Influence of dyskalemia at admission and early dyskalemia correction on survival
and cardiac events of critically ill patients.
Bouadma L(1)(2)(3), Mankikian S(4), Darmon M(5)(6), Argaud L(7), Vinclair C(8),
Siami S(9), Garrouste-Orgeas M(10), Papazian L(11), Cohen Y(12)(13), Marcotte
G(14), Styfalova L(15), Reignier J(16), Lautrette A(17), Schwebel C(18), Timsit
JF(8)(19); OUTCOMEREA STUDY GROUP.
Message:
la dyskaliémie à laquelle nous sommes très fréquemment confronté, aggrave le pronostic des patients de réanimation. Sa correction dans les 48 premières heures améliore le pronostic.
OBJECTIVES: Our objectives were (1) to characterize the distribution of serum
potassium levels at ICU admission, (2) to examine the relationship between
dyskalemia at ICU admission and occurrence of cardiac events, and (3) to study
both the association between dyskalemia at ICU admission and dyskalemia
correction by day 2 on 28-day mortality.
DESIGN: Inception cohort study from the longitudinal prospective French
multicenter OUTCOMEREA database (1999-2014) SETTING: 22 French OUTCOMEREA
network ICUs PATIENTS: Patients were classified into six groups according to
their serum potassium level at admission: three groups of hypokalemia and three
groups of hyperkalemia defined as serious hypokalemia [K+] < 2.5 and serious
hyperkalemia [K+] > 7 mmol/L, moderate hypokalemia 2.5 ≤ [K+] < 3 mmol/L and
moderate hyperkalemia 6 < [K+] ≤ 7 mmol/L, and mild hypokalemia 3 ≤ [K+]
< 3.5 mmol/L and mild hyperkalemia 5 < [K+] ≤ 6 mmol/L. We sorted evolution at
day 2 of dyskalemia into three categories: balanced, not-balanced, and
overbalanced.
INTERVENTION: None MEASUREMENTS AND MAIN RESULTS: Of 12,090 patients, 2108
(17.4%) had hypokalemia and 1445 (12%) had hyperkalemia. Prognostic impact of
dyskalemia and its correction was assessed using multivariate Cox models. After
adjustment, hypokalemia and hyperkalemia were independently associated with a
greater risk of 28-day mortality. Mild hyperkalemic patients had the highest
mortality (hazard ratio (HR) 1.29, 95% confidence interval (CI) [1.13-1.47],
p < 0.001). Adjusted 28-day mortality was higher if serum potassium level was
not-balanced at day 2 (aHR = 1.51, 95% CI [1.30-1.76], p < 0.0001) and
numerically higher but not significantly different if serum potassium level was
overbalanced at day 2 (aHR = 1.157, 95% CI [0.84-1.60], p = 0.38). Occurrence of
cardiac events was evaluated by logistic regression. Except for patients with
serious hypokalemia at admission, the depth of dyskalemia was associated with
increased risk of cardiac events.
CONCLUSIONS: Dyskalemia is common at ICU admission and associated with increased
mortality. Occurrence of cardiac events increased with dyskalemia depth. A
correction of serum potassium level by day 2 was associated with improved
prognosis.
DOI: 10.1186/s13054-019-2679-z
PMCID: PMC6921444
PMID: 31856891 [Indexed for MEDLINE]
Conflict of interest statement: The authors declare that they have no competing
interests.
The Fami-life study: protocol of a prospective observational multicenter mixed
study of psychological consequences of grieving relatives in French palliative
care units on behalf of the family research in palliative care (F.R.I.P.C
research network).
Garrouste-Orgeas M(1)(2)(3)(4), Flahault C(5), Poulain E(6), Evin A(7),
Guirimand F(8)(9), Fossez-Diaz V(10), Perruchio S(11), Verlaine C(12), Vanbésien
A(13), Kaczmarek W(14), Birkui de Francqueville L(15), De Larivière E(16),
Bouquet G(17), Copel L(18), Verliac V(19), Marché V(20), Mathias C(21), Gracia
D(22), Mhalla A(23), Michonneau-Gandon V(24), Poupardin C(25), Touzet L(26),
Ranchou G(27), Guastella V(28), Richard B(29), Bienfait F(30), Sonrier M(5),
Michel D(6), Ruckly S(31), Bailly S(32), Timsit JF(33)(34).
BACKGROUND: Grieving relatives can suffer from numerous consequences like
anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and
prolonged grief. This study aims to assess the psychological consequences of
grieving relatives after patients' death in French palliative care units and
their needs for support.
