome-wide blood gene expression profiling (in 111 patients with HAP and 110 patients with CAP). MEASUREMENTS AND MAIN RESULTS Patients with HAP and CAP presented with similar disease severities and mortality rates did not differ up to 1 year after admission. Plasma proteome analysis revealed largely similar responses, including systemic inflammatory and cytokine responses, and activation of coagulation and the vascular endothelium. The blood leukocyte genomic response was greater than 75% common in patients with HAP and CAP, comprising proinflammatory, antiinflammatory, T-cell signaling, and metabolic pathway gene sets. Patients with HAP showed overexpression of genes involved in cell-cell junction remodeling, adhesion, and diapedesis, which corresponded with lower plasma levels of matrix metalloproteinase-8 and soluble E-selectin. In addition, patients with HAP demonstrated underexpression of a type-I interferon signaling gene signature. CONCLUSIONS Patients with HAP and CAP present with a largely similar host response at ICU admission.
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Affiliation(s)
- Lonneke A van Vught
- 1 Center for Experimental and Molecular Medicine.,2 Center for Infection and Immunity
| | - Brendon P Scicluna
- 1 Center for Experimental and Molecular Medicine.,2 Center for Infection and Immunity
| | - Maryse A Wiewel
- 1 Center for Experimental and Molecular Medicine.,2 Center for Infection and Immunity
| | - Arie J Hoogendijk
- 1 Center for Experimental and Molecular Medicine.,2 Center for Infection and Immunity
| | - Peter M C Klein Klouwenberg
- 3 Department of Intensive Care Medicine.,4 Department of Medical Microbiology, and.,5 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and
| | - Marek Franitza
- 6 Cologne Center for Genomics.,7 Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, and
| | | | - Peter Nürnberg
- 6 Cologne Center for Genomics.,7 Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, and.,8 Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | | | | | | | | | - Tom van der Poll
- 1 Center for Experimental and Molecular Medicine.,2 Center for Infection and Immunity.,10 Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Elliott D, Elliott R, Burrell A, Harrigan P, Murgo M, Rolls K, Sibbritt D. Incidence of ventilator-associated pneumonia in Australasian intensive care units: use of a consensus-developed clinical surveillance checklist in a multisite prospective audit. BMJ Open 2015; 5:e008924. [PMID: 26515685 PMCID: PMC4636654 DOI: 10.1136/bmjopen-2015-008924] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/24/2015] [Accepted: 09/18/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES With disagreements on diagnostic criteria for ventilator-associated pneumonia (VAP) hampering efforts to monitor incidence and implement preventative strategies, the study objectives were to develop a checklist for clinical surveillance of VAP, and conduct an audit in Australian/New Zealand intensive care units (ICUs) using the checklist. SETTING Online survey software was used for checklist development. The prospective audit using the checklist was conducted in 10 ICUs in Australia and New Zealand. PARTICIPANTS Checklist development was conducted with members of a bi-national professional society for critical care physicians using a modified Delphi technique and survey. A 30-day audit of adult patients mechanically ventilated for >72 h. PRIMARY AND SECONDARY OUTCOME MEASURES Presence of items on the screening checklist; physician diagnosis of VAP, clinical characteristics, investigations, treatments and patient outcome. RESULTS A VAP checklist was developed with five items: decreasing gas exchange, sputum changes, chest X-ray infiltrates, inflammatory response, microbial growth. Of the 169 participants, 17% (n=29) demonstrated characteristics of VAP using the checklist. A similar proportion had an independent physician diagnosis (n=30), but in a different patient subset (only 17% of cases were identified by both methods). The VAP rate per 1000 mechanical ventilator days for the checklist and clinician diagnosis was 25.9 and 26.7, respectively. The item 'inflammatory response' was most associated with the first episode of physician-diagnosed VAP. CONCLUSIONS VAP rates using the checklist and physician diagnosis were similar to ranges reported internationally and in Australia. Of note, different patients were identified with VAP by the checklist and physicians. While the checklist items may assist in identifying patients at risk of developing VAP, and demonstrates synergy with the recently developed Centers for Disease Control (CDC) guidelines, decision-making processes by physicians when diagnosing VAP requires further exploration.
