Intensive Care Medicine

, Volume 37, Issue 7, pp 1128–1135 | Cite as

Severity of ICU-acquired pneumonia according to infectious microorganisms

  • Pierre Damas
  • Nathalie Layios
  • Laurence Seidel
  • Monique Nys
  • Pierrette Melin
  • Didier Ledoux



To assess the severity of intensive care unit (ICU)-acquired pneumonia (ICUAP) according to the bacteria involved, classified into seven groups: third-generation cephalosporin-resistant non-fermenting Gram-negative bacilli (resistant C3NF); sensitive C3NF; methicillin-resistant Staphylococcus aureus; methicillin-sensitive Staphylococcus aureus; extended-spectrum beta-lactamase-producing Enterobacteriaceae; Enterobacteriaceae not producing extended-spectrum beta-lactamase; Haemophilus influenzae and Streptococcus pneumoniae.


Over a 4-year period, sequential organ failure assessment (SOFA) score was prospectively measured daily in 453 adult patients with ICUAP. ICUAP severity was evaluated by the severity of sepsis and by the occurrence of new organ dysfunctions or failures (OD/F) during ICUAP.


Septic shock occurred in 21% of all cases of ICUAP. The occurrence of new OD/F during ICUAP was similar regardless of the identified microorganism. These new OD/F represented less than 11% of SOFAmax, defined as the sum of all OD/F occurring at any time during the ICU stay. There was a significant association between SOFApreICUAP, defined as the sum of all the OD/F occurring before ICUAP, and ICUAP severity. In the multivariate analysis, the type of bacteria was not a risk factor (RF) for occurrence of septic shock and mortality. Age and SOFApreICUAP were RF for the sepsis severity. The ICUAP severity was an RF for ICU mortality.


ICUAP was responsible for a minor proportion of OD/F occurring during the ICU stay. Severity of ICUAP was related to clinical status prior to ICUAP, but not to the type of bacteria. ICU mortality depended on the severity of ICUAP.


