Antibiotics against Pseudomonas aeruginosa for COPD exacerbation in ICU: a 10-year retrospective study.
CONCLUSIONS
Chronic obstructive pulmonary disease (COPD) is a frequent source of hospitalization. Antibiotics are largely prescribed during COPD exacerbation. Our hypothesis is that large broad-spectrum antibiotics are more and more frequently prescribed. Our results confirm this trend and highlight that the increase in large broad-spectrum use in COPD exacerbation is largely unexplained.


BACKGROUND
Acute COPD exacerbation (AECOPD) is frequently due to respiratory tract infection, and the benefit of antipseudomonal antibiotics (APA) is still debated. Health care-associated pneumonia (HCAP) was defined in 2005 and requires broad-spectrum antibiotherapy. The main objectives are to describe the antibiotic use for AECOPD in intensive care unit and to identify factors associated with APA use and AECOPD prognosis.


METHODS
We conducted a monocentric, retrospective study on all AECOPDs in the intensive care unit treated by antibiotics for respiratory tract infection. Treatment failure (TF) was defined by death, secondary need for mechanical ventilation, or secondary systemic steroid treatment. A multivariate analysis was used to assess factors associated with APA prescription and TF.


RESULTS
From January 2000 to December 2011, 111 patients were included. Mean age was 69 years (±12), mean forced expiratory volume 38% of theoretic value (±13). Thirty-five (31%) patients were intubated, and 52 (47%) were treated with noninvasive ventilation. From 107 patients, 8 (7%) cases of Pseudomonas aeruginosa were documented. APAs were prescribed in 21% of patients before 2006 versus 57% after (P=0.001). TF prevalence was 31%. Risk factors for P. aeruginosa in COPD and HCAP diagnosis did not influence APA, whereas the post-2006 period was independently associated with APA prescription (odds ratio 6.2; 95% confidence interval 1.9-20.3; P=0.0013). APA did not improve TF (odds ratio 1.09; 95% confidence interval 0.37-3.2).


CONCLUSIONS
HCAP guidelines were followed by an increase in APA use in AECOPD, without an improvement in prognosis. HCAP prevalence cannot account for the increasing APA trend. Time effect reveals a drift in practices. The microbiological effect of such a drift must be evaluated.
Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France ; Unité de Biostatistique Médicale, Hôpital Lyon Sud, Lyon, France ; Service de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France ; Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, Université Paris René Descartes, Paris, France.
Benjamin
B
Planquette
Unité de Biostatistique Médicale, Hôpital Lyon Sud, Lyon, France.
Julien
J
Péron
Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France.
Etienne
E
Dubuisson
Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France.
Ariane
A
Roujansky
Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France.
Virginie
V
Laurent
Service de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Alban
A
Le Monnier
Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France.
Stephane
S
Legriel
Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, Université Paris René Descartes, Paris, France.
Alexis
A
Ferre
Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France.
Fabrice
F
Bruneel
Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, CA, USA.
Peter G
PG
Chiles
Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France.
Jean P
JP
Bedos
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000472:pathogenicity; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
D000900:Anti-Bacterial Agents
COPD; ICU; Pseudomonas aeurginosa; antibiotics; exacerbation