Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection.
BACKGROUND
Experimental studies suggest that intra-abdominal infection (IAI) induces biological alterations that may affect the risk of lung infection.


OBJECTIVE
To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP).


METHODS
We used data entered into the French prospective multicenter Outcomerea database in 1997-2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included.


RESULTS
Of 2623 database patients meeting the inclusion criteria, 290 (11.1%) had IAI and 2333 (88.9%) had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01) and longer time to VAP (5.0 vs.10.5 days; P<0.01). After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46-0.83; P<0.0017). The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively). Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16).


CONCLUSIONS
In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites.
Medical-Surgical ICU, Groupe Hospitalier Paris Saint Joseph, Paris, France.
François
F
Philippart
Department of Anesthesia and Intensive Care, Gustave Roussy Institute, Villejuif, France.
Gaëlle
G
Bouroche
Université Grenoble 1, U823, Albert Bonniot Institute, La Tronche, France; Medical ICU, Groupe hospitalier Bichat-Claude Bernard, Paris, France.
Jean-François
JF
Timsit
Medical-Surgical ICU, Groupe Hospitalier Paris Saint Joseph, Paris, France; Université Grenoble 1, U823, Albert Bonniot Institute, La Tronche, France.
Maité
M
Garrouste-Orgeas
Medical ICU, Saint Louis Teaching Hospital, Paris, France; Université Paris VII-Denis Diderot, Paris, France.
Elie
E
Azoulay
Medical ICU, St Etienne Hospital, St Etienne, France.
Michael
M
Darmon
Physiology laboratory, Cochin hospital, Paris, France.
Christophe
C
Adrie
Surgical ICU, Edouart Herriot Hospital, Lyon, France; Université Lyon I-Claude Bernard, Lyon, France.
Bernard
B
Allaouchiche
Université Grenoble 1, U823, Albert Bonniot Institute, La Tronche, France; Medical ICU, Albert Michallon Teaching Hospital, Grenoble, France.
Claire
C
Ara-Somohano
Université Grenoble 1, U823, Albert Bonniot Institute, La Tronche, France.
Stéphane
S
Ruckly
Surgical ICU, Antoine Béclère Hospital, Clamart, France.
Anne-Sylvie
AS
Dumenil
Medical ICU, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
Bertrand
B
Souweine
Medical-Surgical ICU, Gonesse Hospital, Gonesse, France.
Dany
D
Goldgran-Toledano
Université Paris VII-Denis Diderot, Paris, France; Medical-Surgical ICU, Gonesse Hospital, Gonesse, France.
Lila
L
Bouadma
Medical-Surgical ICU, Groupe Hospitalier Paris Saint Joseph, Paris, France; Université Paris Descartes, Paris, France.
Benoît
B
Misset
D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D016208:Databases, Factual; D004755:Enterobacteriaceae / Q000254:growth & development; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D059413:Intraabdominal Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000254:growth & development; D012121:Respiration, Artificial; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D013211:Staphylococcus aureus / Q000254:growth & development; D016019:Survival Analysis