The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection

[en] Purpose: Ventilator associated-lower respiratory tract infections (VA-LRTIs), either ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), accounts for most nosocomial infections in intensive care units (ICU) including. Our aim was to determine if appropriate antibiotic treatment in patients with VA-LRTI will effectively reduce mortality in patients who had cardiovascular failure. Methods: This was a pre-planned subanalysis of a large prospective cohort of mechanically ventilated patients for at least 48 h in eight countries in two continents. Patients with a modified Sequential Organ Failure Assessment (mSOFA) cardiovascular score of 4 (at the time of VA-LRTI diagnosis and needed be present for at least 12 h) were defined as having cardiovascular failure. Results: VA-LRTI occurred in 689 (23.2%) out of 2960 patients and 174 (25.3%) developed cardiovascular failure. Patients with cardiovascular failure had significantly higher ICU mortality than those without (58% vs. 26.8%; p < 0.001; OR 3.7; 95% CI 2.6–5.4). A propensity score analysis found that the presence of inappropriate antibiotic treatment was an independent risk factor for ICU mortality in patients without cardiovascular failure, but not in those with cardiovascular failure. When the propensity score analysis was conducted in patients with VA-LRTI, the use of appropriate antibiotic treatment conferred a survival benefit for patients without cardiovascular failure who had only VAP. Conclusions: Patients with VA-LRTI and cardiovascular failure did not show an association to a higher ICU survival with appropriate antibiotic treatment. Additionally, we found that in patients without cardiovascular failure, appropriate antibiotic treatment conferred a survival benefit for patients only with VAP. Trial registry: ClinicalTrials.gov, number NCT01791530. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Martin-Loeches, I.; Department of Anaesthesia and Critical Care Medicine, St. James’s Hospital, Dublin, Ireland, Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, P.O. Box 580, James’s Street, Dublin 8, Ireland, Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain

Torres, A.; Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain

Povoa, P.; Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal, NOVA Medical School, New University of Lisbon, Lisbon, Portugal, Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark

Zampieri, F. G.; HCor Research Institute, Hospital do Coração, São Paulo, Brazil

Salluh, J.; Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio De Janeiro, Brazil

Nseir, S.; Critical Care Center, University Hospital of Lille, Lille University, Lille, France

Ferrer, M.; Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain

Rodriguez, A.; Critical Care Department, Hospital Universitario Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain

Martin-Loeches, I.

Povoa, P.

More authors (154 more)

Language :

English

Title :

The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection

Publication date :

2019

Journal title :

Intensive Care Medicine

ISSN :

0342-4642

eISSN :

1432-1238

Publisher :

Springer

Volume :

Issue :

Pages :

1753-1762

Peer reviewed :

Peer Reviewed verified by ORBi

Funders :

Joint Programming Initiative on Antimicrobial Resistance, JPIAMR: 2018-06335

Available on ORBi :

