title: COPD patients with ventilator-associated pneumonia: implications for management.
abstract: Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.
authors.affiliation: 2nd Critical Care Department, Attikon University Hospital, Athens, Greece.|Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Koulenti
authors.affiliation: Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. stijn.blot@UGent.be.|Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. stijn.blot@UGent.be.
authors.forename: S
authors.initials: S
authors.lastname: Blot
authors.affiliation: Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.|Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Dulhunty
authors.affiliation: Department of Intensive Care Medicine, Réanimation des Détresses Respiratoires et Infections Sévères Hôpital Nord-Assistance Publique-Hôpitaux de Marseille Aix-Marseille Université, Μarseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Papazian
authors.affiliation: Department of Intensive Care Medicine, Corporació Sanitària Parc Taulí, Sabadell, Spain.|Department of Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.|Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Martin-Loeches
authors.affiliation: 2nd Critical Care Department, Attikon University Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Dimopoulos
authors.affiliation: Department of Intensive Care Medicine, Henri-Mondor University Hospital, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: Department of Intensive Care Medicine, St. Jan Hospital, Bruges, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Nauwynck
authors.affiliation: Department of Intensive Care Medicine, Bonn University Hospital, Bonn, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Putensen
authors.affiliation: Department of Intensive Care Medicine, Dr. Negrin University Hospital, Las Palmas, Gran Canaria, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sole-Violan
authors.affiliation: 2nd Critical Care Department, Attikon University Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Armaganidis
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.|Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents