title: Pseudomonas aeruginosa ventilator-associated pneumonia. predictive factors of treatment failure.
abstract: BACKGROUND
  The predictive factors of treatment failure for ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa (PA) remain uncertain.
  
  
  OBJECTIVE
  To describe PA-VAP recurrence prognosis and to identify associated risk factors in a large cohort of intensive care unit patients with PA-VAP.
  
  
  METHODS
  From the multicenter OUTCOMEREA database (1997-2011), PA-VAP onset and recurrence were recorded. All suspected cases of VAP were confirmed by a positive quantitative culture of a respiratory sample. Multidrug-resistant PA strains were defined by the resistance to two antibiotics among piperacillin, ceftazidime, imipenem, colistine, and fluoroquinolones (FQ). An extensively resistant PA was defined by resistance to piperacillin, ceftazidime, imipenem, and FQ. A treatment failure was defined as a PA-VAP recurrence or by the death occurrence.
  
  
  RESULTS
  A total of 314 patients presented 393 PA-VAP. Failure occurred for 112 of them, including 79 recurrences. Susceptible, multidrug resistant, and extensively resistant PA represented 53.7%, 32%, and 14.3% of the samples, respectively. Factors associated with treatment failure were age (P = 0.02); presence of at least one chronic illness (P = 0.02); limitation of life support (P = 0.0004); a high Sepsis-Related Organ Failure Assessment score (P < 0.0001); PA bacteremia (P = 0.003); and previous use of FQ before the first PA-VAP (P = 0.0007). The failure risk was not influenced by the strain resistance profile or by the biantibiotic treatment, but decreased in case of VAP treatment that includes FQ (subdistribution hazard ratio, 0.5 [0.3-0.7]; P = 0.0006). However, the strain resistance profile slowed down the intensive care unit discharge hazard (subdistribution hazard ratio, 0.6 [0.4-1.0]; P = 0.048).
  
  
  CONCLUSIONS
  Neither resistance profile nor biantibiotic therapy decreased the risk of PA-VAP treatment failure. However, the profile of PA resistance prolonged the length of stay. Better evaluation of the potential benefit of an initial treatment containing FQ requires further randomized trials.
authors: André Mignot Hospital, Versailles-Le Chesnay, France. benjamin.planquette@gmail.com
authors: Benjamin
authors: B
authors: Planquette
authors: Jean-Francois
authors: JF
authors: Timsit
authors: Benoit Y
authors: BY
authors: Misset
authors: Carole
authors: C
authors: Schwebel
authors: Elie
authors: E
authors: Azoulay
authors: Christophe
authors: C
authors: Adrie
authors: Aurélien
authors: A
authors: Vesin
authors: Samir
authors: S
authors: Jamali
authors: Jean-Ralph
authors: JR
authors: Zahar
authors: Bernard
authors: B
authors: Allaouchiche
authors: Bertrand
authors: B
authors: Souweine
authors: Michael
authors: M
authors: Darmon
authors: Anne-Sylvie
authors: AS
authors: Dumenil
authors: Dany
authors: D
authors: Goldgran-Toledano
authors: Bruno H
authors: BH
authors: Mourvillier
authors: Jean-Pierre
authors: JP
authors: Bédos
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012008:Recurrence; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents