Impact of Chronic Obstructive Pulmonary Disease on Incidence, Microbiology and Outcome of Ventilator-Associated Lower Respiratory Tract Infections

Rouzé, Anahita; Boddaert, Pauline; Martín‐Loeches, Ignacio; Póvoa, Pedro; Rodríguez, Alejandro; Ramdane, Nassima; Salluh, Jorge I.; Houard, Marion; Nseir, Saad

doi:10.3390/microorganisms8020165

Cited by 12 publications

(22 citation statements)

References 28 publications

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“…However, what is clinically useful is that PA occurred in Early onset-VAP (Eo-VAP) 2.5 times more frequently than in patients without early-onset VAP. On the other hand, a cohort study by Rouze et al [ 39 ] found that among COPD patients mechanically ventilated in Europe and Latin America, neither VAP nor VAT were more frequent. Moreover, among patients with VA-LRTI, Escherichia coli and Stenotrophomonas maltophilia were found at significantly higher rates in COPD patients.…”

Section: Vulnerable Patients At Risk For Nosocomial Infectionsmentioning

confidence: 99%

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

Martín‐Loeches

2020

Antibiotics

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It is widely known that pneumonia (either community acquired or hospital acquired, as like ventilator associated pneumonia (VAP)), is the most frequent type of severe infection and continues to pose a significant burden on healthcare services worldwide. Despite new diagnostic developments, most pneumonia cases continue to be difficult to diagnose clinically, partly due to acquired antibiotic resistance and the lack of a ‘gold standard’ method of diagnosis. In other words, the lack of a rapid, accurate diagnostic test, as well as the uncertainty of the initial etiologic diagnosis and the risk stratification, results in empirical antibiotic treatments. There are significant changes in the aetiology of patients with ventilator associated lower respiratory tract infections (VA-LRTI), which are characterised by a higher incidence of multi drug resistant organisms. Evidence suggests that when patients with VA-LRTI develop organ failure, the associated mortality can be exceptionally high with frequent complications, including acute respiratory distress syndrome, acute kidney injury, and septic shock. Appropriate antibiotic treatments must consider that the present cardiovascular failure seen in patients has a different association with the patient’s mortality. Unlike patients with less severe clinical presentations, who have a higher chance of survival when the appropriate antibiotics are administered promptly, for patients with a severe subtype of the disease, the appropriateness of antibiotic treatment will impact the patient’s outcome to a lesser extent. The present review highlights certain factors detectable at the time of admission that could indicate patients who are at a high risk of bacteraemia and who, therefore, merit more intense therapy and stratified care.

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Section: Vulnerable Patients At Risk For Nosocomial Infectionsmentioning

confidence: 99%

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

Martín‐Loeches

2020

Antibiotics

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“…According to previous studies, COPD is a commonco-morbidity in patients with VAP (18,19). However, it was demonstrated that the presence of COPD is not associated with a higher incidence of VAP as compared with that of patients without COPD (1,12). Over the last decades, several studies have attempted to assess the impact of COPD on the outcomes of patients with VAP.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were admitted to the ICUs for both medical and surgical reasons. The included studies did not report any statistically significant differences in patient co-morbidities between COPD and non-COPD patients, except for that by Rouze et al (1), which reported a significant difference in the number of diabetics. Furthermore, disease severity was significantly higher in the COPD group in the study of Makris et al (16).…”

Section: Study Search and Selectionmentioning

confidence: 97%

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Effect of chronic obstructive pulmonary disease combined with ventilator‑associated pneumonia on patient outcomes: A systematic review and meta‑analysis

Yin

Liu

2020

Exp Ther Med

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The purpose of the present systematic review and meta-analysis was to uncover whether chronic obstructive pulmonary disease (COPD) as a co-morbidity influences outcomes of patients with ventilator-associated pneumonia (VAP) compared to VAP alone and whether the development of VAP in patients with COPD is associated with poor outcome in comparison to COPD alone. An electronic search of the PubMed, Embase, Scopus, BioMed Central, CENTRAL and Google scholar databases for all types of studies assessing the influence of COPD on outcomes of patients with VAP and vice versa was performed. A total of 7 studies were included. Of these, 3 studies assessed the impact of COPD on outcomes of patients with VAP. Meta-analysis indicated that the presence of COPD significantly increased the mortality of patients with VAP [risk ratio (RR): 1.37, 95% CI: 1.14-1.65, I 2 =3%, P= 0.007]. The analysis failed to demonstrate any significant effect of COPD on the duration of mechanical ventilation in patients with VAP [mean difference (MD): 2.37, 95% CI:-5.77 to 10.50, I 2 =38%, P=0.57]. However, the duration of the intensive care unit (ICU) stay was significantly longer in patients with COPD and VAP as compared with that of patients with VAP without COPD (MD: 5.53, 95% CI: 0.73-10.33, I 2 =0%, P=0.02). A total of 4 studies assessed the impact of VAP on outcomes of patients with COPD. Meta-analysis indicated that the presence of VAP significantly increased mortality of patients with COPD (RR: 1.52, 95% CI: 1.08-2.12, I 2 =71%, P=0.02). Pooled analysis indicated that the presence of VAP in patients with COPD significantly increased the duration of mechanical ventilation (MD: 13.73, 95% CI: 7.86-19.61, I 2 =92%, P<0.00001) and the duration of the ICU stay as compared to patients with COPD but without VAP (MD: 17.36, 95% CI: 9.55-25.17, I 2 =90%, P<0.0001). To conclude, within the limitations of the study, the present results indicated that the combination of COPD and VAP significantly increased patient mortality and the duration of ICU stay. The development of VAP in patients with COPD also significantly increased the duration of mechanical ventilation. Further case-matched studies are required to assess the influence of the severity of COPD in combination with VAP on patient outcomes.

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“…MDR pathogens are usually implicated in nosocomial infections. Rouzé et al conducted an ancillary analysis of a prospective multicenter study on the impact of chronic obstructive pulmonary disease (COPD) in ventilator-associated lower respiratory tract infections, and found that the rate of MDR bacteria was not significantly different between COPD and non-COPD patients, while Escherichia coli and Stenotrophomonas maltophilia were significantly more frequent in COPD patients [ 2 ]. A retrospective five-year single cohort observational study on the epidemiology of MDR infection in 73 oncological patients by Perdikouri et al showed that the most frequently isolated pathogens were carbapenem-resistant Klebsiella pneumoniae , methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii , while infection-associated mortality was as high as 32% [ 3 ].…”

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confidence: 99%

Editorial for Special Issue “Multidrug-Resistant Pathogens”

2020

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Impact of Chronic Obstructive Pulmonary Disease on Incidence, Microbiology and Outcome of Ventilator-Associated Lower Respiratory Tract Infections

Cited by 12 publications

References 28 publications

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

Effect of chronic obstructive pulmonary disease combined with ventilator‑associated pneumonia on patient outcomes: A systematic review and meta‑analysis

Editorial for Special Issue “Multidrug-Resistant Pathogens”

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