Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation
Abstract Background Although multidrug-resistant bacteria (MDR) are common in patients undergoing prolonged weaning, there is little data on their impact on weaning and patient outcomes. Methods This is a retrospective analysis of consecutive patients who underwent prolonged weaning and were at a un...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Respiratory Research |
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| Online Access: | https://doi.org/10.1186/s12931-024-02694-5 |
| _version_ | 1827326469179703296 |
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| author | Julia D. Michels-Zetsche Vicky Gassmann Jasmin K. Jasuja Benjamin Neetz Philipp Höger Jan Meis Simone Britsch Urte Sommerwerck Sebastian Fähndrich Florian Bornitz Michael M. Müller Felix J.F. Herth Franziska C. Trudzinski |
| author_facet | Julia D. Michels-Zetsche Vicky Gassmann Jasmin K. Jasuja Benjamin Neetz Philipp Höger Jan Meis Simone Britsch Urte Sommerwerck Sebastian Fähndrich Florian Bornitz Michael M. Müller Felix J.F. Herth Franziska C. Trudzinski |
| author_sort | Julia D. Michels-Zetsche |
| collection | DOAJ |
| description | Abstract Background Although multidrug-resistant bacteria (MDR) are common in patients undergoing prolonged weaning, there is little data on their impact on weaning and patient outcomes. Methods This is a retrospective analysis of consecutive patients who underwent prolonged weaning and were at a university weaning centre from January 2018 to December 2020. The influence of MDR colonisation and infection on weaning success (category 3a and 3b), successful prolonged weaning from invasive mechanical ventilation (IMV) with or without the need for non-invasive ventilation (NIV) compared with category 3c (weaning failure 3cI or death 3cII) was investigated. The pathogen groups considered were: multidrug-resistant gram-negative bacteria (MDRGN), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. (VRE). Results A total of 206 patients were studied, of whom 91 (44.2%) showed evidence of MDR bacteria (32% VRE, 1.5% MRSA and 16% MDRGN), with 25 patients also meeting the criteria for MDR infection. 70.9% of the 206 patients were successfully weaned from IMV, 8.7% died. In 72.2% of cases, nosocomial pneumonia and other infections were the main cause of death. Patients with evidence of MDR (infection and colonisation) had a higher incidence of weaning failure than those without evidence of MDR (48% vs. 34.8% vs. 21.7%). In multivariate analyses, MDR infection (OR 4.9, p = 0.004) was an independent risk factor for weaning failure, along with male sex (OR 2.3, p = 0.025), Charlson Comorbidity Index (OR 1.2, p = 0.027), pH (OR 2.7, p < 0.001) and duration of IMV before admission (OR 1.01, p < 0.001). In addition, MDR infection was the only independent risk factor for death (category 3cII), (OR 6.66, p = 0.007). Conclusion Patients with MDR infection are significantly more likely to die during the weaning process. There is an urgent need to develop non-antibiotic approaches for the prevention and treatment of MDR infections as well as clinical research on antibiotic stewardship in prolonged weaning as well as in ICUs. |
| first_indexed | 2024-03-07T14:45:03Z |
| format | Article |
| id | doaj.art-c01ab54fb87e440ea0431b2c3bb21e0c |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-03-07T14:45:03Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-c01ab54fb87e440ea0431b2c3bb21e0c2024-03-05T20:02:43ZengBMCRespiratory Research1465-993X2024-02-0125111010.1186/s12931-024-02694-5Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilationJulia D. Michels-Zetsche0Vicky Gassmann1Jasmin K. Jasuja2Benjamin Neetz3Philipp Höger4Jan Meis5Simone Britsch6Urte Sommerwerck7Sebastian Fähndrich8Florian Bornitz9Michael M. Müller10Felix J.F. Herth11Franziska C. Trudzinski12Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)Department for Infectious Diseases, University Hospital HeidelbergDepartment of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)Institute of Medical Biometry, University of HeidelbergDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, European Center for Angioscience (ECAS), University Medical Center Mannheim, German Center for Cardiovascular Research (DZHK), Partner SiteDepartment of Pneumology, Krankenhaus der Augustinerinnen CologneDepartment of Pneumology, University Medical Center Freiburg, University of FreiburgDepartment of Pneumology and Internal Intensive Care Medicine, Asklepios Hospital BarmbekDepartment of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)Abstract Background Although multidrug-resistant bacteria (MDR) are common in patients undergoing prolonged weaning, there is little data on their impact on weaning and patient outcomes. Methods This is a retrospective analysis of consecutive patients who underwent prolonged weaning and were at a university weaning centre from January 2018 to December 2020. The influence of MDR colonisation and infection on weaning success (category 3a and 3b), successful prolonged weaning from invasive mechanical ventilation (IMV) with or without the need for non-invasive ventilation (NIV) compared with category 3c (weaning failure 3cI or death 3cII) was investigated. The pathogen groups considered were: multidrug-resistant gram-negative bacteria (MDRGN), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. (VRE). Results A total of 206 patients were studied, of whom 91 (44.2%) showed evidence of MDR bacteria (32% VRE, 1.5% MRSA and 16% MDRGN), with 25 patients also meeting the criteria for MDR infection. 70.9% of the 206 patients were successfully weaned from IMV, 8.7% died. In 72.2% of cases, nosocomial pneumonia and other infections were the main cause of death. Patients with evidence of MDR (infection and colonisation) had a higher incidence of weaning failure than those without evidence of MDR (48% vs. 34.8% vs. 21.7%). In multivariate analyses, MDR infection (OR 4.9, p = 0.004) was an independent risk factor for weaning failure, along with male sex (OR 2.3, p = 0.025), Charlson Comorbidity Index (OR 1.2, p = 0.027), pH (OR 2.7, p < 0.001) and duration of IMV before admission (OR 1.01, p < 0.001). In addition, MDR infection was the only independent risk factor for death (category 3cII), (OR 6.66, p = 0.007). Conclusion Patients with MDR infection are significantly more likely to die during the weaning process. There is an urgent need to develop non-antibiotic approaches for the prevention and treatment of MDR infections as well as clinical research on antibiotic stewardship in prolonged weaning as well as in ICUs.https://doi.org/10.1186/s12931-024-02694-5Multidrug-resistant bacteriaWeaningProlonged weaningWeaning failureMortality in weaning |
| spellingShingle | Julia D. Michels-Zetsche Vicky Gassmann Jasmin K. Jasuja Benjamin Neetz Philipp Höger Jan Meis Simone Britsch Urte Sommerwerck Sebastian Fähndrich Florian Bornitz Michael M. Müller Felix J.F. Herth Franziska C. Trudzinski Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation Respiratory Research Multidrug-resistant bacteria Weaning Prolonged weaning Weaning failure Mortality in weaning |
| title | Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation |
| title_full | Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation |
| title_fullStr | Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation |
| title_full_unstemmed | Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation |
| title_short | Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation |
| title_sort | role of multidrug resistant bacteria in weaning from invasive mechanical ventilation |
| topic | Multidrug-resistant bacteria Weaning Prolonged weaning Weaning failure Mortality in weaning |
| url | https://doi.org/10.1186/s12931-024-02694-5 |
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