Impact of ventilator-associated pneumonia on outcome in patients with COPD

• Published in: Chest Vol. 128; no. 3; p. 1650
• Main Authors: Nseir, Saad, Di Pompeo, Christophe, Soubrier, Stéphane, Cavestri, Béatrice, Jozefowicz, Elsa, Saulnier, Fabienne, Durocher, Alain
• Format: Journal Article
• Language: English
• Published: United States 01-09-2005
• Subjects: Aged; Case-Control Studies; Cross Infection; Female; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Outcome Assessment (Health Care); Pneumonia, Bacterial - etiology; Pneumonia, Bacterial - microbiology; Pneumonia, Bacterial - mortality; Prospective Studies; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - therapy; Respiration, Artificial - adverse effects; Time Factors
• ISSN: 0012-3692
• DOI: 10.1378/chest.128.3.1650

The aim of this study was to determine the impact of ventilator-associated pneumonia (VAP) on outcome in patients with COPD.
Prospective, observational, case-control study conducted in a 30-bed ICU during a 5-year period. All COPD patients who required intubation and mechanical ventilation (MV) for > 48 h were eligible. VAP diagnosis was based on clinical, radiographic, and quantitative microbiologic criteria. Patients with unconfirmed VAP were excluded, as well as patients with ventilator-associated tracheobronchitis without subsequent VAP. Matching (1:1) criteria included MV duration before VAP occurrence, age +/- 5 years, simplified acute physiology score II on ICU admission +/- 5, and ICU admission category. Variables associated with ICU mortality were determined using univariate and multivariate analyses.
A total of 1,241 patients were eligible; 181 patients (14%) were excluded, including 133 patients for VAT and 48 patients for unconfirmed VAP. VAP developed in 77 patients (6%), and all were successfully matched. Pseudomonas aeruginosa was the most frequently isolated bacteria (31%). ICU mortality rate (64% vs 28%), duration of MV (24 +/- 15 d vs 13 +/- 11 d [+/- SD]), and ICU stay (26 +/- 17 d vs 15 +/- 13 d) were significantly (< 0.001) higher in case patients than in control patients. VAP was the only variable independently associated with ICU mortality (odds ratio [OR], 7.7; 95% confidence interval [CI], 3.2 to 18.6; p < 0.001). In VAP patients who received corticosteroids during their ICU stay compared with those who did not receive corticosteroids, mortality rate (50% vs 82%; OR, 1.8; 95% CI, 1.2 to 2.7; p = 0.002), duration of MV (21 +/- 14 d vs 27 +/- 16 d, p = 0.043), and ICU stay (22 +/- 16 d vs 31 +/- 18 d, p = 0.006) were significantly lower.
VAP is associated with increased mortality rates and longer duration of MV and ICU stay in COPD patients.