ICU SOFA score Ventilator-associated pneumonia Nosocomial infection 


  1. 1.
    Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 274:639–644PubMedCrossRefGoogle Scholar
  2. 2.
    Jiménez P, Torres A, Rodríguez-Roisin R, de la Bellacasa JP, Aznar R, Gatell JM, Agustí-Vidal A (1990) Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Resp Dis 142:523–528PubMedGoogle Scholar
  3. 3.
    Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C (1996) Nosocomial pneumonia and mortality among patients in intensive care unit. JAMA 275:866–869PubMedCrossRefGoogle Scholar
  4. 4.
    Kollef MH, Silver P, Murphy DM, Trovillion E (1995) The effect of late-onset ventilator associated pneumonia in determining patient mortality. Chest 108:1655–1662PubMedCrossRefGoogle Scholar
  5. 5.
    Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C (1993) Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 94:281–288PubMedCrossRefGoogle Scholar
  6. 6.
    Kollef MH, Bock KR, Richards RD, Hearns ML (1995) The safety and diagnostic accuracy of minibronchoalveolar lavage in patients with suspected ventilator-associated pneumonia. Ann Intern Med 122:743–748PubMedGoogle Scholar
  7. 7.
    Damas P, Ledoux D, Nys M, Monchi M, Wiesen P, Beauve B, Preiser JC (2008) Intensive care unit acquired infection and organ failure. Intensive Care Med 34:856–864PubMedCrossRefGoogle Scholar
  8. 8.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  9. 9.
    McCabe WR, Jackson GG (1962) Gram-negative bacteremia, aetiology and ecology. Arch Intern Med 110:845–853Google Scholar
  10. 10.
    Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, Gonzalez J, Jusserand D, Asfar P, Perrin D, Fieux F, Aubas S, Pneum A, Trial Group (2003) Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 290:2588–2598PubMedCrossRefGoogle Scholar
  11. 11.
    American College of Chest Physicians/Society of Critical Care Medicine (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874CrossRefGoogle Scholar
  12. 12.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
  13. 13.
    Moreno R, Vincent JL, Matos R, Mendonça A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S (1999) The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis Related Problems of the ESICM. Intensive Care Med 25:686–696PubMedCrossRefGoogle Scholar
  14. 14.
    Alberti C, Brun-Buisson C, Goodman SV, Guidici D, Granton J, Moreno R, Smithies M, Thomas O, Artigas A, Le Gall JR, European Sepsis Group (2003) Influence of systemic inflammatory response syndrome and sepsis outcome of critically ill infected patients. Am J Respir Crit Care Med 168:77–84PubMedCrossRefGoogle Scholar
  15. 15.
    Brown DF, Andrews J, King A, MacGowan AP (2000) Detection of extended-spectrum beta-lactamases with Etest and double disc potentialisation methods. J Antimicrob Chemother 46:327–328PubMedCrossRefGoogle Scholar
  16. 16.
    American Thoracic Society; Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416CrossRefGoogle Scholar
  17. 17.
    Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903PubMedGoogle Scholar
  18. 18.
    Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D, Sepsis Occurrence in Acutely Ill Patients Investigators (2006) Sepsis in European intensive units: results of the SOAP study. Crit Care Med 34:344–353PubMedCrossRefGoogle Scholar
  19. 19.
    Lisboa T, Diaz E, Sa-Borges M, Socias A, Sole-Violan J, Rodríguez A, Rello J (2008) VAP-PIRO: a tool for predicting ICU mortality and health care resources use in ventilator-associated pneumonia. Chest 134:1208–1216PubMedCrossRefGoogle Scholar
  20. 20.
    Nguile-Makao M, Zahar JR, Français A, Tabah A, Garrouste-Orgeas M, Allaouchiche B, Goldgran-Toledano D, Azoulay E, Adrie C, Jamali S, Clec’h C, Souweine B, Timsit JF (2010) Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med 36:781–789PubMedCrossRefGoogle Scholar
  21. 21.
    Klompas M (2009) The paradox of ventilator-associated pneumonia prevention measures. Crit Care 13:315PubMedCrossRefGoogle Scholar
  22. 22.
    Clinel I, Opal SM (2009) Molecular biology of inflammation and sepsis: a primer. Crit Care Med 37:291–304CrossRefGoogle Scholar
  23. 23.
    Carlet J, Cohen J, Calandra T, Opal SM, Masur H (2008) Sepsis: time to reconsider the concept. Crit Care Med 36:964–966PubMedCrossRefGoogle Scholar
  24. 24.
    Melsen WG, Rovers MM, Bonten MJM (2009) Ventilator associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 37:2709–2710PubMedCrossRefGoogle Scholar
  25. 25.
    Leroy O, Meybeck A, d’Escrivan T, Devos P, Kipnis E, Georges H (2003) Impact of adequacy of initial antimicrobial therapy on the prognosis of patients with ventilator-associated pneumonia. Intensive Care Med 29:2170–2173PubMedCrossRefGoogle Scholar
  26. 26.
    Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, Sicignano A, Palazzo M, Moreno R, Boulmé R, Lepage E, Le Gall R (2002) Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 28:108–121PubMedCrossRefGoogle Scholar
  27. 27.
    Brun-Buisson C, Meshaka P, Pinton P, Vallet B, EPISEPSIS Study Group (2004) EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med 30:580–588PubMedCrossRefGoogle Scholar
  28. 28.
    Lisboa T, Rello J (2008) Diagnosis of ventilator-associated pneumonia: Is there a gold standard and a simple approach? Curr Opin Infect Dis 21:174–178PubMedCrossRefGoogle Scholar
  29. 29.
    Niederman M (2010) The argument against using quantitative cultures in clinical trials and for the management of ventilator-associated pneumonia. Clin Infect Dis 51:593–599Google Scholar
  30. 30.
    The Canadian Critical Care Trials Group (2006) A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 355:2619–2630CrossRefGoogle Scholar
  31. 31.
    Eggimann P, Hugonnet S, Sax H, Touveneau S, Chevrolet JC, Pittet D (2003) Ventilator-associated pneumonia: caveats for benchmarking. Intensive Care Med 29:2086–2089PubMedCrossRefGoogle Scholar
  32. 32.
    Lacherade JC, De Jonghe B, Guezennec P, Debbat K, Hayon J, Monsel A, Fangio P, Appere de Vecchi C, Ramaut C, Outin H, Bastuji-Garin S (2010) Intermittent subglottic secretion drainage and ventilator-associated pneumonia : a multicenter trial. Am J Resp Crit Care Med. 182:910–917. doi:  10.1164/rccm.200906-0838OC Google Scholar
  33. 33.
    Magret M, Amaya-Villar R, Garnacho J, Lisboa T, Díaz E, Dewaele J, Deja M, Manno E, Rello J, EU-VAP/CAP Study Group (2010) Ventilator associated pneumonia in trauma patients is associated with lower mortality. Results from EU-VAP study. J Trauma 69:849–854PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Pierre Damas
    • 1
  • Nathalie Layios
    • 1
  • Laurence Seidel
    • 2
  • Monique Nys
    • 1
  • Pierrette Melin
    • 3
  • Didier Ledoux
    • 1
  1. 1.Department of General Intensive CareUniversity Hospital of Liege, University of LiegeLiegeBelgium
  2. 2.Department of BiostatisticsUniversity Hospital of Liege, University of LiegeLiegeBelgium
  3. 3.Department of Clinical MicrobiologyUniversity Hospital of Liege, University of LiegeLiegeBelgium

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