METHODS: This is a prospective observational multicenter mixed study. Relatives
of adult patients with a neoplasia expected to be hospitalized more than 72 h in
a palliative care unit for end-of-life issues will be included within 48 h after
patient admission. End-of-life issues are defined by the physician at patient
admission. Relatives who are not able to have a phone call at 6-months are
excluded. The primary outcome is the incidence of prolonged grief reaction
defined by an ICG (Inventory Complicate Grief) > 25 (0 best-76 worst) at
6 months after patient' death. Prespecified secondary outcomes are the risk
factors of prolonged grief, anxiety and depression symptoms between day 3 and
day 5 and at 6 months after patients' death based on an Hospital Anxiety and
Depression score (range 0-42) > 8 for each subscale (minimal clinically
important difference: 2.5), post-traumatic stress disorder symptoms 6 months
after patient' death based on the Impact of Events Scale questionnaire (0
best-88 worst) score > 22, experience of relatives during palliative care based
on the Fami-Life questionnaire, specifically built for the study. Between 6 and
12 months after the patient's death, a phone interview with relatives with
prolonged grief reactions will be planned by a psychologist to understand the
complex system of grief. It will be analyzed with the Interpretative
Phenomenological Analysis. We planned to enroll 500 patients and their close
relatives assuming a 25% prolonged grief rate and a 6-month follow-up available
in 60% of relatives.
DISCUSSION: This study will be the first to report the psychological
consequences of French relatives after a loss of a loved one in palliative care
units. Evaluating relatives' experiences can provide instrumental insights for
means of improving support for relatives and evaluation of bereavement programs.
TRIAL REGISTRATION: NCT03748225 registered on 11/19/2018. Recruiting patients.
DOI: 10.1186/s12904-019-0496-4
PMCID: PMC6902332
PMID: 31818281 [Indexed for MEDLINE]
Conflict of interest statement: No authors have competing interests for the
enclosed work.
Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day
mortality in critical care-an analysis of the OUTCOMEREA database.
Morvan AC(1), Hengy B(2), Garrouste-Orgeas M(3), Ruckly S(4), Forel JM(5),
Argaud L(6), Rimmelé T(2), Bedos JP(7), Azoulay E(8), Dupuis C(9), Mourvillier
B(9), Schwebel C(10), Timsit JF(9); OUTCOMEREA study group.
Collaborators: Timsit JF, Azoulay E, Garrouste-Orgeas M, Zahar JR, Mourvillier
B, Darmon M, Clec'h C, Alberti C, Ruckly S, Bailly S, Vannieuwenhuyze A, Hernu
R, Adrie C, Agasse C, Allaouchiche B, Andremont O, Andreu P, Argaud L,
Ara-Somohano C, Azoulay E, Barbier F, Boyer D, Bedos JP, Baudry T, Bedel J, Bohé
J, Bouadma L, Bourenne J, Brule N, Brétonnière C, Chemouni F, Cheval C, Carvelli
J, Coupez E, Cour M, Dupuis C, de Montmollin E, Dopeux L, Dumenil AS, Forel JM,
Gainnier M, Garret C, Goldgran-Tonedano D, Grangé S, Gros A, Hammed H, Haouache
A, Hernu R, Hissem T, Ha VHT, Jochmans S, Joffredo JB, Kallel H, Lacave G,
Laurent V, Lautrette A, Magalhaes CLBE, Lemiale V, Marcotte G, Lebut J, Lugosi
M, Merceron S, Misset B, Neuville M, Nicolet L, Oziel J, Papazian L, Patrier J,
Planquette B, Radjou A, Simon M, Sonneville R, Reignier J, Souweine B, Schwebel
C, Siami S, Sonneville R, Terzi N, Troché G, Thuong M, Thierry G, Venot M,
Yaacoubi S, Zambon O, Fournier J, Bagur S, Adda M, Vindrieux V, de la Salle S,
Enguerrand P, Gobert V, Guessens S, Merle H, Kaddour N, Berthe B, Bekkhouche S,
Mellouk K, Lebrazic M, Ouisse C, Maugars D, Aparicio C, Theodose I, Nouacer M,
Deiler V, Lamara F, Moussa M, Mouaci A, Viguier N.
