Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study

Koulenti, D., Tsigou, E. and Rello, J. (2016) Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study. European Journal of Clinical Microbiology and Infectious Diseases, 1-8. doi:10.1007/s10096-016-2703-z


Author Koulenti, D.
Tsigou, E.
Rello, J.
Title Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study
Journal name European Journal of Clinical Microbiology and Infectious Diseases   Check publisher's open access policy
ISSN 1435-4373
0934-9723
Publication date 2016-06-10
Sub-type Article (original research)
DOI 10.1007/s10096-016-2703-z
Open Access Status Not yet assessed
Start page 1
End page 8
Total pages 8
Place of publication Heidelberg, Germany
Publisher Springer
Collection year 2017
Language eng
Formatted abstract
We report on intensive care nosocomial pneumonia (NP) in Europe through a review of EU-VAP/CAP manuscripts: a prospective observational study, enrolling patients from 27 ICUs in nine European countries. From 2,436 eligible ICU patients, 827 cases presented NP, with 18.3 episodes of VAP per 1000 ventilator-days. Most common findings were worsening oxygenation, purulent respiratory secretions and temperature increase. At least three criteria from Clinical Pulmonary Infection score (CPIS) were present in 77.9 % of episodes, but only 0.2 % met six CPIS criteria. Diagnosis was confirmed mainly noninvasively (74.8 %), with half qualitative and quantitative cultures. The dominant isolate was S. aureus in Spain, France, Belgium and Ireland, P. aeruginosa in Italy and Portugal, Acinetobacter in Greece and Turkey, but Escherichia coli in Germany. NP resulted in 6 % higher mortality, longer ICU stay and duration of mechanical ventilation (12 and 10 days). COPD and age ≥45 years were not associated with higher VAP incidence but did correlate with increased mortality. Trauma had higher VAP incidence but lower mortality. Bacteremia (led by MRSA and Acinetobacter baumannii) was documented in 14.6 %, being associated with extra ICU stay and mortality. Vasopressors and ICUs with above 25 % prevalence of Potential Resistant Organisms (PRM) were independently associated with PRM, being documented in 50.7 % of patients with early-onset VAP without known risk factors. Most patients initially received combination therapy. Delay in appropriate antimicrobial choice significantly increased mortality, and LOS in survivors was six days longer (p < 0.05). In conclusion, NP management in Europe presents local differences and major shifts when compared to reports from North America, outcomes of randomized trials and general guidelines.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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