Per citar aquest document: http://ddd.uab.cat/record/113415
Bacteremia is an independent risk factor for mortality in nosocomial pneumonia : a prospective and observational multicenter study
Magret, Mònica (Universitat Rovira i Virgili)
Lisboa, Thiago (Universitat Rovira i Virgili)
Martin-Loeches, Ignacio (Master Misericordiae University Hospital (Dublín, Irlanda))
Máñez, Rafael (Hospital de Bellvitge)
Nauwynck, Marc (St Jan Hospital (Bruges, Bèlgica))
Wrigge, Hermann (University Hospital Bonn (Bonn, Alemanya))
Cardellino, Silvano (Cardinal Massaia Hospital (Asti, Itàlia))
Díaz, Emili (Universitat Rovira i Virgili)
Koulenti, Despina (University General Hospital Attikon (Haidari, Grècia))
Rello Condomines, Jordi (Universitat Autònoma de Barcelona. Departament de Medicina)
EU-VAP/CAP Study Group

Data: 2011
Resum: Introduction: Since positive blood cultures are uncommon in patients with nosocomial pneumonia (NP), the responsible pathogens are usually isolated from respiratory samples. Studies on bacteremia associated with hospital-acquired pneumonia (HAP) have reported fatality rates of up to 50%. The purpose of the study is to compare risk factors, pathogens and outcomes between bacteremic nosocomial pneumonia (B-NP) and nonbacteremic nosocomial pneumonia (NB-NP) episodes. Methods: This is a prospective, observational and multicenter study (27 intensive care units in nine European countries). Consecutive patients requiring invasive mechanical ventilation for an admission diagnosis of pneumonia or on mechanical ventilation for > 48 hours irrespective of admission diagnosis were recruited. Results: A total of 2,436 patients were evaluated; 689 intubated patients presented with NP, 224 of them developed HAP and 465 developed ventilation-acquired pneumonia. Blood samples were extracted in 479 (69. 5%) patients, 70 (14. 6%) being positive. B-NP patients had higher Simplified Acute Physiology Score (SAPS) II score (51. 5 ± 19. 8 vs. 46. 6 ± 17. 5, P = 0. 03) and were more frequently medical patients (77. 1% vs. 60. 4%, P = 0. 01). Mortality in the intensive care unit was higher in B-NP patients compared with NB-NP patients (57. 1% vs. 33%, P < 0. 001). B-NP patients had a more prolonged mean intensive care unit length of stay after pneumonia onset than NB-NP patients (28. 5 ± 30. 6 vs. 20. 5 ± 17. 1 days, P = 0. 03). Logistic regression analysis confirmed that medical patients (odds ratio (OR) = 5. 72, 95% confidence interval (CI) = 1. 93 to 16. 99, P = 0. 002), methicillin-resistant Staphylococcus aureus (MRSA) etiology (OR = 3. 42, 95% CI = 1. 57 to 5. 81, P = 0. 01), Acinetobacter baumannii etiology (OR = 4. 78, 95% CI = 2. 46 to 9. 29, P < 0. 001) and days of mechanical ventilation (OR = 1. 02, 95% CI = 1. 01 to 1. 03, P < 0. 001) were independently associated with B-NP episodes. Bacteremia (OR = 2. 01, 95% CI = 1. 22 to 3. 55, P = 0. 008), diagnostic category (medical patients (OR = 3. 71, 95% CI = 2. 01 to 6. 95, P = 0. 02) and surgical patients (OR = 2. 32, 95% CI = 1. 10 to 4. 97, P = 0. 03)) and higher SAPS II score (OR = 1. 02, 95% CI = 1. 01 to 1. 03, P = 0. 008) were independent risk factors for mortality. Conclusions: B-NP episodes are more frequent in patients with medical admission, MRSA and A. baumannii etiology and prolonged mechanical ventilation, and are independently associated with higher mortality rates.
Drets: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. Creative Commons
Llengua: Anglès
Document: article ; publishedVersion
Publicat a: Critical care, Vol. 15, Núm. R62 (February 2011) , p. 1-8, ISSN 1466-609X

DOI: 10.1186/cc10036


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