INTRODUCTION: Enterococcus species are associated with an increased morbidity in
intraabdominal infections (IAI). However, their impact on mortality remains
uncertain. Moreover, the influence on outcome of the appropriate or
inappropriate status of initial antimicrobial therapy (IAT) is subjected to
debate, except in septic shock. The aim of our study was to evaluate whether an
IAT that did not cover Enterococcus spp. was associated with 30-day mortality in
ICU patients presenting with IAI growing with Enterococcus spp.
MATERIAL AND METHODS: Retrospective analysis of French database OutcomeRea from
1997 to 2016. We included all patients with IAI with a peritoneal sample growing
with Enterococcus. Primary endpoint was 30-day mortality.
RESULTS: Of the 1017 patients with IAI, 76 (8%) patients were included.
Thirty-day mortality in patients with inadequate IAT against Enterococcus was
higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of
postoperative complications was similar. Presence of Enterococcus spp. other
than E. faecalis alone was associated with a significantly higher mortality,
even greater when IAT was inadequate. Main risk factors for having an
Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0,
ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI
especially with third-generation cephalosporins. Univariate analysis found a
higher hazard ratio of death with an Enterococcus other than E. faecalis alone
that had an inadequate IAT (HR = 4.4 [1.3-15.3], p = 0.019) versus an adequate
IAT (HR = 3.1 [1.0-10.0], p = 0.053). However, after adjusting for confounders
(i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and
adequacy of IAT for other germs), the impact of the adequacy of IAT was no
longer significant in multivariate analysis. Septic shock at diagnosis and
ICU-acquired IAI were prognostic factors.
CONCLUSION: An IAT which does not cover Enterococcus is associated with an
increased 30-day mortality in ICU patients presenting with an IAI growing with
Enterococcus, especially when it is not an E. faecalis alone. It seems
reasonable to use an IAT active against Enterococcus in severe postoperative
ICU-acquired IAI, especially when a third-generation cephalosporin has been used
within 3 months.
DOI: 10.1186/s13054-019-2581-8
PMCID: PMC6731585
PMID: 31492201 [Indexed for MEDLINE]
Conflict of interest statement: The authors declare that they have no competing
interests.
Effect of an ICU Diary on Posttraumatic Stress Disorder Symptoms Among Patients
Receiving Mechanical Ventilation: A Randomized Clinical Trial.
Garrouste-Orgeas M(1)(2)(3), Flahault C(4), Vinatier I(5), Rigaud JP(6),
Thieulot-Rolin N(7), Mercier E(8), Rouget A(9), Grand H(10), Lesieur O(11),
Tamion F(12)(13), Hamidfar R(14), Renault A(15), Parmentier-Decrucq E(16),
Monseau Y(17), Argaud L(18), Bretonnière C(19)(20), Lautrette A(21)(22), Badié
J(23), Boulet E(24), Floccard B(25), Forceville X(26), Kipnis E(27), Soufir
L(28), Valade S(29), Bige N(30), Gaffinel A(31), Hamzaoui O(32), Simon G(33),
Thirion M(34), Bouadma L(1)(35), Large A(36), Mira JP(37), Amdjar-Badidi N(38),
Jourdain M(16)(39), Jost PH(40), Maxime V(41), Santoli F(42), Ruckly S(2),
Vioulac C(4), Leborgne MA(4), Bellalou L(4), Fasse L(4), Misset B(12), Bailly
S(1)(43), Timsit JF(1)(2)(35).
IMPORTANCE: Keeping a diary for patients while they are in the intensive care
unit (ICU) might reduce their posttraumatic stress disorder (PTSD) symptoms.
OBJECTIVES: To assess the effect of an ICU diary on the psychological
consequences of an ICU hospitalization.
DESIGN, SETTING, AND PARTICIPANTS: Assessor-blinded, multicenter, randomized
clinical trial in 35 French ICUs from October 2015 to January 2017, with
follow-up until July 2017. Among 2631 approached patients, 709 adult patients
(with 1 family member each) who received mechanical ventilation within 48 hours
after ICU admission for at least 2 days were eligible, 657 were randomized, and
339 were assessed 3 months after ICU discharge.
INTERVENTIONS: Patients in the intervention group (n = 355) had an ICU diary
filled in by clinicians and family members. Patients in the control group
(n = 354) had usual ICU care without an ICU diary.
