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Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study

Abstract

We report on intensive care nosocomial pneumonia (NP) in Europe through a review of EU-VAP/CAP manuscripts: a prospective observational study, enrolling patients from 27 ICUs in nine European countries. From 2,436 eligible ICU patients, 827 cases presented NP, with 18.3 episodes of VAP per 1000 ventilator-days. Most common findings were worsening oxygenation, purulent respiratory secretions and temperature increase. At least three criteria from Clinical Pulmonary Infection score (CPIS) were present in 77.9 % of episodes, but only 0.2 % met six CPIS criteria. Diagnosis was confirmed mainly noninvasively (74.8 %), with half qualitative and quantitative cultures. The dominant isolate was S. aureus in Spain, France, Belgium and Ireland, P. aeruginosa in Italy and Portugal, Acinetobacter in Greece and Turkey, but Escherichia coli in Germany. NP resulted in 6 % higher mortality, longer ICU stay and duration of mechanical ventilation (12 and 10 days). COPD and age ≥45 years were not associated with higher VAP incidence but did correlate with increased mortality. Trauma had higher VAP incidence but lower mortality. Bacteremia (led by MRSA and Acinetobacter baumannii) was documented in 14.6 %, being associated with extra ICU stay and mortality. Vasopressors and ICUs with above 25 % prevalence of Potential Resistant Organisms (PRM) were independently associated with PRM, being documented in 50.7 % of patients with early-onset VAP without known risk factors. Most patients initially received combination therapy. Delay in appropriate antimicrobial choice significantly increased mortality, and LOS in survivors was six days longer (p < 0.05). In conclusion, NP management in Europe presents local differences and major shifts when compared to reports from North America, outcomes of randomized trials and general guidelines.

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Acknowledgments

EU-VAP/CAP Study was endorsed by the European Critical Care Research Network (ECCRN).

Conflict of interest

JR served in the speakers’ bureau or as consultant for Pfizer, Paratek, Astra-Zeneca, KENTA, Nabriva. DK and ET report no conflict of interest.

EU-VAP/CAP Study Investigators

Djilali Annane (Raymond Poincaré Univ. Hospital, Garches, France), Rosario Amaya-Villar (Virgen de Rocio Univ. Hospital, Seville, Spain), Apostolos Armaganidis (Attikon Univ. Hospital, Athens, Greece; National Coordinator [NC]), Stijn Blot (1,2Ghent Univ. Hospital, Ghent, Belgium, 1RBWH University of Queenland,), Christian Brun-Buisson (Henri-Mondor Univ. Hospital, Paris, France; NC), Silvano Cardellino (Cardinal Massaia Hospital, Asti, Italy), Antonio Carneiro (2Santo Antonio Hospital, Porto, Portugal; NC), Maria Deja (Charite Univ. Hospital, Berlin, Germany), Jan DeWaele (Ghent Univ. Hospital, Ghent, Belgium; NC), Emili Diaz (Joan XIII Univ. Hospital, CIBERES, Tarragona, Spain), George Dimopoulos (1,2Attikon Univ. Hospital, 2Sotiria Hospital, Athens, Greece), Jose Garnacho-Montero (Virgen de Rocio Univ. Hospital, Seville, Spain), Muhammet Guven (Erciyes Univ. Hospital, Kayseri, Turkey), Apostolos Komnos (Larisa Hospital, Larisa, Greece), Despoina Koulenti (Study Coordinator, 1,2Attikon Univ. Hospital, Athens, Greece, 1RBWH University of Queenland), Wolfgang Krueger (1Constance Hospital, Constance, Germany,2Tuebingen Univ. Hospital, Tuebingen, Germany; NC), Thiago Lisboa (2Joan XIII Univ. Hospital, Tarragona, Spain and CIBERES), Antonio Macor (Amedeo di Savoia Hospital, Torino, Italy; NC), Emilpaolo Manno (Maria Vittoria Hospital, Torino, Italy), Rafael Mañez (Bellvitge Univ. Hospital, Barcelona, Spain), Brian Marsh (Mater Misericordiae Univ. Hospital, Dublin, Ireland), Claude Martin (Nord Univ. Hospital, Marseille, France), Pavlos Myrianthefs (Aghioi Anargyroi Hospital1, KAT Hospital2, Athens, Greece), Marc Nauwynck (St Jan Hospital, Brugges, Belgium), Laurent Papazian (Hôpitaux de Marseille Aix-Marseille Université, 2Sainte-Marguerite Univ. Hospital, Marseille, France), Christian Putensen (Bonn Univ. Hospital, Bonn, Germany), Bernard Regnier (Claude Bernard Univ. Hospital, Paris, France), Jordi Rello (Principal Investigator, 1CIBERES, Universitat Autonoma de Barcelona, Spain, 2Joan XIII Univ. Hospital, Tarragona, Spain; NC), Jordi Sole-Violan (Dr Negrin Univ. Hospital, Gran Canarias, Spain), Giuseppe Spina (Mauriziano Umberto I Hospital, Torino, Italy), Arzu Topeli (Hacettepe Univ. Hospital, Ankara, Turkey; NC), Hermann Wrigge (Bonn Univ. Hospital, Bonn, Germany). [1Current affiliation, 2affiliation during the period of the study].

Funding

CIBERES (PCI Pneumonia) Instituto Salud Carlos III, Madrid.

Author information

Correspondence to J. Rello.

Additional information

The EU-VAP/CAP study of the WG on Pneumonia of the Infection Section of ESICM was a project endorsed by ESICM.

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Koulenti, D., Tsigou, E. & Rello, J. Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study. Eur J Clin Microbiol Infect Dis 36, 1999–2006 (2017). https://doi.org/10.1007/s10096-016-2703-z

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Keywords

  • Chronic Obstructive Pulmonary Disease
  • Chronic Obstructive Pulmonary Disease Patient
  • Colistin
  • Nosocomial Pneumonia
  • Acinetobacter Baumannii