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COPD patients with ventilator-associated pneumonia: implications for management

Despoina Koulenti, Stijn Blot UGent, Joel M Dulhunty, Laurent Papazian, Ignacio Martin-Loeches, George Dimopoulos, Christian Brun-Buisson, Marc Nauwynck, C Putensen, Jorge Sole-Violan, et al. (2015) EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES. 34(12). p.2403-2411
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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
COMMUNITY-ACQUIRED PNEUMONIA, OBSTRUCTIVE PULMONARY-DISEASE, INTENSIVE-CARE UNITS, RISK-FACTORS, INHALED CORTICOSTEROIDS, PSEUDOMONAS-AERUGINOSA, TRAUMA PATIENTS, ORGAN FAILURE, MORTALITY, IMPACT
journal title
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
Eur. J. Clin. Microbiol. Infect. Dis.
volume
34
issue
12
pages
2403 - 2411
Web of Science type
Article
Web of Science id
000365424200012
JCR category
INFECTIOUS DISEASES
JCR impact factor
2.857 (2015)
JCR rank
29/83 (2015)
JCR quartile
2 (2015)
ISSN
0934-9723
DOI
10.1007/s10096-015-2495-6
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
6964783
handle
http://hdl.handle.net/1854/LU-6964783
date created
2015-10-21 16:36:54
date last changed
2016-12-19 15:45:27
@article{6964783,
  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 {\textlangle} 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 {\textrangle} 13 days in ICU stay (p {\textlangle} 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.},
  author       = {Koulenti, Despoina and Blot, Stijn and Dulhunty, Joel M and Papazian, Laurent and Martin-Loeches, Ignacio and Dimopoulos, George and Brun-Buisson, Christian and Nauwynck, Marc and Putensen, C and Sole-Violan, Jorge and Armaganidis, A and Rello, Jordi},
  issn         = {0934-9723},
  journal      = {EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY \& INFECTIOUS DISEASES},
  keyword      = {COMMUNITY-ACQUIRED PNEUMONIA,OBSTRUCTIVE PULMONARY-DISEASE,INTENSIVE-CARE UNITS,RISK-FACTORS,INHALED CORTICOSTEROIDS,PSEUDOMONAS-AERUGINOSA,TRAUMA PATIENTS,ORGAN FAILURE,MORTALITY,IMPACT},
  language     = {eng},
  number       = {12},
  pages        = {2403--2411},
  title        = {COPD patients with ventilator-associated pneumonia: implications for management},
  url          = {http://dx.doi.org/10.1007/s10096-015-2495-6},
  volume       = {34},
  year         = {2015},
}

Chicago
Koulenti, Despoina, Stijn Blot, Joel M Dulhunty, Laurent Papazian, Ignacio Martin-Loeches, George Dimopoulos, Christian Brun-Buisson, et al. 2015. “COPD Patients with Ventilator-associated Pneumonia: Implications for Management.” European Journal of Clinical Microbiology & Infectious Diseases 34 (12): 2403–2411.
APA
Koulenti, Despoina, Blot, S., Dulhunty, J. M., Papazian, L., Martin-Loeches, I., Dimopoulos, G., Brun-Buisson, C., et al. (2015). COPD patients with ventilator-associated pneumonia: implications for management. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 34(12), 2403–2411.
Vancouver
1.
Koulenti D, Blot S, Dulhunty JM, Papazian L, Martin-Loeches I, Dimopoulos G, et al. COPD patients with ventilator-associated pneumonia: implications for management. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES. 2015;34(12):2403–11.
MLA
Koulenti, Despoina, Stijn Blot, Joel M Dulhunty, et al. “COPD Patients with Ventilator-associated Pneumonia: Implications for Management.” EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES 34.12 (2015): 2403–2411. Print.