MAIN OUTCOMES AND MEASURES: The primary outcome was significant PTSD symptoms,
defined as an Impact Event Scale-Revised (IES-R) score greater than 22 (range,
0-88; a higher score indicates more severe symptoms), measured in patients 3
months after ICU discharge. Secondary outcomes, also measured at 3 months and
compared between groups, included significant PTSD symptoms in family members;
significant anxiety and depression symptoms in patients and family members,
based on a Hospital Anxiety and Depression Scale score greater than 8 for each
subscale (range, 0-42; higher scores indicate more severe symptoms; minimal
clinically important difference, 2.5); and patient memories of the ICU stay,
reported with the ICU memory tool.
RESULTS: Among 657 patients who were randomized (median [interquartile range]
age, 62 [51-70] years; 126 women [37.2%]), 339 (51.6%) completed the trial. At 3
months, significant PTSD symptoms were reported by 49 of 164 patients (29.9%) in
the intervention group vs 60 of 175 (34.3%) in the control group (risk
difference, -4% [95% CI, -15% to 6%]; P = .39). The median (interquartile range)
IES-R score was 12 (5-25) in the intervention group vs 13 (6-27) in the control
group (difference, -1.47 [95% CI, -1.93 to 4.87]; P = .38). There were no
significant differences in any of the 6 prespecified comparative secondary
outcomes.
CONCLUSIONS AND RELEVANCE: Among patients who received mechanical ventilation in
the ICU, the use of an ICU diary filled in by clinicians and family members did
not significantly reduce the number of patients who reported significant PTSD
symptoms at 3 months. These findings do not support the use of ICU diaries for
preventing PTSD symptoms.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02519725.
PMCID: PMC6635906
PMID: 31310299 [Indexed for MEDLINE]
Conflict of interest statement: Conflict of Interest Disclosures: Dr
Garrouste-Orgeas reports grants from Fondation de France during the conduct of
the study. Dr Bouadma reported receiving grants from Fondation De France during
the conduct of the study. Dr Kipnis reported receiving grants, personal fees,
and nonfinancial support from MSD France, personal fees from Pfizer and Sanofi,
and nonfinancial support from Astellas and LFB Biomédicament outside the
submitted work. Dr Mira reported receiving personal fees from Roche and personal
fees from AKSA outside the submitted work. Dr Simon reported receiving a grant
from Centre Hospitalier de Troyes. Dr Soufir reported receiving grants from
Groupe Hospitalier Paris Saint Joseph during the conduct of the study. Dr Bailly
reported receiving consulting fees for methodology from ICUREsearch society. Dr
Timsit reported receiving personal fees and grants from Medical Specialties
Distributors, personal fees from Pfizer, Nabriva, and Biomerieux, and grants
from Astelas outside the submitted work. No other disclosures were reported.
Pneumonia in acute ischemic stroke patients requiring invasive ventilation:
Impact on short and long-term outcomes.
de Montmollin E(1), Ruckly S(2), Schwebel C(3), Philippart F(4), Adrie C(5),
Mariotte E(6), Marcotte G(7), Cohen Y(8), Sztrymf B(9), da Silva D(10), Bruneel
F(11), Gainnier M(12), Garrouste-Orgeas M(13), Sonneville R(14), Timsit JF(15);
OUTCOMEREA Study Group.
OBJECTIVES: To describe the epidemiology and prognostic impact of pneumonia in
acute ischemic stroke patients requiring invasive mechanical ventilation.
METHODS: Retrospective analysis from a prospective multicenter cohort study of
critically ill patients with acute ischemic stroke requiring invasive mechanical
ventilation at admission. Impact of pneumonia was investigated using Cox
regression for 1-year mortality, and competing risk survival models for ICU
mortality censored at 30-days.
RESULTS: We included 195 patients. Stroke was supratentorial in 62% and 64% of
patients had a Glasgow coma scale score <8 on admission. Mortality at day-30 and
1 year were 56%, and 70%, respectively. Post-stroke pneumonia was identified in
78 (40%) patients, of which 46/78 (59%) episodes were present at ICU admission.
Post-stroke pneumonia was associated with an increase in 1-year mortality
(adjusted HR 1.49, 95%CI [1.01-2.20]). Post-stroke pneumonia was not associated
with ICU mortality but was associated with a 1.6-fold increase in ICU length of
stay (CSHR 0.62 [0.39-0.99], p = 0.06).
CONCLUSIONS: In ischemic stroke patients requiring invasive ventilation,
pneumonia occurred in 40% of cases and was associated with a 49% increase in
1-year mortality. Post-stroke pneumonia did not impact day-30 mortality but
increased ICU length of stay.
Copyright © 2019 The British Infection Association. Published by Elsevier Ltd.
All rights reserved.