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Affiliation(s)
- Doug Elliott
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Anthony Burrell
- NSW Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Peter Harrigan
- Department of Intensive Care, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Margherita Murgo
- NSW Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Kaye Rolls
- Intensive Care Coordinating and Monitoring Unit, Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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7
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Fekih Hassen M, Ben Haj Khalifa A, Tilouche N, Ben Sik Ali H, Ayed S, Kheder M, Elatrous S. [Severe community-acquired pneumonia admitted at the intensive care unit: main clinical and bacteriological features and prognostic factors: a Tunisian experience]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:253-259. [PMID: 24874404 DOI: 10.1016/j.pneumo.2014.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 03/11/2014] [Accepted: 03/15/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Severe community-acquired pneumonia (SCAP) remains a major cause of death. The aim of this study was to describe the main clinical and bacteriological features and to determine predictive factors for death in patients with SCAP who were admitted in intensive care unit (ICU) in a Tunisian setting. METHOD It is a retrospective study conducted between March 2005 and December 2010 at the intensive care unit of the University Hospital of Mahdia (Tunisia). All patients hospitalized at the ICU with a SCAP diagnosis according to the American Thoracic Society criteria were included. RESULTS Two hundred and nine patients (mean age: 64±16 years, and mean SAPS II: 42±17) were included. Overall, 24% had a bacteriological diagnosis. Streptococcus pneumoniae was the most frequently detected. Use of mechanical ventilation was required in 57% of patients and 45% experimented septic shock upon admission. The mortality rate at ICU was 29% (n=60). In multivariate analysis, a septic shock at admission and the use of mechanical ventilation were both associated with death. CONCLUSION SCAP were associated with high mortality in the ICU.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Community-Acquired Infections/diagnosis
- Community-Acquired Infections/microbiology
- Community-Acquired Infections/mortality
- Community-Acquired Infections/therapy
- Drug Resistance, Bacterial
- Female
- Hospital Mortality
- Hospitals, University
- Humans
- Intensive Care Units
- Male
- Middle Aged
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/mortality
- Pneumonia, Bacterial/therapy
- Pneumonia, Pneumococcal/diagnosis
- Pneumonia, Pneumococcal/microbiology
- Pneumonia, Pneumococcal/mortality
- Pneumonia, Pneumococcal/therapy
- Prognosis
- Respiration, Artificial
- Retrospective Studies
- Shock, Septic/diagnosis
- Shock, Septic/microbiology
- Shock, Septic/therapy
- Tunisia
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Affiliation(s)
- M Fekih Hassen
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - A Ben Haj Khalifa
- Laboratoire de microbiologie, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie.
| | - N Tilouche
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - H Ben Sik Ali
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - S Ayed
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - M Kheder
- Laboratoire de microbiologie, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie
| | - S Elatrous
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
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Nates JL, Cárdenas-Turanzas M, Wakefield C, Kish Wallace S, Shaw A, Samuels JA, Ensor J, Price KJ. Automating and simplifying the SOFA score in critically ill patients with cancer. Health Informatics J 2011; 16:35-47. [PMID: 20413411 DOI: 10.1177/1460458209353558] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim was to demonstrate the performance of a modified version of the Sequential Organ Failure Assessment (SOFA) score to predict mortality in medical and surgical patients with cancer. We performed an electronic retrospective review of databases. We included adult patients with cancer admitted into a 53-bed ICU over 28 months. We electronically calculated a modified SOFA (mSOFA) score at admission. A majority of the patients were admitted into the surgical ICU. Of 328 nonsurvivors, 85.1 per cent were medical patients and only 14.9 per cent surgical patients. The mean admission mSOFA scores for medical and surgical patients were 4.7 +/- 3.2 and 1.7 +/- 1.9, respectively. The overall area under the curve (AUC) of the mSOFA score was 0.84. The AUCs for medical and surgical patients were 0.72 and 0.78, respectively. Our results demonstrate that electronic assessment of mSOFA score has potential in resource allocation decisions as well as in critical care outreach programs.
