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Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study

Adrian Ceccato, Cristina Dominedò, Miquel Ferrer, Ignacio Martin-Loeches, Enric Barbeta, Albert Gabarrús, Catia Cillóniz, Otavio T. Ranzani, Gennaro De Pascale, Stefano Nogas, Pierluigi Di Giannatale, Massimo Antonelli, Antoni Torres
European Respiratory Journal 2022 59: 2100620; DOI: 10.1183/13993003.00620-2021
Adrian Ceccato
1August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona and Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
2Intensive Care Unit, Hospital Universitari Sagrat Cor, Barcelona, Spain
11These authors contributed equally to this work
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  • ORCID record for Adrian Ceccato
Cristina Dominedò
3Dept of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
4Università Cattolica del Sacro Cuore, Rome, Italy
11These authors contributed equally to this work
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Miquel Ferrer
1August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona and Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
5Dept of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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Ignacio Martin-Loeches
1August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona and Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
6Dept of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Trinity College Dublin, Dublin, Ireland
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Enric Barbeta
1August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona and Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
2Intensive Care Unit, Hospital Universitari Sagrat Cor, Barcelona, Spain
5Dept of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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Albert Gabarrús
1August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona and Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
5Dept of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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Catia Cillóniz
1August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona and Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
5Dept of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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Otavio T. Ranzani
7Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
8Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Gennaro De Pascale
3Dept of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
4Università Cattolica del Sacro Cuore, Rome, Italy
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Stefano Nogas
9Dept of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
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Pierluigi Di Giannatale
10University of Chieti-Pescara “Gabriele D'Annunzio”, Hospital of Chieti “SS Annunziata”, Chieti, Italy
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Massimo Antonelli
3Dept of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
4Università Cattolica del Sacro Cuore, Rome, Italy
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Antoni Torres
1August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona and Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
5Dept of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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  • For correspondence: atorres@ub.edu
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Abstract

Background Ventilator-associated pneumonia (VAP) is a leading infectious cause of morbidity in critically ill patients, yet current guidelines offer no indications for follow-up cultures. We aimed to evaluate the role of follow-up cultures and microbiological response 3 days after diagnosing VAP as predictors of short- and long-term outcomes.

Methods We performed a retrospective analysis of a cohort prospectively collected from 2004 to 2017. VAP was diagnosed based on clinical, radiographical and microbiological criteria. For microbiological identification, a tracheobronchial aspirate was performed at diagnosis and repeated after 72 h. We defined three groups when comparing the two tracheobronchial aspirate results: persistence, superinfection and eradication of causative pathogens.

Results 157 patients were enrolled in the study, among whom microbiological persistence, superinfection or eradication was present in 67 (48%), 25 (16%) and 65 (41%), respectively, after 72 h. Those with superinfection had the highest mortalities in the intensive care unit (p=0.015) and at 90 days (p=0.036), while also having the fewest ventilator-free days (p=0.019). Multivariable analysis revealed shock at VAP diagnosis (OR 3.43, 95% CI 1.25–9.40), Staphylococcus aureus isolation at VAP diagnosis (OR 2.87, 95% CI 1.06–7.75) and hypothermia at VAP diagnosis (OR 0.67, 95% CI 0.48–0.95, per +1°C) to be associated with superinfection.

Conclusions Our retrospective analysis suggests that VAP short- and long-term outcomes may be associated with superinfection in follow-up cultures. Follow-up cultures may help guide antibiotic therapy and its duration. Further prospective studies are necessary to verify our findings.

Abstract

Follow-up cultures on day 3 after a VAP diagnosis can help the clinician stratify patients. Those patients who present early with superinfection have worse ICU mortality, worse 90-day mortality and require more days of mechanical ventilation. https://bit.ly/2W5wFLk

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Author contributions: C. Dominedò, A. Ceccato, M. Ferrer, I. Martin-Loeches and A. Torres: conception and design. E. Barbeta, C. Cilloniz and O. Ranzani: acquisition, analysis or interpretation of data. A. Ceccato, C. Dominedò, I. Martin-Loeches, G. De Pascale, S. Nogas, P. Di Giannatale, M. Antonelli and A. Torres: drafting the manuscript for important intellectual content. A. Gabarrús: statistical analysis. A. Ceccato: administrative, technical or material support. A. Torres: study supervision. All authors reviewed, revised and approved the manuscript for submission.

  • Conflict of interest: A. Ceccato has nothing to disclose.

  • Conflict of interest: C. Dominedò has nothing to disclose.

  • Conflict of interest: M. Ferrer has nothing to disclose.

  • Conflict of interest: I. Martin-Loeches has nothing to disclose.

  • Conflict of interest: E. Barbeta has nothing to disclose.

  • Conflict of interest: A Gabarrús has nothing to disclose.

  • Conflict of interest: C. Cilloniz has nothing to disclose.

  • Conflict of interest: O. Ranzani has nothing to disclose.

  • Conflict of interest: G. De Pascale has nothing to disclose.

  • Conflict of interest: S. Nogas has nothing to disclose.

  • Conflict of interest: P. Di Giannatale has nothing to disclose.

  • Conflict of interest: M. Antonelli has nothing to disclose.

  • Conflict of interest: A. Torres has nothing to disclose.

  • Support statement: This study was supported by Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) and August Pi i Sunyer Biomedical Research Institute (IDIBAPS). The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and in the decision to submit the manuscript for publication. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received March 1, 2021.
  • Accepted August 12, 2021.
  • Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
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Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study
Adrian Ceccato, Cristina Dominedò, Miquel Ferrer, Ignacio Martin-Loeches, Enric Barbeta, Albert Gabarrús, Catia Cillóniz, Otavio T. Ranzani, Gennaro De Pascale, Stefano Nogas, Pierluigi Di Giannatale, Massimo Antonelli, Antoni Torres
European Respiratory Journal Apr 2022, 59 (4) 2100620; DOI: 10.1183/13993003.00620-2021

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Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study
Adrian Ceccato, Cristina Dominedò, Miquel Ferrer, Ignacio Martin-Loeches, Enric Barbeta, Albert Gabarrús, Catia Cillóniz, Otavio T. Ranzani, Gennaro De Pascale, Stefano Nogas, Pierluigi Di Giannatale, Massimo Antonelli, Antoni Torres
European Respiratory Journal Apr 2022, 59 (4) 2100620; DOI: 10.1183/13993003.00620-2021
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