Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections : An ENIRRI Analysis
Reyes, L.F. (University of Oxford)
Torres, A. (Instititut d'investigacions Biomédiques August Pi i Sunyer)
Olivella-Gomez, J. (Universidad de La Sabana)
Ibáñez-Prada, E.D. (Clinica Universidad de La Sabana)
Nseir, Saad (Université de Lille)
Ranzani, O.T. (Universidade de São Paulo)
Povoa, P. (Hospital de São Francisco Xavier (Lisboa, Portugal))
Diaz, Emilio (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Schultz, M. J. (Laboratory for Experimental Intensive Care & Anesthesiology (LEICA))
Rodríguez, A.H. (Hospital Universitari Joan XXIII de Tarragona)
Serrano-Mayorga, C.C. (Universidad de La Sabana)
De Pascale, G. (Fondazione Policlinico Universitario A. Gemelli IRCCS)
Navalesi, Paolo (Sant'Andrea (ASL VC))
Skoczynski, S. (Medical University of Silesia)
Esperatti, M. (Universidad Nacional de Mar del Plata)
Coelho, L.M. (Hospital de São Francisco Xavier (Lisboa, Portugal))
Cortegiani, Andrea (University of Palermo)
Aliberti, S. (Humanitas Research Hospital (Itàlia))
Caricato, A. (Fondazione Policlinico Universitario A. Gemelli IRCCS)
Salzer, H.J.F. (Ignaz Semmelweis Institute)
Ceccato, Adrian (Universitat de Barcelona)
Civljak, R. (Dr Fran. Mihaljevic" University Hospital for Infectious Diseases)
Soave, P.M. (Fondazione Policlinico Universitario A. Gemelli IRCCS)
Luyt, Charles-Edouard (Assistance Publique-Hôpitaux de Paris)
Korkmaz Ekren, P. (Ege University)
Rios, Fernando (Hospital Nacional Alejandro Posadas)
Masclans, Joan R (Hospital del Mar (Barcelona, Catalunya))
Marin, Judith (Hospital del Mar (Barcelona, Catalunya))
Iglesias-Moles, Silvia (Hospital Universitari Arnau de Vilanova (Lleida))
Nava, S. (University of Bologna)
Chiumello, D. (ASST Santi Paolo e Carlo)
Bos, Lieuwe D (University of Amsterdam)
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Froes, F. (Hospital Pulido Valente)
Grimaldi, D. (Université Libre de Bruxelles (ULB))
Panigada, M. (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Milà, Itàlia))
Taccone, F.S. (Université Libre de Bruxelles (ULB))
Antonelli, M. (Fondazione Policlinico Universitario A. Gemelli IRCCS)
Martin-Loeches, Ignacio (St James's University Hospital)
Universitat Autònoma de Barcelona

Data:	2025
Resum:	Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76. 4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2. 96 [1. 28-6. 80], p = 0. 01). The 90-day mortality-associated factor was MDRP infection (1. 98 [1. 13-3. 44], p = 0. 01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2. 38 [1. 06-5. 31] p = 0. 03), with no variable showing statistical and clinical significance at 90 days. The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach.
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.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Critical care ; Mechanical ventilation ; Nosocomial lower respiratory tract infections
Publicat a:	Antibiotics, Vol. 14 Núm. 2 (february 2025) , p. 127, ISSN 2079-6382

DOI: 10.3390/antibiotics14020127
PMID: 40001371

17 p, 556.5 KB

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