Respective impact of implementation of prevention strategies, colonization with multiresistant bacteria and antimicrobial use on the risk of early- and late-onset VAP: An analysis of the OUTCOMEREA network

被引：18

作者：

Ibn Saied, Wafa ^{[1
,2
]}

Souweine, Bertrand ^{[3
]}

Garrouste-Orgeas, Maite ^{[4
]}

Ruckly, Stephane ^{[1
]}

Darmon, Michael ^{[5
]}

Bailly, Sebastien ^{[1
,6
]}

Cohen, Yves ^{[7
]}

Azoulay, Elie ^{[8
]}

Schwebel, Carole ^{[2
]}

Radjou, Aguila ^{[9
]}

Kallel, Hatem ^{[10
]}

Adrie, Christophe ^{[11
]}

Dumenil, Anne-Sylvie ^{[12
]}

Argaud, Laurent ^{[13
]}

Marcotte, Guillaume ^{[14
]}

Jamali, Samir ^{[15
]}

Papazian, Laurent ^{[16
]}

Goldgran-Toledano, Dany ^{[17
]}

Bouadma, Lila ^{[9
]}

Timsit, Jean-Francois ^{[1
,9
]}

机构：

[1] Paris Diderot Univ, Sorbonne Paris Cite, UMR 1137,IAME Team 5, DeSCID Decis Sci Infect Dis Control & Care,Inserm, Paris, France

[2] Grenoble 1 Univ, Grenoble Univ Hosp, Med Intens Care Unit, U823, La Tronche, France

[3] Gabriel Montpied Univ Hosp, Med Intens Care Unit, Clermont Ferrand, France

[4] St Joseph Hosp Network, Intens Care Unit, Paris, France

[5] St Etienne Univ Hosp, Med Intens Care Unit, St Etienne, France

[6] Grenoble Alpes Univ, U823, Rond Point Chantourne, La Tronche, France

[7] Paris 13 Univ, Paris & Med Univ, Avicenne Hosp, AP HP,Intens Care Unit, Bobigny, France

[8] St Louis Hosp, AP HP, Med Intens Care Unit, Paris, France

[9] Paris Diderot Univ, Bichat Hosp, AP HP, Med & Infect Dis Intens Care Unit, Paris, France

[10] Ctr Hosp Cayenne, Med Surg ICU, Guyane, France

[11] Cochin Univ Hosp, Sorbonne Cite, Physiol Dept, Paris, France

[12] Antoine Beclere Univ Hosp, AP HP, Med Surg Intens Care Unit, Clamart, France

[13] Lyon Univ Hosp, Med Intens Care Unit, Lyon, France

[14] Edouard Herriot Univ Hosp, Surg ICU, Lyon, France

[15] Dourdan Hosp, Crit Care Med Unit, Dourdan, France

[16] Aix Marseille Univ, Hop Nord, APHM, Resp & Infect Dis, Marseille, France

[17] Gonesse Hosp, Intens Care Unit, Gonesse, France

来源：

PLOS ONE | 2017年 / 12卷 / 11期

关键词：

VENTILATOR-ASSOCIATED PNEUMONIA; CRITICALLY-ILL PATIENTS; INTENSIVE-CARE UNITS; NOSOCOMIAL PNEUMONIA; INTRAHOSPITAL TRANSPORT; RESISTANT BACTERIA; STRESS-ULCER; ICU PATIENTS; MULTICENTER; TRIAL;

D O I：

10.1371/journal.pone.0187791

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Rationale The impact of prevention strategies and risk factors for early-onset (EOP) versus late-onset (LOP) ventilator -associated pneumonia (VAP) are still debated. Objectives To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies. Methods 7,784 patients with mechanical ventilation (MV) for at least 48 hours were selected into the multicenter prospective OUTCOMEREA database (1997-2016). VAP occurring between the 3rd and 6th day of MV defined EOP, while those occurring after defined LOPs. We used a Fine and Gray subdistribution model to take the successful extubation into account as a competing event. Measurements and main results Overall, 1,234 included patients developed VAP (EOP: 445 (36%); LOP: 789 (64%)). Male gender was a risk factor for both EOP and LOP. Factors specifically associated with EOP were admission for respiratory distress, previous colonization with multidrug-resistant Pseudomonas aeruginosa, chest tube and enteral feeding within the first 2 days of MV. Antimicrobials administrated within the first 2 days of MV were all protective of EOP. ICU admission for COPD exacerbation or pneumonia were early risk factors for LOP, while imidazole and vancomycin use within the first 2 days of MV were protective factors. Late risk factors (between the 3rd and the 6th day of MV) were the intra-hospital transport, PAO2-F102<200 mmHg, vasopressor use, and known colonization with methicillin-resistant Staphylococcus aureus. Among the antimicrobials administered between the 3rd and the 6th day, fluoroquinolones were the solely protective one.Contrarily to LOP, the risk of EOP decreased across the study time periods, concomitantly with an increase in the compliance with bundle of prevention measures. Conclusion VAP risk factors are mostly different according to the pneumonia time of onset, which should lead to differentiated prevention strategies.

