Excess ICU mortality attributable to ventilator-associated pneumonia: The role of early vs late onset

Vallès, Jordi; Pobo, Angel; Garcia-Esquirol, Oscar; Mariscal, Dolores; Real, Jordi; Fernàndez, R.

doi:10.1007/s00134-007-0721-0

Cited by 114 publications

(85 citation statements)

References 41 publications

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“…24 In unselected populations of mixed ICU patients, an incidence of early-onset pneumonia between 5% and 25% has usually been reported. [25][26][27][28][29] Our rate of 15.5% among liver recipients agrees with previously reported rates of pneumonia after LT ranging from 5% to 34%. [4][5][6][7][8][9][10]30 Two recent studies showed a rate of pneumonia of 21.1% in liver recipients receiving a 3-day prophylactic regimen of CTX and ampicillin and a rate of 18% in living donor-related recipients receiving selective digestive decontamination.…”

Section: Discussionsupporting

confidence: 92%

“…However, in an unselected ICU population, it has been suggested that late-onset pneumonia and not early-onset pneumonia can be associated with excessive mortality. 27,31,32 The SAPS II score, serum lactatemia, and vasopressor requirements on ICU admission were significantly higher in patients who developed E-HAP. They also required immediate postoperative mechanical ventilation exceeding 2 days more frequently.…”

Section: Discussionmentioning

confidence: 95%

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Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum b-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed. Orthotopic liver transplantation (LT) is a widely accepted treatment for patients with end-stage liver disease. Despite global improvements in survival over the last few decades, sepsis remains the leading cause of early postoperative mortality. 1,2 Lower respiratory tract infections are a major concern in this context.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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“…Mortality in patients with VAP is a controversial subject concerning patients admitted to the ICU because the target population is severely ill and the level of associated mortality is high. Several studies have attempted to clarify the issue [3,15,16]. Bueno-Cavanillas et al [15] found that critically ill patients with a nosocomial infection, mainly bacteremia and pneumonia, have a higher rate of mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reached conflicting conclusions regarding the impact of VAP on mortality [1,[8][9][10][11][12][13][14][15][16][17]. Although the gross mortality rate is high, there are doubts as to whether the higher mortality rate is due to VAP itself or to the seriousness of the underlying illness.…”

Section: Introductionmentioning

confidence: 99%

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Ventilator-Associated Pneumonia Is an Important Risk Factor for Mortality After Major Cardiac Surgery

Tamayo¹,

Álvarez²,

Martínez-Rafael³

et al. 2012

Survey of Anesthesiology

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Purpose: Ventilator-associated pneumonia (VAP) is the main infectious complication in cardiac surgery patients and is associated with an important increase in morbidity and mortality. The aim of our study was to analyze the impact of VAP on mortality excluding other comorbidities and to study its etiology and the risk factors for its development. Materials and Methods: This prospective cohort study included 1610 postoperative cardiac surgery patients' status post cardiopulmonary bypass (CPB)

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Attributable risk estimation for adjusted disability multistate models: Application to nosocomial infections

Coeurjolly

Nguilé-Makao²,

Timsit³

et al. 2012

Biometrical J

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Attributable risk has become an important concept in clinical epidemiology. In this paper, we suggest to estimate the attributable risk of nosocomial infections using a multistate approach. Recently, a multistate model (called progressive disability model in the literature) has been developed in order to take into consideration both the time-dependency of the risk factor (e.g., nosocomial infections) and the presence of competing risks (e.g., death and discharge) at each time point. However, this approach does not take into account the possible heterogeneity of the study population. In this paper, we investigate an extension of this model and suggest an adjusted disability multistate model including covariates in each transition. This new multistate model has led us to define the concepts of overall and profiled attributable risk. We use a classical semiparametric approach to estimate the model and the new attributable risk. A simulation study is investigated and we show, in particular, that neglecting the presence of covariates when estimating the model can lead to an important bias. The methodology developed in this paper is applied to data on ventilator-associated pneumonia in 12 French intensive care units.

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Excess ICU mortality attributable to ventilator-associated pneumonia: The role of early vs late onset

Abstract: In mechanically ventilated patients, VAP is associated with excess mortality, mostly restricted to late-onset VAP and despite appropriate antibiotic treatment.

Cited by 114 publications

References 41 publications

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Ventilator-Associated Pneumonia Is an Important Risk Factor for Mortality After Major Cardiac Surgery

Attributable risk estimation for adjusted disability multistate models: Application to nosocomial infections

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