DOI: 10.1016/j.jinf.2019.06.012
PMID: 31238051 [Indexed for MEDLINE]
Impact of bronchial colonization with Candida spp. on the risk of bacterial
ventilator-associated pneumonia in the ICU: the FUNGIBACT prospective cohort
study.
Timsit JF(1)(2), Schwebel C(3), Styfalova L(4), Cornet M(5)(6), Poirier P(7),
Forrestier C(8), Ruckly S(9)(4), Jacob MC(10)(11), Souweine B(12).
Author information:
(1)Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP,
Paris, France. Cette adresse e-mail est protégée contre les robots spammeurs. Vous devez activer le JavaScript pour la visualiser..
(2)INSERM, IAME UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris,
France. Cette adresse e-mail est protégée contre les robots spammeurs. Vous devez activer le JavaScript pour la visualiser..
(3)Medical ICU, Albert Michallon University Hospital, Grenoble, France.
(4)OUTCOMEREA Network, Aulnay Sous Bois, France.
(5)Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG,
38000, Grenoble, France.
(6)Institute of Engineering, Univ. Grenoble Alpes, Grenoble, France.
(7)Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, CNRS,
Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
(8)Université Clermont Auvergne, UMR CNRS 6023, Clermont-Ferrand, France.
(9)INSERM, IAME UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris,
France.
(10)Department of Immunology, Grenoble-Alpes University Hospital (CHUGA) 38700
Grenoble, France.
(11)INSERM U1209, CNRS UMR 5309, Institute for Advanced Biosciences,, Université
Grenoble Alpes,, 38700, Grenoble, France.
(12)Medical ICU, Gabriel-Montpied University Hospital,, Clermont-Ferrand,,
France.
INTRODUCTION: Respiratory tract Candida spp. colonization is associated with
more frequent bacterial ventilator-associated pneumonia (VAP). However, this
colonization could be causally related to VAP or simply reflect the immune
paralysis associated with multiple organ failure.
OBJECTIVE: To prospectively evaluate the relationship between Candida spp.
colonization and bacterial VAP in mechanically ventilated patients with multiple
organ failure.
INCLUSION: Patients receiving mechanical ventilation for > 4 days and presenting
multiple organ failure were included. Tracheal colonization with Candida spp.
was evaluated at inclusion (day 0, D0) and every 4 days until extubation.
Quantitative proximal and tracheal cultures were performed at each VAP episode.
Monocyte human leukocyte antigen-DR isotype (mHLA-DR) expression and the ratio
of polymononuclear leukocytes to lymphocytes were used to evaluate
immunoparalysis at D0 and D7. The relationship between fungal colonization and
VAP was modelled using cause-specific models for repeated events with adjustment
for time-dependent confounders and immune factors.
RESULTS: A total of 213 patients, with a median age of 64, simplified acute
physiology score II (SAPS II) score 55 and sequential organ failure assessment
(SOFA) score 10, mainly admitted for medical reasons (n = 197, 92%), were
enrolled in 2012-2015. The median ICU stay was 24 days and the mortality rate
was 32% (69 cases). Median mHLA-DR was 5916 Ab-bound/cell [3863-8934]; median
lymphocyte count, 0.9Giga/L [0.6-1.3]; neutrophil-to-lymphocyte ratio, 10.9
[6.5-19.7]. Overall, 146 cases (68.5%) had tracheal colonization with Candida
spp. An episode of VAP occurred (either for the first or only time) in 62
(29.1%) cases 5.5 days (median) after D0; a second episode occurred in 12 (5.6%)
cases, 15.5 days (median) after D0. After adjustment, bronchial colonization
with Candida was not associated with VAP [adjusted cause-specific hazard
ratio = 0.98 (0.59-1.65), p = 0.95].
CONCLUSION: In patients with mechanical ventilation for more than 4 days and
multiple organ failure, bronchial colonization with Candida spp. was not
associated with VAP, even after adjustment for immune function.
DOI: 10.1007/s00134-019-05622-0
PMID: 31020361 [Indexed for MEDLINE]
Impact of macrolide therapy in critically ill patients with acute respiratory
failure: a desirability of outcome ranking analysis to investigate the
OUTCOMEREA database.
Pons S(1), Timsit JF(2)(3), Ruckly S(3), Schwebel C(4), Papazian L(5), Azoulay
E(6), Reignier J(7), Zafrani L(8)(9).