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Affiliation(s)
- Joseph L Nates
- Department of Critical Care Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 2009; 37:2709-18. [PMID: 19885994 DOI: 10.1097/ccm.0b013e3181ab8655] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the attributable mortality of ventilator-associated pneumonia in a systematic review and meta-analysis of observational studies. Ventilator-associated pneumonia is generally believed to increase the mortality of patients. This notion is predominantly based on the results of observational studies. DATA SOURCE We performed a systematic search strategy using PubMed, Web of Science, and Embase from their inception through February 2007. In addition, a reference and related article search was performed. STUDY SELECTION Studies were included if they reported mortality rates of patients with and without ventilator-associated pneumonia. DATA EXTRACTION AND SYNTHESIS Fifty-two studies with a total of 17,347 patients met the inclusion criteria. Pooling of all studies resulted in relative risk of 1.27 (95% Confidence Interval = 1.15-1.39), but heterogeneity was considerable (I2 statistic = 69%). The origin of heterogeneity could not be explained by differences in study design, study quality, and diagnostic approach. However, heterogeneity was limited for studies investigating only trauma patients (I2 = 1.3%) or patients with acute respiratory distress syndrome (I2 = 0%), with estimated relative risk of 1.09 (95% Confidence Interval = 0.87-1.37) among trauma patients and 0.86 (95% Confidence Interval = 0.72-1.04) among patients with acute respiratory distress syndrome. CONCLUSIONS There is no evidence of attributable mortality due to ventilator-associated pneumonia in patients with trauma or acute respiratory distress syndrome. However, in other nonspecified patient groups, there is evidence for attributable mortality due to ventilator-associated pneumonia, but this could not be quantified due to heterogeneity in study results. More detailed studies, allowing subgroup analyses, are needed to determine the attributable mortality of ventilator-associated pneumonia in these patient populations.
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Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units. Crit Care Med 2009; 37:2360-8. [PMID: 19531951 DOI: 10.1097/ccm.0b013e3181a037ac] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Information on clinical practice regarding the diagnosis of pneumonia in European intensive care units is limited. The aim of this study was to describe the spectrum of actual diagnostic practices in a large sample of European intensive care units. DESIGN Prospective, observational, multicenter study. SETTING Twenty-seven intensive care units of nine European countries. PATIENTS Consecutive patients requiring invasive mechanical ventilation for an admission diagnosis of pneumonia or receiving mechanical ventilation for >48 hrs irrespective of admission diagnosis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 2,436 patients were evaluated; 827 were admitted with or developed nosocomial pneumonia (hospital-acquired pneumonia [HAP], 27.1%; ventilator-associated pneumonia [VAP], 56.2%; very early onset VAP, 16.7%). Mean age was 59.4 +/- 18.1 yrs, 65.0% were men, and mean admission Simplified Acute Physiology Score II was 46.7 +/- 17.1. Worsening oxygenation (76.8%), purulent/changing respiratory secretions (72.1%), and new temperature elevation (69.2%) were the most frequent clinical signs of nosocomial pneumonia. Etiological diagnosis was based on noninvasive respiratory specimens in 74.8% of episodes. Bronchoscopy was performed in 23.3% of episodes. Bronchoscopy performance, after adjustment by severity of illness, age, and type of hospital, were predicted by worsening oxygenation (odds ratio 2.03; 95% confidence interval, 1.27-3.24) and male sex (odds ratio 1.77; 95% confidence interval, 1.19-2.65). Definite cause was documented in 69.5% of nosocomial pneumonia cases. The most common isolates were Staphylococcus aureus (16.3% methicillin-sensitive S. aureus and 16.0% methicillin-resistant S. aureus), Pseudomonas aeruginosa (23.1%), and Acinetobacter baumannii (19.1%). Presence of nosocomial pneumonia significantly prolonged mean length of mechanical ventilation (10.3 days, p < .05) and mean intensive care unit length of stay (12.2 days, p < .05) in intensive care unit survivors. Mortality rate was 37.7% for nosocomial pneumonia vs. 31.6% for patients without pneumonia (p < .05). CONCLUSIONS Etiological diagnosis of nosocomial pneumonia in a large sample of European intensive care units was based mainly on noninvasive techniques. However, there was high variability in bronchoscopy use between the participating intensive care units.
