title: Pseudomonas aeruginosa ventilator-associated pneumonia: comparison of episodes due to piperacillin-resistant versus piperacillin-susceptible organisms.
abstract: We sought to determine the epidemiological characteristics of patients in an intensive care unit (ICU) who developed ventilator-associated pneumonia (VAP) caused by piperacillin-resistant Pseudomonas aeruginosa (PRPA; n=34) or piperacillin-susceptible P. aeruginosa (PSPA; n=101). According to univariate analysis, the factors associated with the development of PRPA VAP were presence of an underlying fatal medical condition, immunocompromised status, longer previous hospital stay, less-severe illness at the time of ICU admission, duration of mechanical ventilation before onset of VAP, number of classes of antibiotic received, and previous exposure to imipenem or fluoroquinolone. Multivariate logistic regression analysis identified the following significant independent factors: presence of an underlying fatal medical condition (odds ratio [OR], 5.6), previous fluoroquinolone use (OR, 4.6), and initial disease severity (OR, 0.8). We concluded that the clinical characteristics of patients who develop PRPA VAP differ from those of patients who develop PSPA VAP. Restricted fluoroquinolone use is the sole independent risk factor for PRPA VAP that is open to medical intervention.
authors.affiliation: Hôpital Pitie-Salpêtrière, 75651 Paris Cedex 13, France. jean-louis.trouillet@psl.ap-hop-paris.fr
authors.forename: J L
authors.initials: JL
authors.lastname: Trouillet
authors.forename: A
authors.initials: A
authors.lastname: Vuagnat
authors.forename: A
authors.initials: A
authors.lastname: Combes
authors.forename: N
authors.initials: N
authors.lastname: Kassis
authors.forename: J
authors.initials: J
authors.lastname: Chastre
authors.forename: C
authors.initials: C
authors.lastname: Gibert
mesh_terms: D000368:Aged; D002228:Carbenicillin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010403:Penicillin Resistance; D010406:Penicillins / Q000627:therapeutic use; D010878:Piperacillin / Q000494:pharmacology*; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012121:Respiration, Artificial; D012307:Risk Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical
chemical_list: D010406:Penicillins; D002228:Carbenicillin; D010878:Piperacillin