since 10 December 2019

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Bibliography

de Pascale G, Ranzani OT, Nseir S et al (2017) Intensive care unit patients with lower respiratory tract nosocomial infections: the ENIRRIs project. ERS Monogr. 10.1183/23120541.00092-2017
Coeurjolly J-F, Nguile-Makao M, Timsit J-F, Liquet B (2012) Attributable risk estimation for adjusted disability multistate models: application to nosocomial infections. Biom J 54:600–616. 10.1002/bimj.201100222
Martin-Loeches I, Povoa P, Rodríguez A et al (2015) Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med 3:859–868. 10.1016/S2213-2600(15)00326-4
Grgurich PE, Hudcova J, Lei Y et al (2013) Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr Opin Infect Dis 26:140–150. 10.1097/QCO.0b013e32835ebbd0
Simpson VS, Bailey A, Higgerson RA, Christie LM (2013) Ventilator-associated tracheobronchitis in a mixed medical/surgical pediatric ICU. Chest 144:32–38. 10.1378/chest.12-2343
Keane S, Vallecoccia MS, Nseir S, Martin-Loeches I (2018) How can we distinguish ventilator-associated tracheobronchitis from pneumonia? Clin Chest Med 39:785–796. 10.1016/j.ccm.2018.08.003
Palmer LB, Smaldone GC, Chen JJ et al (2008) Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 36:2008–2013. 10.1097/CCM.0b013e31817c0f9e
Fihman V, Messika J, Hajage D et al (2015) Five-year trends for ventilator-associated pneumonia: correlation between microbiological findings and antimicrobial drug consumption. Int J Antimicrob Agents 46:518–525. 10.1016/j.ijantimicag.2015.07.010
De Bus L, Gadeyne B, Steen J et al (2018) A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit: results from a prospective four-year registration. Crit Care 22:241. 10.1186/s13054-018-2178-7
Martin-Loeches I, Rodriguez AH, Torres A (2018) New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia: USA vs Europe. Curr Opin Crit Care 24:347–352. 10.1097/MCC.0000000000000535
Wilke M, Grube R (2013) Update on management options in the treatment of nosocomial and ventilator assisted pneumonia: review of actual guidelines and economic aspects of therapy. Infect Drug Resist 7:1–7. 10.2147/IDR.S25985
http://www.independent.co.uk/life-style/health-and-families/health-news/antibiotics-resistance-apocalypse-warning-chief-medical-officer-professor-dame-sally-davies-drugs-a7996806.html. Accessed 23 July 2019
Martin-Loeches I, Deja M, Koulenti D et al (2013) Potentially resistant microorganisms in intubated patients with hospital-acquired pneumonia: the interaction of ecology, shock and risk factors. Intensive Care Med. 10.1007/s00134-012-2808-5
Zampieri FG, Póvoa P, Salluh JI et al (2018) Lower respiratory tract infection and short-term outcome in patients with acute respiratory distress syndrome. J Intensive Care Med. 10.1177/0885066618772498
Moreau A-S, Martin-Loeches I, Povoa P et al (2018) Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections. Eur Respir J. 10.1183/13993003.01656-2017
Vincent JL, Moreno R et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710
Rouze A, Martin-Loeches I, Nseir S et al (2018) Community-acquired pneumonia: now you see it, now you don’t! Ann Transl Med 5:442. 10.1183/13993003.01656-2017
Magiorakos A-P, Srinivasan A, Carey RB et al (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281. 10.1111/j.1469-0691.2011.03570.x
White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30:377–399. 10.1002/sim.4067
Kahan BC (2014) Accounting for centre-effects in multicentre trials with a binary outcome—when, why, and how? BMC Med Res Methodol 14:20. 10.1186/1471-2288-14-20
Brookhart MA, Schneeweiss S, Rothman KJ et al (2006) Variable selection for propensity score models. Am J Epidemiol 163:1149–1156. 10.1093/aje/kwj149
Joffe MM, Rosenbaum PR (1999) Invited commentary: propensity scores. Am J Epidemiol 150:327–333. 10.1093/oxfordjournals.aje.a010011
Ho DE, Imai K, King G, Stuart EA (2011) MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw. 10.18637/jss.v042.i08
Hranjec T, Rosenberger LH, Swenson B et al (2012) Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensive-care-unit-acquired infection: a quasi-experimental, before and after observational cohort study. Lancet Infect Dis 12:774–780. 10.1016/S1473-3099(12)70151-2
Rhodes A, Phillips G, Beale R et al (2015) The surviving sepsis campaign bundles and outcome: results from the international multicentre prevalence study on sepsis (the IMPreSS study). Intensive Care Med 41:1620–1628. 10.1007/s00134-015-3906-y
Rhodes A, Evans LE, Alhazzani W et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377. 10.1007/s00134-017-4683-6
Klompas M, Calandra T, Singer M (2018) Antibiotics for sepsis-finding the equilibrium. JAMA 320:1433–1434. 10.1001/jama.2018.12179
Kumar AA, Zarychanski R, Light B et al (2010) Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis. Crit Care Med 38:1773–1785. 10.1097/CCM.0b013e3181eb3ccd
Coopersmith CM, de Backer D, Deutschman CS et al (2018) Surviving sepsis campaign: research priorities for sepsis and septic shock. Intensive Care Med. 10.1007/s00134-018-5175-z
Martin-Loeches I, Martinez M, de Haro C, et al (2012) Impact Of Time To Broad-Spectrum Antibiotic On Mortality Of Severe Sepsis And Septic Shock. Results From The Surviving Sepsis Campaign. Am J Respir Crit Care Med 185:A4004
Feemster LC, Saft HL, Bartlett SJ et al (2018) Patient-centered outcomes research in pulmonary, critical care, and sleep medicine. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 15:1005–1015. 10.1513/AnnalsATS.201806-406WS
Warren MM, Gibb AP, Walsh TS (2005) Antibiotic prescription practice in an intensive care unit using twice-weekly collection of screening specimens: a prospective audit in a large UK teaching hospital. J Hosp Infect 59:90–95. 10.1016/j.jhin.2004.09.014
Kalanuria AA, Ziai W, Zai W, Mirski M (2014) Ventilator-associated pneumonia in the ICU. Crit Care 18:208. 10.1186/cc13775
Forel J-M, Voillet F, Pulina D et al (2012) Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy. Crit Care 16:R65. 10.1186/cc11312
Melsen WG, Rovers MM, Koeman M, Bonten MJM (2011) Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med 39:2736–2742. 10.1097/CCM.0b013e3182281f33
https://clinicaltrials.gov/ct2/show/NCT03012360. Accessed 23 July 2019
Perner A, Gordon AC, De Backer D et al (2016) Sepsis: frontiers in diagnosis, resuscitation and antibiotic therapy. Intensive Care Med 42:1958–1969. 10.1007/s00134-016-4577-z