title: Impact of ureido/carboxypenicillin resistance on the prognosis of ventilator-associated pneumonia due to Pseudomonas aeruginosa.
abstract: BACKGROUND
  Although Pseudomonas aeruginosa is a leading pathogen responsible for ventilator-associated pneumonia (VAP), the excess in mortality associated with multi-resistance in patients with P. aeruginosa VAP (PA-VAP), taking into account confounders such as treatment adequacy and prior length of stay in the ICU, has not yet been adequately estimated.
  
  
  METHODS
  A total of 223 episodes of PA-VAP recorded into the Outcomerea database were evaluated. Patients with ureido/carboxy-resistant P. aeruginosa (PRPA) were compared with those with ureido/carboxy-sensitive P. aeruginosa (PSPA) after matching on duration of ICU stay at VAP onset and adjustment for confounders.
  
  
  RESULTS
  Factors associated with onset of PRPA-VAP were as follows: admission to the ICU with septic shock, broad-spectrum antimicrobials at admission, prior use of ureido/carboxypenicillin, and colonization with PRPA before infection. Adequate antimicrobial therapy was more often delayed in the PRPA group. The crude ICU mortality rate and the hospital mortality rate were not different between the PRPA and the PSPA groups. In multivariate analysis, after controlling for time in the ICU before VAP diagnosis, neither ICU death (odds ratio (OR) = 0.73; 95% confidence interval (CI): 0.32 to 1.69; P = 0.46) nor hospital death (OR = 0.87; 95% CI: 0.38 to 1.99; P = 0.74) were increased in the presence of PRPA infection. This result remained unchanged in the subgroup of 87 patients who received adequate antimicrobial treatment on the day of VAP diagnosis.
  
  
  CONCLUSIONS
  After adjustment, and despite the more frequent delay in the initiation of an adequate antimicrobial therapy in these patients, resistance to ureido/carboxypenicillin was not associated with ICU or hospital death in patients with PA-VAP.
authors.affiliation: Surgical ICU, Hôpital Edouard Herriot, 5 place d'Arsonval, Lyon 69437, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kaminski
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Yohann
authors.initials: Y
authors.lastname: Dubois
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Maïté
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Céline
authors.initials: C
authors.lastname: Feger
authors.forename: Anne-Sylvie
authors.initials: AS
authors.lastname: Dumenil
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002228:Carbenicillin / Q000627:therapeutic use*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology; D011379:Prognosis; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002228:Carbenicillin