Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort
Abstract Background Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbat...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04631-2 |
| _version_ | 1797675311205187584 |
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| author | Louis-Marie Galerneau Sébastien Bailly Nicolas Terzi Stéphane Ruckly Maité Garrouste-Orgeas Johanna Oziel Vivien Hong Tuan Ha Marc Gainnier Shidasp Siami Claire Dupuis Jean-Marie Forel Anaïs Dartevel Julien Dessajan Christophe Adrie Dany Goldgran-Toledano Virginie Laurent Laurent Argaud Jean Reignier Jean-Louis Pepin Michael Darmon Jean-François Timsit OUTCOME R. E. A. network |
| author_facet | Louis-Marie Galerneau Sébastien Bailly Nicolas Terzi Stéphane Ruckly Maité Garrouste-Orgeas Johanna Oziel Vivien Hong Tuan Ha Marc Gainnier Shidasp Siami Claire Dupuis Jean-Marie Forel Anaïs Dartevel Julien Dessajan Christophe Adrie Dany Goldgran-Toledano Virginie Laurent Laurent Argaud Jean Reignier Jean-Louis Pepin Michael Darmon Jean-François Timsit OUTCOME R. E. A. network |
| author_sort | Louis-Marie Galerneau |
| collection | DOAJ |
| description | Abstract Background Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients. Methods Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU. Results Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01). Conclusion We found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD. |
| first_indexed | 2024-03-11T22:12:57Z |
| format | Article |
| id | doaj.art-604e807eddab4dbeb127bbcfe24a035c |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-11T22:12:57Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-604e807eddab4dbeb127bbcfe24a035c2023-09-24T11:21:00ZengBMCCritical Care1364-85352023-09-0127111010.1186/s13054-023-04631-2Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohortLouis-Marie Galerneau0Sébastien Bailly1Nicolas Terzi2Stéphane Ruckly3Maité Garrouste-Orgeas4Johanna Oziel5Vivien Hong Tuan Ha6Marc Gainnier7Shidasp Siami8Claire Dupuis9Jean-Marie Forel10Anaïs Dartevel11Julien Dessajan12Christophe Adrie13Dany Goldgran-Toledano14Virginie Laurent15Laurent Argaud16Jean Reignier17Jean-Louis Pepin18Michael Darmon19Jean-François Timsit20OUTCOME R. E. A. networkMedical Intensive Care Unit, University Hospital of Grenoble AlpesGrenoble Alpes UniversityMedical Intensive Care Unit, University Hospital of Grenoble AlpesDepartment of BiostatisticsMedical Unit, French and British Hospital Cognacq-Jay FondationIntensive Care Unit, Avicenne Hospital, AP-HPMedical Intensive Care Unit, Meaux HospitalMedical Intensive Care Unit, La Timone HospitalCritical Care Medicine Unit, Etampes-Dourdan HospitalMedical Intensive Care Unit, Gabriel Montpied University HospitalMedical Intensive Care Unit, Nord University HospitalMedical Intensive Care Unit, University Hospital of Grenoble AlpesMedical and Infectious Diseases Intensive Care Unit (MI2), Bichat Hospital, AP-HPPolyvalent Intensive Care Unit, Delafontaine HospitalMedical Intensive Care Unit, Le Raincy-Montfermeil HospitalIntensive Care Unit, André Mignot HospitalMedical Intensive Care Unit, Edouard Herriot Hospital, Lyon Civil HospicesMedical Intensive Care Unit, Nantes University HospitalGrenoble Alpes UniversityIntensive Care Unit, Saint-Louis Hospital, AP-HPMedical and Infectious Diseases Intensive Care Unit (MI2), Bichat Hospital, AP-HPAbstract Background Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients. Methods Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU. Results Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01). Conclusion We found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD.https://doi.org/10.1186/s13054-023-04631-2Intensive care medicineNon-ventilator-associated ICU-acquired pneumoniaAcute exacerbation of chronic obstructive pulmonary diseasePrevalencePrognosis |
| spellingShingle | Louis-Marie Galerneau Sébastien Bailly Nicolas Terzi Stéphane Ruckly Maité Garrouste-Orgeas Johanna Oziel Vivien Hong Tuan Ha Marc Gainnier Shidasp Siami Claire Dupuis Jean-Marie Forel Anaïs Dartevel Julien Dessajan Christophe Adrie Dany Goldgran-Toledano Virginie Laurent Laurent Argaud Jean Reignier Jean-Louis Pepin Michael Darmon Jean-François Timsit OUTCOME R. E. A. network Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort Critical Care Intensive care medicine Non-ventilator-associated ICU-acquired pneumonia Acute exacerbation of chronic obstructive pulmonary disease Prevalence Prognosis |
| title | Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort |
| title_full | Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort |
| title_fullStr | Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort |
| title_full_unstemmed | Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort |
| title_short | Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort |
| title_sort | non ventilator associated icu acquired pneumonia nv icu ap in patients with acute exacerbation of copd from the french outcomerea cohort |
| topic | Intensive care medicine Non-ventilator-associated ICU-acquired pneumonia Acute exacerbation of chronic obstructive pulmonary disease Prevalence Prognosis |
| url | https://doi.org/10.1186/s13054-023-04631-2 |
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