引用

页数：16

共 33 条

[1] Risk factors for early-onset, ventilator-associated pneumonia in critical care patients -: Selected multiresistant versus nonresistant bacteria [J].

Akça, O ;

Koltka, K ;

Uzel, S ;

Çakar, N ;

Pembeci, K ;

Sayan, MA ;

Tütüncü, AS ;

Karakas, SE ;

Çalangu, S ;

Özkan, T ;

Esen, F ;

Telci, L ;

Sessler, DI ;

Akpir, K .

ANESTHESIOLOGY, 2000, 93 (03) :638-645

[2]

Bassetti M, 2012, EXPERT REV ANTI-INFE, V10, P585, DOI [10.1586/ERI.12.36, 10.1586/eri.12.36]

[3] Attributable Mortality of Ventilator-Associated Pneumonia A Reappraisal Using Causal Analysis [J].

Bekaert, Maarten ;

Timsit, Jean-Francois ;

Vansteelandt, Stijn ;

Depuydt, Pieter ;

Vesin, Aurelien ;

Garrouste-Orgeas, Maite ;

Decruyenaere, Johan ;

Clec'h, Christophe ;

Azoulay, Elie ;

Benoit, Dominique .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2011, 184 (10) :1133-1139

[4] Intrahospital transport of critically ill ventilated patients: A risk factor for ventilator-associated pneumonia - A matched cohort study [J].

Bercault, N ;

Wolf, M ;

Runge, I ;

Fleury, JC ;

Boulain, T .

CRITICAL CARE MEDICINE, 2005, 33 (11) :2471-2478

[5] Sedation, sucralfate, and antibiotic use are potential means for protection against early-onset ventilator-associated pneumonia [J].

Bornstain, C ;

Azoulay, E ;

De Lassence, A ;

Cohen, Y ;

Costa, MA ;

Mourvillier, B ;

Descorps-Declere, A ;

Garrouste-Orgeas, M ;

Thuong, M ;

Schlemmer, B ;

Timsit, JF .

CLINICAL INFECTIOUS DISEASES, 2004, 38 (10) :1401-1408

[6] Long-Term Impact of a Multifaceted Prevention Program on Ventilator-Associated Pneumonia in a Medical Intensive Care Unit [J].

Bouadma, Lila ;

Deslandes, Emmanuelle ;

Lolom, Isabelle ;

Le Corre, Bertrand ;

Mourvillier, Bruno ;

Regnier, Bernard ;

Porcher, Raphael ;

Wolff, Michel ;

Lucet, Jean-Christophe .

CLINICAL INFECTIOUS DISEASES, 2010, 51 (10) :1115-1122

[7] Ventilator-associated pneumonia [J].

Chastre, J ;

Fagon, JY .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2002, 165 (07) :867-903

[8] Decontamination of the Digestive Tract and Oropharynx in ICU Patients [J].

de Smet, A. M. G. A. ;

Kluytmans, J. A. J. W. ;

Cooper, B. S. ;

Mascini, E. M. ;

Benus, R. F. J. ;

van der Werf, T. S. ;

van der Hoeven, J. G. ;

Pickkers, P. ;

Bogaers-Hofman, D. ;

van der Meer, N. J. M. ;

Bernards, A. T. ;

Kuijper, E. J. ;

Joore, J. C. A. ;

Hall, M. A. Leverstein-van ;

Bindels, A. J. G. H. ;

Jansz, A. R. ;

Wesselink, R. M. J. ;

de Jongh, B. M. ;

Dennesen, P. J. W. ;

van Asselt, G. J. ;

Velde, L. F. te ;

Frenay, I. H. M. E. ;

Kaasjager, K. ;

Bosch, F. H. ;

van Iterson, M. ;

Thijsen, S. F. T. ;

Kluge, G. H. ;

Pauw, W. ;

de Vries, J. W. ;

Kaan, J. A. ;

Arends, J. P. ;

Aarts, L. P. H. J. ;

Sturm, P. D. J. ;

Harinck, H. I. J. ;

Voss, A. ;

Uijtendaal, E. V. ;

Blok, H. E. M. ;

Groen, E. S. Thieme ;

Pouw, M. E. ;

Kalkman, C. J. ;

Bonten, M. J. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2009, 360 (01) :20-31

[9] Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients:: a randomised trial [J].

Drakulovic, MB ;

Torres, A ;

Bauer, TT ;

Nicolas, JM ;

Nogué, S ;

Ferrer, N .

LANCET, 1999, 354 (9193) :1851-1858

[10] Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria [J].

Giantsou, E ;

Liratzopoulos, N ;

Efraimidou, E ;

Panopoulou, M ;

Alepopoulou, E ;

Kartali-Ktenidou, S ;

Minopoulos, GI ;

Zakynthinos, S ;

Manolas, KI .

INTENSIVE CARE MEDICINE, 2005, 31 (11) :1488-1494

← 1 2 3 4 →