Epidemiology of Hospital-Acquired Pulmonary Infections in Acutely Poisoned Patients Admitted to an Intensive Care Unit in Paris, France

Objective: Hospital-acquired pneumonia may be responsible for significant morbidities in poisoned patients admitted to the intensive care unit (ICU). Our objectives were to investigate toxicants that may facilitate these infections and to determine the sensitivity to antibiotics of the causative bacteria, in order to choose the best therapeutic strategy. Methods: Inclusion of all the patients admitted to our ICU during a 6-month period for a severe poisoning resulting in a hospital-acquired pneumonia (onset >48h after admission); prospective data collection, including pulmonary microbiology (cultures of sputum, protected specimen brush samples, and bronchoalveolar lavage as well as their corresponding antibiograms); descriptive analysis (median [10%, 90%-percentiles]). Results: Fifty-eight poisoned patients (18F/40M, 42 years [38-61], SAPS II 62 [37-79], ICU stay duration: 25 days [7-81]) were included. Toxicants were either psychotropic drugs (57%; antipsychotic 15/58, sedatives 9/58, antidepressants 6/58, opioids 3/58) or cardiotropic drugs (41%; chloroquine 13/58, beta-blockers 9/58, calcium-channel blockers 1/58, anti-arrhythmic drugs 1/58) or smoke inhalation (1/58). Fifty-six patients were mechanically ventilated (duration: 24 days [5-47]) at time of diagnosis. Among these patients, 41/58 had already received antibiotics for aspiration pneumonia and 14/58 had been re-intubated. Causative bacteria were the following: Pseudomonas aeruginosa (24/58), enterobacteriae (15/58), Haemophilus influenza (5/58), Staphylococcus aureus (8/58), Acinetobacter baumanii (2/58), Streptococcus pneumoniae (2/58), and Stenotrophomonas maltophilia (1/58). Based on antibiograms, the best choices of antibiotics were the combination of piperacillin/tazobactam+amikacine or cefepime+ciprofloxacin. Vancomycin appeared necessary only if the onset was >7 days, due to potential methicillin-resistant Staphylococcus aureus (3/8). Conclusions: Mechanically-ventilated poisoned patients in ICU may suffer from hospital-acquired pneumonia resulting in significant morbidity. Both psychotropic and cardiotropic drugs were associated with the onset of pneumonia. In poisoned patients, optimal management should include the characterization of local bacterial ecology to guide the appropriate antibiotic treatments.