Impact of ventilator-associated pneumonia on outcome in patients with COPD.
OBJECTIVE
The aim of this study was to determine the impact of ventilator-associated pneumonia (VAP) on outcome in patients with COPD.


METHODS
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.


RESULTS
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.


CONCLUSIONS
VAP is associated with increased mortality rates and longer duration of MV and ICU stay in COPD patients.
Nseir
Saad
S
Intensive Care Unit, Calmette Hospital, Regional University Centre, Lille II University, France. s-nseir@chru-lille.fr
Di Pompeo
Christophe
C
Soubrier
Stéphane
S
Cavestri
Béatrice
B
Jozefowicz
Elsa
E
Saulnier
Fabienne
F
Durocher
Alain
A
D000368:Aged; D016022:Case-Control Studies; D003428:Cross Infection; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000209:etiology* / Q000382:microbiology / Q000401:mortality*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects*; D013997:Time Factors