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Charlton TS. A repeatable biofilm removal assay and its application in the assessment of commercial cleaning formulations for medical devices. ACTA ACUST UNITED AC 2008. [DOI: 10.1071/hi08030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wolkewitz M, Vonberg RP, Grundmann H, Beyersmann J, Gastmeier P, Bärwolff S, Geffers C, Behnke M, Rüden H, Schumacher M. Risk factors for the development of nosocomial pneumonia and mortality on intensive care units: application of competing risks models. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:R44. [PMID: 18384672 PMCID: PMC2447589 DOI: 10.1186/cc6852] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 02/07/2008] [Accepted: 04/02/2008] [Indexed: 12/18/2022]
Abstract
Introduction Pneumonia is a very common nosocomial infection in intensive care units (ICUs). Many studies have investigated risk factors for the development of infection and its consequences. However, the evaluation in most of theses studies disregards the fact that there are additional competing events, such as discharge or death. Methods A prospective cohort study was conducted over 18 months in five intensive care units at one university hospital. All patients that were admitted for at least 2 days were included, and surveillance of nosocomial pneumonia was conducted. Various potential risk factors (baseline- and time-dependent) were evaluated in two competing risks models: the acquisition of nosocomial pneumonia and discharge (dead or alive; model 1) and for the risk of death in the ICU and discharge alive (model 2). Results Patients from 1,876 admissions were included. A total of 158 patients developed nosocomial pneumonia. The main risk factors for nosocomial pneumonia in the multivariate analysis in model 1 were: elective surgery (cause-specific hazard ratio = 1.95; 95% CI 1.33 to 2.85) or emergency surgery (1.59; 95% CI 1.10 to 2.28) prior to ICU admission, usage of a nasogastric tube (3.04; 95% CI 1.25 to 7.37) and mechanical ventilation (5.90; 95% CI 2.47 to 14.09). Nosocomial pneumonia prolonged the length of ICU stay but was not directly associated with a fatal outcome (p = 0.55). Conclusion More studies using competing risk models, which provide more accurate data compared to naive survival curves or logistic models, should be carried out to verify the impact of risk factors and patient characteristics for the acquisition of nosocomial infections and infection-associated mortality.
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Affiliation(s)
- Martin Wolkewitz
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany.
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Vardakas KZ, Siempos II, Falagas ME. Diabetes mellitus as a risk factor for nosocomial pneumonia and associated mortality. Diabet Med 2007; 24:1168-71. [PMID: 17888136 DOI: 10.1111/j.1464-5491.2007.02234.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with diabetes mellitus (DM) are considered to be more susceptible to several types of infections, including community-acquired pneumonia. However, it is not clear whether DM is a risk factor for development of hospital-acquired pneumonia (HAP), an infection with considerable morbidity and mortality worldwide. METHODS We searched PubMed for relevant publications that included data on the possible association between DM and HAP. Cohort studies, case-control studies and observational studies were included in this analysis. Two of the authors performed the literature search independently. RESULTS We identified 84 studies designed to identify risk factors and predictors of mortality as a result of HAP. Of these, 13 studied patients in the ward or intensive care unit (ICU), 28 studied patients treated in the ICU only, and 44 studied patients with ventilator-associated pneumonia. Only 14 considered the role of DM for this nosocomial complication. The reviewed data suggest that DM is not a risk factor for development of HAP in patients who require ICU treatment. In addition, patients with DM are not at increased risk for development of ventilator-associated pneumonia. Moreover, DM is not a prognostic factor for mortality in patients with HAP based on data from two out of 84 identified studies that provided relevant information. CONCLUSIONS There is a relative scarcity of studies examining DM as a potential risk factor for HAP. Our analysis of the available data supports the conclusion that DM is not a risk factor for development of HAP and mortality associated with this nosocomial infection.
