Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study

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...

Descripción completa

Detalles Bibliográficos
Autores: Magret, Mònica, Lisboa, Thiago, Martín Loeches, Ignacio, Máñez Mendiluce, Rafael, Nauwynck, Marc, Wrigge, Hermann, Cardellino, Silvano, Díaz, Emili, Koulenti, Despina, Rello, Jordi
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2011
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/126780
Acceso en línea:https://hdl.handle.net/2445/126780
Access Level:acceso abierto
Palabra clave:Pneumònia adquirida a la comunitat
Bacteris gramnegatius
Community-acquired pneumonia
Gram-negative bacteria
id ES_39178bc195a2db29152e37d32dbdbe17
oai_identifier_str oai:diposit.ub.edu:2445/126780
network_acronym_str ES
network_name_str España
repository_id_str
spelling Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter studyMagret, MònicaLisboa, ThiagoMartín Loeches, IgnacioMáñez Mendiluce, RafaelNauwynck, MarcWrigge, HermannCardellino, SilvanoDíaz, EmiliKoulenti, DespinaRello, JordiPneumònia adquirida a la comunitatBacteris gramnegatiusCommunity-acquired pneumoniaGram-negative bacteriaIntroduction: 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.BioMed Central2011info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/126780Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1186/cc10036Critical Care, 2011, vol. 15, num. R62https://doi.org/10.1186/cc10036cc by (c) Magret et al., 2011http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1267802026-05-27T06:46:51Z
dc.title.none.fl_str_mv Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study
title Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study
spellingShingle Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study
Magret, Mònica
Pneumònia adquirida a la comunitat
Bacteris gramnegatius
Community-acquired pneumonia
Gram-negative bacteria
title_short Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study
title_full Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study
title_fullStr Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study
title_full_unstemmed Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study
title_sort Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study
dc.creator.none.fl_str_mv Magret, Mònica
Lisboa, Thiago
Martín Loeches, Ignacio
Máñez Mendiluce, Rafael
Nauwynck, Marc
Wrigge, Hermann
Cardellino, Silvano
Díaz, Emili
Koulenti, Despina
Rello, Jordi
author Magret, Mònica
author_facet Magret, Mònica
Lisboa, Thiago
Martín Loeches, Ignacio
Máñez Mendiluce, Rafael
Nauwynck, Marc
Wrigge, Hermann
Cardellino, Silvano
Díaz, Emili
Koulenti, Despina
Rello, Jordi
author_role author
author2 Lisboa, Thiago
Martín Loeches, Ignacio
Máñez Mendiluce, Rafael
Nauwynck, Marc
Wrigge, Hermann
Cardellino, Silvano
Díaz, Emili
Koulenti, Despina
Rello, Jordi
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Pneumònia adquirida a la comunitat
Bacteris gramnegatius
Community-acquired pneumonia
Gram-negative bacteria
topic Pneumònia adquirida a la comunitat
Bacteris gramnegatius
Community-acquired pneumonia
Gram-negative bacteria
description 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.
publishDate 2011
dc.date.none.fl_str_mv 2011
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/126780
url https://hdl.handle.net/2445/126780
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1186/cc10036
Critical Care, 2011, vol. 15, num. R62
https://doi.org/10.1186/cc10036
dc.rights.none.fl_str_mv cc by (c) Magret et al., 2011
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Magret et al., 2011
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869406142815272960
score 15,301603

Similares en LA Referencia