DOI: 10.1007/s00134-019-05586-1
PMID: 30874823 [Indexed for MEDLINE]
- Crit Care Med. 2019 Mar;47(3):345-352. doi: 10.1097/CCM.0000000000003553.
A Comparison of the Mortality Risk Associated With Ventilator-Acquired Bacterial
Pneumonia and Nonventilator ICU-Acquired Bacterial Pneumonia.
Ibn Saied W, Mourvillier B(1)(2), Cohen Y(3)(4), Ruckly S(1)(5), Reignier J(6),
Marcotte G(7), Siami S(8), Bouadma L(1)(2), Darmon M(9)(10), de Montmollin
E(11), Argaud L(12), Kallel H(13), Garrouste-Orgeas M(1)(14)(15), Soufir
L(14)(15), Schwebel C(16), Souweine B(17), Glodgran-Toledano D(18), Papazian
L(19), Timsit JF(1)(2)(5); OUTCOMEREA Study Group.
Collaborators: Timsit JF, Azoulay E, Garrouste-Orgeas M, Zahar JR, Adrie C,
Darmon M, Clec’h C, Alberti C, Français A, Vesin A, Ruckly S, Bailly S, Lecorre
F, Nakache D, Vannieuwenhuyze A, Adrie C, Allaouchiche B, Argaud L, Ara-Somohano
C, Barbier F, Bedos JP, Bohé J, Bouadma L, Cheval C, Dumenil AS, Dupuis C, Forel
JM, Gainier M, Haouache A, Jamali S, Kallel H, Lautrette A, Marcotte G,
Mourvillier B, Misset B, Moreau D, Papazian L, Planquette B, Souweine B,
Schwebel C, Terzi N, Troché G, Toledano D, Vantalon E, Fournier J, Tournegros C,
Bagur S, Adda M, Vindrieux V, Ferrand L, Kaddour N, Berthe B, Bekkhouche S,
Mellouk K, Conrozier S, Theodose I, Deiler V, Letrou S.
OBJECTIVES: To investigate the respective impact of ventilator-associated
pneumonia and ICU-hospital-acquired pneumonia on the 30-day mortality of ICU
patients.
DESIGN: Longitudinal prospective studies.
SETTING: French ICUs.
PATIENTS: Patients at risk of ventilator-associated pneumonia and
ICU-hospital-acquired pneumonia.
INTERVENTIONS: The first three episodes of ventilator-associated pneumonia or
ICU-hospital-acquired pneumonia were handled as time-dependent covariates in Cox
models. We adjusted using the case-mix, illness severity, Simplified Acute
Physiology Score II score at admission, and procedures and therapeutics used
during the first 48 hours before the risk period. Baseline characteristics of
patients with regard to the adequacy of antibiotic treatment were analyzed, as
well as the Sequential Organ Failure Assessment score variation in the 2 days
before the occurrence of ventilator-associated pneumonia or
ICU-hospital-acquired pneumonia. Mortality was also analyzed for Enterococcus
faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii,
Pseudomonas aeruginosa, and Enterobacter species(ESKAPE) and P. aeruginosa
pathogens.
MEASUREMENTS AND MAIN RESULTS: Of 14,212 patients who were admitted to the ICUs
and who stayed for more than 48 hours, 7,735 were at risk of
ventilator-associated pneumonia and 9,747 were at risk of ICU-hospital-acquired
pneumonia. Ventilator-associated pneumonia and ICU-hospital-acquired pneumonia
occurred in 1,161 at-risk patients (15%) and 176 at-risk patients (2%),
respectively. When adjusted on prognostic variables, ventilator-associated
pneumonia (hazard ratio, 1.38 (1.24-1.52); p < 0.0001) and even more
ICU-hospital-acquired pneumonia (hazard ratio, 1.82 [1.35-2.45]; p < 0.0001)
were associated with increased 30-day mortality. The early antibiotic therapy
adequacy was not associated with an improved prognosis, particularly for
ICU-hospital-acquired pneumonia. The impact was similar for
ventilator-associated pneumonia and ICU-hospital-acquired pneumonia mortality
due to P. aeruginosa and the ESKAPE group.
CONCLUSIONS: In a large cohort of patients, we found that both
ICU-hospital-acquired pneumonia and ventilator-associated pneumonia were
associated with an 82% and a 38% increase in the risk of 30-day mortality,
respectively. This study emphasized the importance of preventing
ICU-hospital-acquired pneumonia in nonventilated patients.
DOI: 10.1097/CCM.0000000000003553
PMID: 30407949 [Indexed for MEDLINE]