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Affiliation(s)
- K Z Vardakas
- Alfa Institute of Biomedical Sciences, Athens, Greece
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McLean AS, Huang SJ, Hyams S, Poh G, Nalos M, Pandit R, Balik M, Tang B, Seppelt I. Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock. Crit Care Med 2007; 35:1019-26. [PMID: 17334249 DOI: 10.1097/01.ccm.0000259469.24364.31] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the changes in B-type natriuretic peptide concentrations in patients with severe sepsis and septic shock and to investigate the value of B-type natriuretic peptide in predicting intensive care unit outcomes. DESIGN Prospective observational study. SETTING General intensive care unit. PATIENTS Forty patients with severe sepsis or septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS B-type natriuretic peptide measurements and echocardiography were carried out daily for 10 consecutive days. In-hospital mortality and length of stay were recorded. The admission B-type natriuretic peptide concentrations were generally increased (747 +/- 860 pg/mL). B-type natriuretic peptide levels were elevated in patients with normal left ventricular systolic function (568 +/- 811 pg/mL), with sepsis-related reversible cardiac dysfunction (630 +/- 726 pg/mL), and with chronic cardiac dysfunction (1311 +/- 1097 pg/mL). There were no significance changes in B-type natriuretic peptide levels over the 10-day period. The daily B-type natriuretic peptide concentrations for the first 3 days neither predicted in-hospital mortality nor correlated with length of intensive care unit or hospital stay. CONCLUSION B-type natriuretic peptide concentrations were increased in patients with severe sepsis or septic shock regardless of the presence or absence of cardiac dysfunction. Neither the B-type natriuretic peptide levels for the first 3 days nor the daily changes in B-type natriuretic peptide provided prognostic value for in-hospital mortality and length of stay in this mixed group of patients, which included patients with chronic cardiac dysfunction.
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Affiliation(s)
- Anthony S McLean
- Department of Intensive Care Medicine, University of Sydney, Nepean Hospital, Sydney, NSW, Australia.
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Iredell J, Thomas L, Espedido B. Beta-lactam resistance in the gram negatives: increasing complexity of conditional, composite and multiply resistant phenotypes. Pathology 2007; 38:498-506. [PMID: 17393976 DOI: 10.1080/00313020601032485] [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: 10/23/2022]
Abstract
The greatest impact of microbiology data on clinical care is in the critically ill. Unfortunately, this is also the area in which microbiology laboratories are most often non-contributive. Attempts to move to rapid, culture-independent diagnostics are driven by the need to expedite urgent results. This is difficult in Gram-negative infection because of the complexity of the antibiotic resistance phenotype. Here, we discuss resistance to modern beta-lactams as a case in point. Recent outbreaks of transmissible carbapenem resistance among Gram-negative enteric pathogens in Sydney and Melbourne serve to illustrate the pitfalls of traditional phenotypical approaches. A better understanding of the epidemiology and mosaic nature of antibiotic resistance elements in the microflora is needed for us to move forward.
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Affiliation(s)
- Jon Iredell
- Centre for Infectious Diseases and Microbiology, University of Sydney, Australia.
