Multidrug-resistant Pseudomonas aeruginosa and mortality in mechanically ventilated ICU patients.
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ pharmacology
Drug Resistance, Multiple, Bacterial
Female
France
Hospitals
Humans
Intensive Care Units
Male
Middle Aged
Pneumonia, Ventilator-Associated
/ microbiology
Pseudomonas Infections
/ microbiology
Pseudomonas aeruginosa
/ drug effects
Respiration, Artificial
/ adverse effects
Retrospective Studies
Survival Analysis
Young Adult
Empirical antiobiotic
Intensive care medicine
Multidrug resistance
Nosocomial pneumonia
Recurrence
Ventilator-associated pneumonia
Journal
American journal of infection control
ISSN: 1527-3296
Titre abrégé: Am J Infect Control
Pays: United States
ID NLM: 8004854
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
02
10
2018
revised:
26
02
2019
accepted:
27
02
2019
pubmed:
10
4
2019
medline:
15
5
2020
entrez:
10
4
2019
Statut:
ppublish
Résumé
The link between bacterial resistance and prognosis remains controversial. Predominant pathogen causing ventilator-associated pneumonia (VAP) is Pseudomonas aeruginosa (Pa), which has increasingly become multidrug resistant (MDR). The aim of this study was to evaluate the relationship between MDR VAP Pa episodes and 30-day mortality. From a longitudinal prospective French multicenter database (2010-2016), Pa VAP onset and physiological data were recorded. MDR was defined as non-susceptibility to at least 1 agent in 3 or more antimicrobial categories. To analyze if MDR episodes were associated with greater in-hospital 30-day mortality, we performed a multivariate survival analysis using the multivariate nonlinear frailty model. A total of 230 patients presented 286 Pa VAP. A maximum of 3 episodes per patient was observed; 73 episodes were MDR and 213 were susceptible. In the multivariate model, factors independently associated with 30-day mortality included hospitalization in the 6 months preceding the first episode (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.50-3.60; P = .0002), chronic renal failure (HR, 2.34; 95% CI, 1.15-4.77; P = .0196), and Pa VAP recurrence (HR, 2.29; 95% CI, 1.79-4.87; P = .032). Finally, MDR Pa VAP was not associated with death (HR, 0.87; 95% CI; 0.52-1.45; P = .59). This study did not identify a relationship between the resistance profile of Pseudomonas aeruginosa and mortality.
Sections du résumé
BACKGROUND
The link between bacterial resistance and prognosis remains controversial. Predominant pathogen causing ventilator-associated pneumonia (VAP) is Pseudomonas aeruginosa (Pa), which has increasingly become multidrug resistant (MDR). The aim of this study was to evaluate the relationship between MDR VAP Pa episodes and 30-day mortality.
METHODS
From a longitudinal prospective French multicenter database (2010-2016), Pa VAP onset and physiological data were recorded. MDR was defined as non-susceptibility to at least 1 agent in 3 or more antimicrobial categories. To analyze if MDR episodes were associated with greater in-hospital 30-day mortality, we performed a multivariate survival analysis using the multivariate nonlinear frailty model.
RESULTS
A total of 230 patients presented 286 Pa VAP. A maximum of 3 episodes per patient was observed; 73 episodes were MDR and 213 were susceptible. In the multivariate model, factors independently associated with 30-day mortality included hospitalization in the 6 months preceding the first episode (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.50-3.60; P = .0002), chronic renal failure (HR, 2.34; 95% CI, 1.15-4.77; P = .0196), and Pa VAP recurrence (HR, 2.29; 95% CI, 1.79-4.87; P = .032). Finally, MDR Pa VAP was not associated with death (HR, 0.87; 95% CI; 0.52-1.45; P = .59).
CONCLUSIONS
This study did not identify a relationship between the resistance profile of Pseudomonas aeruginosa and mortality.
Identifiants
pubmed: 30962023
pii: S0196-6553(19)30144-0
doi: 10.1016/j.ajic.2019.02.030
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1059-1064Informations de copyright
Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.