Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study
- Adrian Ceccato1,2,11,
- Cristina Dominedò3,4,11,
- Miquel Ferrer1,5,
- Ignacio Martin-Loeches1,6,
- Enric Barbeta1,2,5,
- Albert Gabarrús1,5,
- Catia Cillóniz1,5,
- Otavio T. Ranzani7,8,
- Gennaro De Pascale3,4,
- Stefano Nogas9,
- Pierluigi Di Giannatale10,
- Massimo Antonelli3,4 and
- Antoni Torres1,5⇑
- 1August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
- 2Intensive Care Unit, Hospital Universitari Sagrat Cor, Barcelona, Spain
- 3Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- 4Università Cattolica del Sacro Cuore, Rome, Italy
- 5Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
- 6Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Trinity College Dublin, Dublin, Ireland
- 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
- 9Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
- 10University of Chieti-Pescara 'Gabriele D'Annunzio', Hospital of Chieti 'SS. Annunziata', Chieti, Italy
- 11Equal Contribution
- Antoni Torres (atorres{at}ub.edu)
Abstract
Ventilator-associated pneumonia 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 ventilator-associated pneumonia as predictors of short- and long-term outcomes.
We performed a retrospective analysis of a cohort prospectively collected from 2004 to 2017. Ventilator-associated pneumonia was diagnosed based on clinical, radiographic, 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.
One-hundred-fifty-seven patients were enrolled in the study, among whom microbiological persistence, superinfection, and eradication was present in 67 (48%), 25 (16%), and 65 (41%), respectively, after 72hs. 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 ventilation-free days (p=0.024). Multivariable analysis revealed shock at VAP diagnosis (odds ratios [OR] 3.43; 95% confidence interval [CI] 1.25 to 9.40), Staphylococcus aureus isolation at VAP diagnosis (OR 2.87; 95%CI 1.06 to 7.75), and hypothermia at VAP diagnosis (OR 0.67; 95%CI 0.48 to 0.95, per +1°C) to be associated with superinfection.
Our retrospective analysis suggests that ventilator-associated pneumonia short-term and long-term outcomes may be associated with superinfection in follow-up cultures. Follow-up cultures may help guiding antibiotic therapy and its duration. Further prospective studies are necessary to verify our findings.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Ceccato has nothing to disclose.
Conflict of interest: Dr. Dominedo has nothing to disclose.
Conflict of interest: Dr. Ferrer has nothing to disclose.
Conflict of interest: Dr. Martin-Loeches has nothing to disclose.
Conflict of interest: Dr. Barbeta has nothing to disclose.
Conflict of interest: Mr. Gabarrús has nothing to disclose.
Conflict of interest: Dr. Cilloniz has nothing to disclose.
Conflict of interest: Dr. Ranzani has nothing to disclose.
Conflict of interest: Dr. De Pascale has nothing to disclose.
Conflict of interest: Dr. Nogas has nothing to disclose.
Conflict of interest: Dr. Di Giannatale has nothing to disclose.
Conflict of interest: Dr. Antonelli has nothing to disclose.
Conflict of interest: Dr. Torres has nothing to disclose.
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- Received March 1, 2021.
- Accepted August 12, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org