Global Prospective Epidemiologic and Surveillance Study of Ventilator-Associated Pneumonia due to Pseudomonas aeruginosa*
Top Cited Papers
- 1 October 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 42 (10), 2178-2187
- https://doi.org/10.1097/ccm.0000000000000510
Abstract
Objective: To estimate the prevalence of ventilator-associated pneumonia caused by Pseudomonas aeruginosa in patients at risk for ventilator-associated pneumonia and to describe risk factors for P. aeruginosa ventilator-associated pneumonia. Design: Prospective, observational study. Setting: ICUs at 56 sites in 11 countries across four regions: the United States (n = 502 patients), Europe (n = 495), Latin America (n = 500), and Asia Pacific (n = 376). Patients: Adults intubated and mechanically ventilated for 48 hours to 7 days, inclusive. Interventions: None (local standard of care). Measurements and Main Results: Ventilator-associated pneumonia prevalence as defined by local investigators were 15.6% (293/1,873) globally, 13.5% in the United States, 19.4% in Europe, 13.8% in Latin America, and 16.0% in Asia Pacific (p = 0.04). Corresponding P. aeruginosa ventilator-associated pneumonia prevalences were 4.1%, 3.4%, 4.8%, 4.6%, and 3.2% (p = 0.49). Of 50 patients with P. aeruginosa ventilator-associated pneumonia who underwent surveillance testing, 19 (38%) had prior P. aeruginosa colonization and 31 (62%) did not (odds ratio, 7.99; 95% CI, 4.31-14.71). Of predefined risk factors for multidrug resistance (hereafter, risk factors), the most frequent in all patients were antimicrobial therapy within 90 days (51.9% of enrolled patients) and current hospitalization of more than or equal to 5 days (45.3%). None of these risk factors were significantly associated with P. aeruginosa ventilator-associated pneumonia by multivariate logistic regression. Risk factors associated with prior P. aeruginosa colonization were antimicrobial therapy within 90 days (odds ratio, 0.46; 95% CI, 0.29-0.73) and high proportion of antibiotic resistance in the community or hospital unit (odds ratio, 1.79; 95% CI, 1.14-2.82). Conclusions: Our findings suggest that ventilator-associated pneumonia remains a common ICU infection and that P. aeruginosa is one of the most common causative pathogens. The odds of developing P. aeruginosa ventilator-associated pneumonia were eight times higher in patients with prior P. aeruginosa colonization than in uncolonized patients, which in turn was associated with local resistance.Keywords
This publication has 31 references indexed in Scilit:
- Identification of broadly protective human antibodies toPseudomonas aeruginosaexopolysaccharide Psl by phenotypic screeningThe Journal of Experimental Medicine, 2012
- Economic Impact of Ventilator-Associated Pneumonia in a Large Matched CohortInfection Control & Hospital Epidemiology, 2012
- Attributable Mortality of Ventilator-Associated PneumoniaAmerican Journal of Respiratory and Critical Care Medicine, 2011
- Multidrug-Resistant Pseudomonas aeruginosa Ventilator-Associated Pneumonia: The Role of Endotracheal Aspirate Surveillance CulturesAnnals of Pharmacotherapy, 2009
- CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care settingAmerican Journal of Infection Control, 2008
- Ventilator-associated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: Prevalence, incidence, risk factors, and outcomesJournal of Critical Care, 2008
- Previous cultures are not clinically useful for guiding empiric antibiotics in suspected ventilator-associated pneumonia: Secondary analysis from a randomized trialJournal of Critical Care, 2008
- Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: An observational, multicenter study comparing monotherapy with combination antibiotic therapy*Critical Care Medicine, 2007
- Incidence, risk factors, and outcome of ventilator-associated pneumoniaJournal of Critical Care, 2006
- Ventilator-associated pneumonia after heart surgery: A prospective analysis and the value of surveillance*Critical Care Medicine, 2003