Impact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated Pneumonia
To define the influence of prior antibiotic use on the etiology and mortality of ventilator-associated pneumonia (VAP). A university hospital medical-surgical ICU. Prospective clinical study. Over a 35-month period, we prospectively studied 129 consecutive episodes of VAP. Etiologic diagnosis was es...
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| Veröffentlicht in: | Chest 1993-10, Vol.104 (4), p.1230-1235 |
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| creator | Rello, Jordi Ausino, Vicenç Ricart, Maite Castella, Joan Prats, Guillem |
| description | To define the influence of prior antibiotic use on the etiology and mortality of ventilator-associated pneumonia (VAP).
A university hospital medical-surgical ICU.
Prospective clinical study.
Over a 35-month period, we prospectively studied 129 consecutive episodes of VAP. Etiologic diagnosis was established using a protected specimen brush and quantitative culture techniques. We examined prognostic factors by univariate and multivariate analyses using a statistical software package (SPSS).
The rate of VAP caused by Gram-positive cocci or Haemophilus influenzae was statistically lower (p |
| doi_str_mv | 10.1378/chest.104.4.1230 |
| format | Article |
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A university hospital medical-surgical ICU.
Prospective clinical study.
Over a 35-month period, we prospectively studied 129 consecutive episodes of VAP. Etiologic diagnosis was established using a protected specimen brush and quantitative culture techniques. We examined prognostic factors by univariate and multivariate analyses using a statistical software package (SPSS).
The rate of VAP caused by Gram-positive cocci or Haemophilus influenzae was statistically lower (p<0.05) in the patients who had received antibiotics previously, while the rate of VAP caused by Pseudomonas aeruginosa was statistically higher (p<0.01). Patients died of causes directly related to the infection in 18 (14.0 percent) episodes, P aeruginosa being isolated in 9 of these fatal cases. Indeed, we found that 27.7 percent (15/54) of patients who had received prior antimicrobial therapy before the onset of pneumonia died, compared with only 4.0 percent (3/75) of those who did not. In the univariate analysis, the variables significantly associated with attributable mortality were age older than 45 years, use of corticosteroids, presence of shock, hospital day of VAP over 9, antecedent COPD, and a prior antibiotic use. A step-forward logistic regression analysis defined only prior antibiotic use (p<0.0001, OR = 9.2) as significantly influencing the risk of death from VAP. The same result was obtained when severity was included in the model. However, prior antibiotic use entirely dropped out as a significant risk factor when the etiologic agent was included in the regression equation.
Distribution of infecting microorganisms responsible for VAP differs in patients who received prior antimicrobial therapy, and this factor determines a higher mortality rate. We suggest a restrictive antibiotic policy in mechanically ventilated patients with the purpose of reducing the risk of death from VAP.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.104.4.1230</identifier><identifier>PMID: 8404198</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anti-Bacterial Agents - therapeutic use ; Anti-infective agents ; Artificial respiration ; Bacterial pneumonia ; Biological and medical sciences ; Complications and side effects ; Cross Infection - microbiology ; Cross Infection - mortality ; Dosage and administration ; Drug therapy ; Emergency and intensive respiratory care ; Female ; Humans ; Intensive care medicine ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Pneumonia ; Pneumonia - microbiology ; Pneumonia - mortality ; Prospective Studies ; Respiration, Artificial - adverse effects ; Risk Factors</subject><ispartof>Chest, 1993-10, Vol.104 (4), p.1230-1235</ispartof><rights>1993 The American College of Chest Physicians</rights><rights>1994 INIST-CNRS</rights><rights>COPYRIGHT 1993 Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-5fc7728b62ffd1416081c99b152b7b5ec08bd974fa1ee91edf1c4cd9ab9bc7b63</citedby><cites>FETCH-LOGICAL-c585t-5fc7728b62ffd1416081c99b152b7b5ec08bd974fa1ee91edf1c4cd9ab9bc7b63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3793546$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8404198$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rello, Jordi</creatorcontrib><creatorcontrib>Ausino, Vicenç</creatorcontrib><creatorcontrib>Ricart, Maite</creatorcontrib><creatorcontrib>Castella, Joan</creatorcontrib><creatorcontrib>Prats, Guillem</creatorcontrib><title>Impact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated Pneumonia</title><title>Chest</title><addtitle>Chest</addtitle><description>To define the influence of prior antibiotic use on the etiology and mortality of ventilator-associated pneumonia (VAP).
