Outcomes of ventilated COPD patients with nosocomial tracheobronchitis: a case-control study.
BACKGROUND
The aim of this study was to determine the impact of nosocomial tracheobronchitis (NTB) related to new bacteria on the outcome in patients with chronic obstructive pulmonary disease (COPD).


METHODS
A prospective observational case-control study was conducted in medical COPD patients requiring intubation and mechanical ventilation for more than 48 hours. Patients with nosocomial pneumonia were excluded. Six matching criteria were used, including the duration of mechanical ventilation before NTB occurrence.


RESULTS
81 matched case-control pairs were studied. Although the mortality rate was similar (40% vs 34%; p = 0.48), median duration of mechanical ventilation (20 vs 12 days; p = 0.015) and intensive care unit (ICU) stay (25 vs 18 days; p = 0.022) were higher in cases than in controls. NTB was independently associated with a longer than median period of mechanical ventilation among case and control patients (OR = 4.7 [95%CI = 2-10.9]; p < 0.001). In cases with appropriate antibiotic treatment compared with those who did not receive antibiotics, a shorter median duration of mechanical ventilation (12 vs 23 days; p = 0.006) and ICU stay (16 vs 29 days; p = 0.029) were observed.


CONCLUSIONS
NTB is associated with an increased duration of mechanical ventilation and ICU stays. Further studies are required to determine whether antibiotics could improve the outcome of patients with NTB.
Intensive Care Unit, Calmette Hospital, Regional University Center, Boulevard du Pr Leclercq, F-59037, Lille cedex, France. s-nseir@chru-lille.fr
S
S
Nseir
C
C
Di Pompeo
S
S
Soubrier
P
P
Delour
T
T
Onimus
F
F
Saulnier
A
A
Durocher
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001991:Bronchitis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D016022:Case-Control Studies; D003428:Cross Infection / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000473:pathology; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D014133:Tracheal Diseases / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents