title: Five-year trends for ventilator-associated pneumonia: Correlation between microbiological findings and antimicrobial drug consumption.
abstract: The epidemiology of multidrug-resistant bacteria (MDRB) has changed significantly in European healthcare settings, with a decrease in frequency of meticillin-resistant Staphylococcus aureus and an increase in extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Little is known about the effects of these changes on ventilator-associated pneumonia (VAP). A retrospective 5-year trend analysis of ICU antibiotic consumption and resistance in bacteria causing VAP was undertaken. Poisson regression analysis between complete microbiological data and antibiotic consumption was performed. In total, 252 episodes of VAP in 184 patients were identified between 2007 and 2011, from which 364 causal bacteria were isolated. Enterobacteriaceae isolation rates increased significantly over this period [from 6.64 to 10.52 isolates/1000 patient-days; P=0.006], mostly due to an increase in AmpC-producing Enterobacteriaceae (APE) (2.85-4.51 isolates/1000 patient-days; P=0.013), whereas the number of episodes due to S. aureus and Pseudomonas aeruginosa remained stable. A positive association was found between the increase in APE infections and an increase in past-year antibiotic consumption: amoxicillin/clavulanic acid (P=0.003), ceftazidime and cefepime (P=0.007), carbapenems (P=0.002), fluoroquinolones (P=0.012), macrolides (P=0.002) and imidazoles (P=0.004). No such association was found for the emergence of resistance in P. aeruginosa. These results indicate a change in the epidemiology of VAP, with Enterobacteriaceae exceeding P. aeruginosa and S. aureus. Moreover, a positive correlation was observed between antibiotic consumption and the incidence of potentially MDRB such as APE. No such correlation was found for ESBL-producing Escherichia coli and antibiotic-resistant P. aeruginosa.
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Microbiologie-Hygiène, 178 rue des Renouillers, F-92700 Colombes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Fihman
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, UMR 1137, F-75018 Paris, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Messika
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, 178 rue des Renouillers, F-92700 Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010 Paris, France; INSERM, ECEVE, U1123, F-75010 Paris, France; INSERM, CIE-1425, F-75018 Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Hajage
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Pharmacie, 178 rue des Renouillers, F-92700 Colombes, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Tournier
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, UMR 1137, F-75018 Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gaudry
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Microbiologie-Hygiène, 178 rue des Renouillers, F-92700 Colombes, France.
authors.forename: Fatma
authors.initials: F
authors.lastname: Magdoud
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Microbiologie-Hygiène, 178 rue des Renouillers, F-92700 Colombes, France.
authors.forename: Guilène
authors.initials: G
authors.lastname: Barnaud
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Microbiologie-Hygiène, 178 rue des Renouillers, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, UMR 1137, F-75018 Paris, France.
authors.forename: Typhaine
authors.initials: T
authors.lastname: Billard-Pomares
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Microbiologie-Hygiène, 178 rue des Renouillers, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, UMR 1137, F-75018 Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Branger
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, UMR 1137, F-75018 Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Nord Val de Seine, Hôpital Louis Mourier, Service de Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, UMR 1137, F-75018 Paris, France. Electronic address: jean-damien.ricard@lmr.aphp.fr.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Antibiotic usage; Intensive care unit; Ventilator-associated pneumonia