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Abstract
PURPOSE OF REVIEW To review the most recent data on severe Pseudomonas aeruginosa infections. The focus will be on clinical studies with an emphasis on the critically ill. RECENT FINDINGS The frequency of P. aeruginosa as the etiologic agent of infections associated with high morbidity and mortality in hospitalized patients continues to increase. Unfortunately, pan-resistant isolates are now emerging as a significant clinical problem. Highly or pan-resistant isolates are associated with more frequent inappropriate initial therapy and increased mortality. Prevention relies on limitation of antibiotic pressure. Unfortunately, antibiotic class rotation has not resulted in persistent decreases in resistant isolates and the increased use of treatment protocols may actually increase selection. SUMMARY Because of the frequency of antibiotic resistance in clinical isolates of P. aeruginosa and the high associated mortality, combination, broad-spectrum antibiotic therapy should be used for empiric coverage of suspected P. aeruginosa infections. Accurate diagnostic testing can help to discontinue unnecessary antibiotics and decrease the overall selective pressure. Increasing resistance without new antibiotic classes on the horizon suggests the need for better use of available antibiotics and an emphasis on innovative treatment strategies in the future.
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Affiliation(s)
- Gökhan M Mutlu
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R48. [PMID: 16563184 PMCID: PMC1550903 DOI: 10.1186/cc4869] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 02/23/2006] [Accepted: 02/27/2006] [Indexed: 01/23/2023]
Abstract
INTRODUCTION There has been a continuing controversy about whether infection with Acinetobacter baumannii increases morbidity and mortality independently of the effect of other confounding factors. METHODS We performed a systematic review of matched case-control and cohort studies examining the mortality attributable to infection with or acquisition of A. baumannii (infection or colonization). We included in our review studies that compared mortality and/or morbidity of patients with acquisition of or infection with A. baumannii (cases) with the outcomes of matched patients without A. baumannii isolation from clinical specimens (controls). The relevant studies were identified from searches of the PubMed and the Cochrane Library databases. Two independent reviewers performed the literature search, study selection, and data extraction from nine identified relevant studies. RESULTS The attributable mortalities, in the hospital and in the intensive care unit, of patients with A. baumannii infection in six matched case-control studies included in our review ranged from 7.8% to 23% and from 10% to 43%, respectively. In addition, a statistically significantly higher mortality was reported for patients with A. baumannii acquisition; that is, colonization or infection (cases) compared with controls without such an acquisition in all four reviewed studies that reported data on this comparison. CONCLUSION Although definitive statements about the mortality attributable to the acquisition of A. baumannii cannot be made from the available studies because of their methodological heterogeneity, the reviewed data suggest that infection with or acquisition of A. baumannii seems to be associated with increased mortality.
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Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece
- Department of Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Ioannis A Bliziotis
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece
| | - Ilias I Siempos
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece
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Boyadjiev I, Leone M, Garnier F, Albanèse J, Martin C. [Management of ventilator acquired pneumonia]. ACTA ACUST UNITED AC 2006; 25:761-72. [PMID: 16697138 DOI: 10.1016/j.annfar.2006.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2004] [Accepted: 02/13/2006] [Indexed: 01/15/2023]
Abstract
Ventilator-associated pneumonia occurs in the evolution of 8 to 70% of patients in the Intensive Care Unit. It is the main site of nosocomial infection for mechanically ventilated patients. Nosocomial pneumonia represents an important cause of morbidity and mortality, despite progresses in antibiotic prescription, use of intensive care and prevention. This review is based on the ATS guidelines, and reviews epidemiology, diagnosis and treatment of ventilator-acquired pneumonia, in non-immunocompromised adults.
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Affiliation(s)
- I Boyadjiev
- Département d'anesthésie et de réanimation, CHU Nord, boulevard Pierre-Dramard, 13915 Marseille cedex 20, France.
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Duncan A. Pneumonia in Intensive Care—Another Frontier? Anaesth Intensive Care 2005; 33:11-2. [PMID: 15957685 DOI: 10.1177/0310057x0503300102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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