Intensive Care Medicine

, Volume 32, Issue 12, pp 1970–1978

Impact of piperacillin resistance on the outcome of Pseudomonas ventilator-associated pneumonia

  • Alain Combes
  • Charles-Edouard Luyt
  • Jean-Yves Fagon
  • Michel Wolff
  • Jean-Louis Trouillet
  • Jean Chastre
Original

Abstract

Background

The impact of antibiotic resistance on the outcome of infections due to Gram-negative bacilli, especially Pseudomonas, remains highly controversial.

Study objective, design, and patients

We evaluated the impact of piperacillin resistance on the outcomes of Pseudomonasaeruginosa ventilator-associated pneumonia (VAP) for patients who had received appropriate empiric antibiotics before enrollment in the PNEUMA trial, a multicenter randomized study comparing 8 vs 15 days of antibiotics.

Results

Despite similar characteristics at intensive care unit (ICU) admission, patients infected with piperacillin-resistant Pseudomonas strains were more acutely ill at VAP onset and had a higher 28-day mortality rate (37 vs 19%; P = 0.04) than those with piperacillin-susceptible Pseudomonas VAP. Factors associated with 28-day mortality retained by multivariable analysis were: age (OR: 1.07; 95% CI: 1.03–1.12); female gender (OR: 4.00; 95% CI: 1.41–11.11); severe underlying comorbidities (OR: 2.73; 95% CI: 1.02–7.33); and SOFA score (OR: 1.17; 95% CI: 1.03–1.32), but piperacillin resistance did not reach statistical significance (OR: 2.00; 95% CI: 0.72–5.61). The VAP recurrence rates, either superinfection or relapse, and durations of mechanical ventilation and ICU stay did not differ as a function of Pseudomonas-resistance status.

Conclusions

For patients with Pseudomonas VAP benefiting from appropriate empiric antibiotics, piperacillin resistance was associated with increased disease severity at VAP onset and higher 28-day crude mortality; however, after controlling for confounders, piperacillin-resistance was no longer significantly associated with 28-day mortality. The VAP recurrence rates and durations of ICU stay and mechanical ventilation did not differ for susceptible and resistant strains.

Keywords

Antibiotic-resistant bacteria Artificial respiration Outcome assessment Multivariable models 

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Alain Combes
    • 1
  • Charles-Edouard Luyt
    • 1
  • Jean-Yves Fagon
    • 2
  • Michel Wolff
    • 3
  • Jean-Louis Trouillet
    • 1
  • Jean Chastre
    • 1
  1. 1.Groupe Hospitalier Pitié–Salpêtrière, Assistance Publique, Hôpitaux de Paris Université Pierre et Marie Curie, Paris 6Service de Réanimation Médicale, Institut de CardiologieParis Cedex 13France
  2. 2.Hôpital Européen Georges PompidouService de Réanimation MédicaleParisFrance
  3. 3.Hôpital Bichat–Claude BernardService de Réanimation MédicaleParisFrance

Personalised recommendations