A university hospital medical-surgical ICU.
Prospective clinical study.
Over a 35-month period, we prospectively studied 129 consecutive episodes of VAP. Etiologic diagnosis was established using a protected specimen brush and quantitative culture techniques. We examined prognostic factors by univariate and multivariate analyses using a statistical software package (SPSS).
The rate of VAP caused by Gram-positive cocci or Haemophilus influenzae was statistically lower (p<0.05) in the patients who had received antibiotics previously, while the rate of VAP caused by Pseudomonas aeruginosa was statistically higher (p<0.01). Patients died of causes directly related to the infection in 18 (14.0 percent) episodes, P aeruginosa being isolated in 9 of these fatal cases. Indeed, we found that 27.7 percent (15/54) of patients who had received prior antimicrobial therapy before the onset of pneumonia died, compared with only 4.0 percent (3/75) of those who did not. In the univariate analysis, the variables significantly associated with attributable mortality were age older than 45 years, use of corticosteroids, presence of shock, hospital day of VAP over 9, antecedent COPD, and a prior antibiotic use. A step-forward logistic regression analysis defined only prior antibiotic use (p<0.0001, OR = 9.2) as significantly influencing the risk of death from VAP. The same result was obtained when severity was included in the model. However, prior antibiotic use entirely dropped out as a significant risk factor when the etiologic agent was included in the regression equation.
Distribution of infecting microorganisms responsible for VAP differs in patients who received prior antimicrobial therapy, and this factor determines a higher mortality rate. We suggest a restrictive antibiotic policy in mechanically ventilated patients with the purpose of reducing the risk of death from VAP.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Anti-infective agents</subject><subject>Artificial respiration</subject><subject>Bacterial pneumonia</subject><subject>Biological and medical sciences</subject><subject>Complications and side effects</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - mortality</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Emergency and intensive respiratory care</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Pneumonia</subject><subject>Pneumonia - microbiology</subject><subject>Pneumonia - mortality</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Risk Factors</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUtv1DAUhSMEKkNhzwYpC8SKDHbiPMxuVBWoVKldFLaWH9eJK8cebKdo_j0eMipCKvLCsu937usUxVuMtrjph09ygpi2GJEt2eK6Qc-KDaYNrpqWNM-LDUK4rpqO1i-LVzHeo_zGtDsrzgaCCKbDphiv5j2XqfS6vA3wYPwSy51LZjYyeGG4Le8mCHx_KL0r0wTlZTLe-vFQcqfKmyVJP8NR_QOyyvLkQ8Vj9NLwBKq8dbDM3hn-unihuY3w5nSfF9-_XN5dfKuub75eXeyuK9kObapaLfu-HkRXa60wwR0asKRU4LYWvWhBokEo2hPNMQDFoDSWRCrKBRWyF11zXnxY8-6D_7nk5bDZRAnWcgd5Nta3dBjaDmfw4wqO3AIzTvsUuBzB5Wmtd6BN_t5h0lFcI5rx6gk8HwV5VU_xaOXzGmMMoNk-mJmHA8OIHa1jf6zLL8IIO1qXJe9OrS9iBvUoOHmV4-9PcR4ltzpwJ018xJqeZte7v5UnM06_TAAWZ25tTtqsNe_9Ehy3_1T-vEogO_NgILAoDTgJKstlYsqb_7f9G-xoyLU</recordid><startdate>19931001</startdate><enddate>19931001</enddate><creator>Rello, Jordi</creator><creator>Ausino, Vicenç</creator><creator>Ricart, Maite</creator><creator>Castella, Joan</creator><creator>Prats, Guillem</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><general>Elsevier B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19931001</creationdate><title>Impact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated Pneumonia</title><author>Rello, Jordi ; Ausino, Vicenç ; Ricart, Maite ; Castella, Joan ; Prats, Guillem</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c585t-5fc7728b62ffd1416081c99b152b7b5ec08bd974fa1ee91edf1c4cd9ab9bc7b63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Anti-infective agents</topic><topic>Artificial respiration</topic><topic>Bacterial pneumonia</topic><topic>Biological and medical sciences</topic><topic>Complications and side