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Intensive Care Medicine

, Volume 39, Issue 4, pp 672–681 | Cite as

Potentially resistant microorganisms in intubated patients with hospital-acquired pneumonia: the interaction of ecology, shock and risk factors

  • Ignacio Martin-Loeches
  • Maria Deja
  • Despoina Koulenti
  • George Dimopoulos
  • Brian Marsh
  • Antonio Torres
  • Michael S. Niederman
  • Jordi RelloEmail author
  • EU-VAP Study Investigators
Original

Abstract

Purpose

As per 2005 American Thoracic Society and Infectious Disease Society of America (ATS/IDSA) guidelines for managing hospital-acquired pneumonia, patients with early-onset pneumonia and without risk factors do not need to be treated for potentially resistant microorganisms (PRM).

Methods

This was a secondary analysis of a prospective, observational, cohort, multicentre study conducted in 27 ICUs from nine European countries.

Results

From a total of 689 patients with nosocomial pneumonia who required mechanical ventilation, 485 patients with confirmed etiology and antibiotic susceptibility were further analysed. Of these patients, 152 (31.3 %) were allocated to group 1 with early-onset pneumonia and no risk factors for PRM acquisition, and 333 (68.7 %) were classified into group 2 with early-onset pneumonia with risk factors for PRM or late-onset pneumonia. Group 2 patients were older and had more chronic renal failure and more severe illness (SAPS II score, 44.6 ± 16.5 vs. 47.4 ± 17.8, p = 0.04) than group 1 patients. Trauma patients were more frequent and surgical patients less frequent in group 1 than in group 2 (p < 0.01). In group 1, 77 patients (50.7 %) had PRM in spite of the absence of classic risk factors recognised by the current guidelines. A logistic regression analysis identified that presence of severe sepsis/septic shock (OR = 3.7, 95 % CI 1.5–8.9) and pneumonia developed in centres with greater than 25 % prevalence of PRM (OR = 11.3, 95 % CI 2.1–59.3) were independently associated with PRM in group 1 patients.

Conclusions

In patients admitted to ICUs with a prevalence of PRM greater than 25 % or with severe sepsis/septic shock, empiric therapy for group 1 nosocomial pneumonia requiring mechanical ventilation should also include agents likely to be effective for PRM pathogens.

Keywords

HAP VAP Multidrug-resistant organisms Septic shock Guidelines Antibiotic treatment 

Notes

Acknowledgments

Supported by AGAUR 2005/SGR/920, CibeRes 06/06/0036.

Conflicts of interest

The authors declare no conflict of interest regarding the present manuscript.

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Ignacio Martin-Loeches
    • 1
    • 2
    • 3
    • 12
  • Maria Deja
    • 4
  • Despoina Koulenti
    • 5
  • George Dimopoulos
    • 6
  • Brian Marsh
    • 3
  • Antonio Torres
    • 7
    • 12
  • Michael S. Niederman
    • 8
  • Jordi Rello
    • 9
    • 10
    • 11
    • 12
  • EU-VAP Study Investigators
  1. 1.Critical Care CentreCoporació Sanitaria Parc TauliSabadellSpain
  2. 2.Institut Universitari UABBarcelonaSpain
  3. 3.Critical Care DepartmentMater Misericordiae University HospitalDublinIreland
  4. 4.Department of Anesthesiology and Critical Care MedicineCharité Medical Center, Campus Virchow-ClinicBerlinGermany
  5. 5.Critical Care DepartmentUniversity Hospital AttikonHaidariGreece
  6. 6.Department of Critical Care Medicine, University Hospital ATTIKON, Medical SchoolUniversity of AthensAthensGreece
  7. 7.Pneumology Department, Hospital ClinicBarcelonaSpain
  8. 8.Department of MedicineWinthrop-University HospitalMineolaUSA
  9. 9.Critical Care DepartmentHospital Vall d’HebronBarcelonaSpain
  10. 10.Vall d’ Hebron Research Institute (VHIR)BarcelonaSpain
  11. 11.Universitat Autónoma de BarcelonaBarcelonaSpain
  12. 12.CIBERESBarcelonaSpain

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