title: Early ICU energy deficit is a risk factor for Staphylococcus aureus ventilator-associated pneumonia.
abstract: BACKGROUND
  Caloric insufficiency during the first week of ICU stay has been associated with increased infection rates. The connection between specific pathogens and host nutritional status in the ICU is not well known. This study was undertaken to determine the impact of patients' early in-ICU energy balance on the pathogens responsible for ventilator-associated pneumonia (VAP).
  
  
  METHODS
  In this prospective, observational, cohort study conducted in a teaching hospital ICU, energy balance (energy delivered - calculated resting energy expenditure) was compared according to the microbiologic results of the fiber-optic BAL cultures of 76 consecutive patients receiving acute prolonged (≥ 96 h) mechanical ventilation who developed VAP during their ICU stay.
  
  
  RESULTS
  Among the 76 BAL cultures, 22 contained significant Staphylococcus aureus concentrations. The cumulated energy deficit of patients with S aureus VAP was greater than those with VAP caused by other pathogens (-10,275 ± 4,211 kcal vs -7,376 ± 4,013 kcal from ICU admission to day of BAL, P < .01). ICU admission, nutritional status, and conditions potentially limiting feeding did not differ significantly between the two groups. Patients with S aureus VAP had lower prescribed and delivered energy, causing higher energy deficits. Multivariate analysis identified energy deficit as being independently associated with S aureus VAP. More-severe energy deficit and higher rate of S aureus-positive BAL cultures (P = .01 comparing quartiles) were observed.
  
  
  CONCLUSIONS
  Early ICU energy deficit is an independent determinant for acquiring S aureus VAP in patients on acute prolonged mechanical ventilation.
authors: Medical Intensive Care Unit, European Georges Pompidou Hospital, University Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: christophe.faisy@egp.aphp.fr.
authors: Christophe
authors: C
authors: Faisy
authors: Intensive Care Unit, San Isidro Central Hospital Melchor Angel Posse, Buenos Aires, Argentina.
authors: Maria
authors: M
authors: Candela Llerena
authors: Medical Intensive Care Unit, European Georges Pompidou Hospital, University Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors: Magali
authors: M
authors: Savalle
authors: Department of Microbiology, European Georges Pompidou Hospital, University Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors: Jean-Luc
authors: JL
authors: Mainardi
authors: Medical Intensive Care Unit, European Georges Pompidou Hospital, University Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors: Jean-Yves
authors: JY
authors: Fagon
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D053717:Pneumonia, Ventilator-Associated / Q000378:metabolism* / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000378:metabolism*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D018709:Statistics, Nonparametric