effects</topic><topic>Cross Infection - microbiology</topic><topic>Cross Infection - mortality</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Emergency and intensive respiratory care</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Pneumonia</topic><topic>Pneumonia - microbiology</topic><topic>Pneumonia - mortality</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rello, Jordi</creatorcontrib><creatorcontrib>Ausino, Vicenç</creatorcontrib><creatorcontrib>Ricart, Maite</creatorcontrib><creatorcontrib>Castella, Joan</creatorcontrib><creatorcontrib>Prats, Guillem</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rello, Jordi</au><au>Ausino, Vicenç</au><au>Ricart, Maite</au><au>Castella, Joan</au><au>Prats, Guillem</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated Pneumonia</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1993-10-01</date><risdate>1993</risdate><volume>104</volume><issue>4</issue><spage>1230</spage><epage>1235</epage><pages>1230-1235</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>To define the influence of prior antibiotic use on the etiology and mortality of ventilator-associated pneumonia (VAP).
A university hospital medical-surgical ICU.
Prospective clinical study.
Over a 35-month period, we prospectively studied 129 consecutive episodes of VAP. Etiologic diagnosis was established using a protected specimen brush and quantitative culture techniques. We examined prognostic factors by univariate and multivariate analyses using a statistical software package (SPSS).
The rate of VAP caused by Gram-positive cocci or Haemophilus influenzae was statistically lower (p<0.05) in the patients who had received antibiotics previously, while the rate of VAP caused by Pseudomonas aeruginosa was statistically higher (p<0.01). Patients died of causes directly related to the infection in 18 (14.0 percent) episodes, P aeruginosa being isolated in 9 of these fatal cases. Indeed, we found that 27.7 percent (15/54) of patients who had received prior antimicrobial therapy before the onset of pneumonia died, compared with only 4.0 percent (3/75) of those who did not. In the univariate analysis, the variables significantly associated with attributable mortality were age older than 45 years, use of corticosteroids, presence of shock, hospital day of VAP over 9, antecedent COPD, and a prior antibiotic use. A step-forward logistic regression analysis defined only prior antibiotic use (p<0.0001, OR = 9.2) as significantly influencing the risk of death from VAP. The same result was obtained when severity was included in the model. However, prior antibiotic use entirely dropped out as a significant risk factor when the etiologic agent was included in the regression equation.
Distribution of infecting microorganisms responsible for VAP differs in patients who received prior antimicrobial therapy, and this factor determines a higher mortality rate. We suggest a restrictive antibiotic policy in mechanically ventilated patients with the purpose of reducing the risk of death from VAP.</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>8404198</pmid><doi>10.1378/chest.104.4.1230</doi><tpages>6</tpages></addata></record> |
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| ispartof | Chest, 1993-10, Vol.104 (4), p.1230-1235 |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Bacterial Agents - therapeutic use Anti-infective agents Artificial respiration Bacterial pneumonia Biological and medical sciences Complications and side effects Cross Infection - microbiology Cross Infection - mortality Dosage and administration Drug therapy Emergency and intensive respiratory care Female Humans Intensive care medicine Logistic Models Male Medical sciences Middle Aged Multivariate Analysis Pneumonia Pneumonia - microbiology Pneumonia - mortality Prospective Studies Respiration, Artificial - adverse effects Risk Factors |
| title | Impact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated Pneumonia |
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