COPD patients with ventilator-associated pneumonia: implications for management

Koulenti, D., Blot, S., Dulhunty, J.M., Papazian, L., Martin-Loeches, I., Dimopoulos G., Brun-Buisson C., Nauwynck M., Putensen C., Sole-Violan J., Armaganidis A., Rello J. and The Eu-Vap/Cap Study Group (2015) COPD patients with ventilator-associated pneumonia: implications for management. European Journal of Clinical Microbiology and Infectious Diseases, 34 12: 2403-2411. doi:10.1007/s10096-015-2495-6


Author Koulenti, D.
Blot, S.
Dulhunty, J.M.
Papazian, L.
Martin-Loeches, I.
Dimopoulos G.
Brun-Buisson C.
Nauwynck M.
Putensen C.
Sole-Violan J.
Armaganidis A.
Rello J.
The Eu-Vap/Cap Study Group
Title COPD patients with ventilator-associated pneumonia: implications for management
Journal name European Journal of Clinical Microbiology and Infectious Diseases   Check publisher's open access policy
ISSN 1435-4373
0934-9723
Publication date 2015-09-25
Year available 2015
Sub-type Article (original research)
DOI 10.1007/s10096-015-2495-6
Open Access Status Not yet assessed
Volume 34
Issue 12
Start page 2403
End page 2411
Total pages 9
Place of publication Heidelberg, Germany
Publisher Springer
Language eng
Abstract Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.
Formatted abstract
Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1 %) had COPD; 79 (19.9 %) patients with COPD and 332 (19.7 %) patients without COPD developed VAP. ICU mortality increased by 17 % (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95 % confidence interval (CI) 1.35–3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1 % vs. 18.7 %, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3 % vs. 13.3 %, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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