Author:
Galerneau Louis-Marie,Bailly Sébastien,Terzi Nicolas,Ruckly Stéphane,Garrouste-Orgeas Maité,Oziel Johanna,Hong Tuan Ha Vivien,Gainnier Marc,Siami Shidasp,Dupuis Claire,Forel Jean-Marie,Dartevel Anaïs,Dessajan Julien,Adrie Christophe,Goldgran-Toledano Dany,Laurent Virginie,Argaud Laurent,Reignier Jean,Pepin Jean-Louis,Darmon Michael,Timsit Jean-François,Timsit Jean-François,Azoulay Elie,Garrouste-Orgeas Maïté,Zahar Jean-Ralph,Mourvillier Bruno,Darmon Michael,Alberti Corinne,Ruckly Stephane,Bailly Sébastien,Vannieuwenhuyze Aurélien,Adrie Christophe,Agasse Carole,Allaouchiche Bernard,Andremont Olivier,Andreu Pascal,Argaud Laurent,Ara-Somohano Claire,Azoulay Elie,Barbier Francois,Bedos Jean-Pierre,Baudry Thomas,Bohé Julien,Bouadma Lila,Bourenne Jeremy,Brule Noel,Chemouni Frank,Coupez Julien Carvelli Elisabeth,Darmon Michael,Dupuis Claire,de Montmollin Etienne,Dopeux Loa,Dumenil Anne-Sylvie,Dupuis Claire,Forel Jean-Marc,Gainnier Marc,Garret Charlotte,Goldgran-Tonedano Dany,Grangé Steven,Gros Antoine,Hammed Hédia,Haouache Akim,Hissem Tarik,Ha Vivien Hong Tuan,Jochmans Sébastien,Joffredo Jean-Baptiste,Kallel Hatem,Lacave Guillaume,Laurent Virgine,Lautrette Alexandre,Le bihan Clément,Lemiale Virgine,Luis David,Marcotte Guillaume,Lebut Jordane,Mourvillier Bruno,Misset Benoît,Mourvillier Bruno,Neuville Mathild,Nicolet Laurent,Oziel Johanna,Papazian Laurent,Patrier Juliette,Planquette Benjamin,Radjou Aguila,Simon Marie,Sonneville Romain,Reignier Jean,Souweine Bertrand,Schwebel Carole,Siami Shidasp,Sonneville Romain,Terzi Nicolas,Troché Gilles,Thiollieres Fabrice,Thierry Guillaume,Van Der Meersch Guillaume,Venot Marion,Wallet Florent,Yaacoubi Sondes,Zambon Olivier,Zarka Jonathan,Adda Mireille,Vindrieux Vanessa,Provent Marion,de la Salle Sylvie,Enguerrand Pauline,Gobert Vincent,Guessens Stéphane,Merle Helene,Kaddour Nadira,Berthe Boris,Bekkhouche Samir,Mellouk Kaouttar,Lebrazic Mélaine,Ouisse Carole,Maugars Diane,Aparicio Christelle,Theodose Igor,Nouacer Manal,Deiler Veronique,Lamara Fariza,Moussa Myriam,Mouaci Atika,Viguier Nassima,
Abstract
Abstract
Background
Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients.
Methods
Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU.
Results
Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01).
Conclusion
We found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine