Top

Published in:

01-12-2019 | Septicemia | Original

The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection

Authors: Ignacio Martin-Loeches, Antoni Torres, Pedro Povoa, Fernando G. Zampieri, Jorge Salluh, Saad Nseir, Miquel Ferrer, Alejandro Rodriguez, TAVeM study Group

Published in: Intensive Care Medicine | Issue 12/2019

Abstract

Purpose

Ventilator associated-lower respiratory tract infections (VA-LRTIs), either ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), accounts for most nosocomial infections in intensive care units (ICU) including. Our aim was to determine if appropriate antibiotic treatment in patients with VA-LRTI will effectively reduce mortality in patients who had cardiovascular failure.

Methods

This was a pre-planned subanalysis of a large prospective cohort of mechanically ventilated patients for at least 48 h in eight countries in two continents. Patients with a modified Sequential Organ Failure Assessment (mSOFA) cardiovascular score of 4 (at the time of VA-LRTI diagnosis and needed be present for at least 12 h) were defined as having cardiovascular failure.

Results

VA-LRTI occurred in 689 (23.2%) out of 2960 patients and 174 (25.3%) developed cardiovascular failure. Patients with cardiovascular failure had significantly higher ICU mortality than those without (58% vs. 26.8%; p < 0.001; OR 3.7; 95% CI 2.6–5.4). A propensity score analysis found that the presence of inappropriate antibiotic treatment was an independent risk factor for ICU mortality in patients without cardiovascular failure, but not in those with cardiovascular failure. When the propensity score analysis was conducted in patients with VA-LRTI, the use of appropriate antibiotic treatment conferred a survival benefit for patients without cardiovascular failure who had only VAP.

Conclusions

Patients with VA-LRTI and cardiovascular failure did not show an association to a higher ICU survival with appropriate antibiotic treatment. Additionally, we found that in patients without cardiovascular failure, appropriate antibiotic treatment conferred a survival benefit for patients only with VAP.

Trial registry

ClinicalTrials.gov, number NCT01791530.

de Pascale G, Ranzani OT, Nseir S et al (2017) Intensive care unit patients with lower respiratory tract nosocomial infections: the ENIRRIs project. ERS Monogr. https://doi.org/10.1183/23120541.00092-2017 CrossRef

Coeurjolly J-F, Nguile-Makao M, Timsit J-F, Liquet B (2012) Attributable risk estimation for adjusted disability multistate models: application to nosocomial infections. Biom J 54:600–616. https://doi.org/10.1002/bimj.201100222 CrossRefPubMed

Martin-Loeches I, Povoa P, Rodríguez A et al (2015) Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med 3:859–868. https://doi.org/10.1016/S2213-2600(15)00326-4 CrossRefPubMed

Grgurich PE, Hudcova J, Lei Y et al (2013) Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr Opin Infect Dis 26:140–150. https://doi.org/10.1097/QCO.0b013e32835ebbd0 CrossRefPubMed

Simpson VS, Bailey A, Higgerson RA, Christie LM (2013) Ventilator-associated tracheobronchitis in a mixed medical/surgical pediatric ICU. Chest 144:32–38. https://doi.org/10.1378/chest.12-2343 CrossRefPubMed

Keane S, Vallecoccia MS, Nseir S, Martin-Loeches I (2018) How can we distinguish ventilator-associated tracheobronchitis from pneumonia? Clin Chest Med 39:785–796. https://doi.org/10.1016/j.ccm.2018.08.003 CrossRefPubMed

Palmer LB, Smaldone GC, Chen JJ et al (2008) Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 36:2008–2013. https://doi.org/10.1097/CCM.0b013e31817c0f9e CrossRefPubMed

Fihman V, Messika J, Hajage D et al (2015) Five-year trends for ventilator-associated pneumonia: correlation between microbiological findings and antimicrobial drug consumption. Int J Antimicrob Agents 46:518–525. https://doi.org/10.1016/j.ijantimicag.2015.07.010 CrossRefPubMed

De Bus L, Gadeyne B, Steen J et al (2018) A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit: results from a prospective four-year registration. Crit Care 22:241. https://doi.org/10.1186/s13054-018-2178-7 CrossRefPubMedPubMedCentral

10.

Martin-Loeches I, Rodriguez AH, Torres A (2018) New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia: USA vs Europe. Curr Opin Crit Care 24:347–352. https://doi.org/10.1097/MCC.0000000000000535 CrossRefPubMed

11.

Wilke M, Grube R (2013) Update on management options in the treatment of nosocomial and ventilator assisted pneumonia: review of actual guidelines and economic aspects of therapy. Infect Drug Resist 7:1–7. https://doi.org/10.2147/IDR.S25985 CrossRefPubMedPubMedCentral

12.

http://www.independent.co.uk/life-style/health-and-families/health-news/antibiotics-resistance-apocalypse-warning-chief-medical-officer-professor-dame-sally-davies-drugs-a7996806.html. Accessed 23 July 2019

13.

Martin-Loeches I, Deja M, Koulenti D et al (2013) Potentially resistant microorganisms in intubated patients with hospital-acquired pneumonia: the interaction of ecology, shock and risk factors. Intensive Care Med. https://doi.org/10.1007/s00134-012-2808-5 CrossRefPubMed

14.

Zampieri FG, Póvoa P, Salluh JI et al (2018) Lower respiratory tract infection and short-term outcome in patients with acute respiratory distress syndrome. J Intensive Care Med. https://doi.org/10.1177/0885066618772498 CrossRefPubMed

15.

Moreau A-S, Martin-Loeches I, Povoa P et al (2018) Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections. Eur Respir J. https://doi.org/10.1183/13993003.01656-2017 CrossRefPubMed

16.

Vincent JL, Moreno R et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRef

17.

Rouze A, Martin-Loeches I, Nseir S et al (2018) Community-acquired pneumonia: now you see it, now you don’t! Ann Transl Med 5:442. https://doi.org/10.1183/13993003.01656-2017 CrossRef

18.

Magiorakos A-P, Srinivasan A, Carey RB et al (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281. https://doi.org/10.1111/j.1469-0691.2011.03570.x CrossRef

19.

White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30:377–399. https://doi.org/10.1002/sim.4067 CrossRef

20.

Kahan BC (2014) Accounting for centre-effects in multicentre trials with a binary outcome—when, why, and how? BMC Med Res Methodol 14:20. https://doi.org/10.1186/1471-2288-14-20 CrossRefPubMedPubMedCentral

21.

Brookhart MA, Schneeweiss S, Rothman KJ et al (2006) Variable selection for propensity score models. Am J Epidemiol 163:1149–1156. https://doi.org/10.1093/aje/kwj149 CrossRefPubMedPubMedCentral

22.

Joffe MM, Rosenbaum PR (1999) Invited commentary: propensity scores. Am J Epidemiol 150:327–333. https://doi.org/10.1093/oxfordjournals.aje.a010011 CrossRefPubMed

23.

Ho DE, Imai K, King G, Stuart EA (2011) MatchIt : nonparametric preprocessing for parametric causal inference. J Stat Softw. https://doi.org/10.18637/jss.v042.i08 CrossRef

24.

Hranjec T, Rosenberger LH, Swenson B et al (2012) Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensive-care-unit-acquired infection: a quasi-experimental, before and after observational cohort study. Lancet Infect Dis 12:774–780. https://doi.org/10.1016/S1473-3099(12)70151-2 CrossRefPubMedPubMedCentral

25.

Rhodes A, Phillips G, Beale R et al (2015) The surviving sepsis campaign bundles and outcome: results from the international multicentre prevalence study on sepsis (the IMPreSS study). Intensive Care Med 41:1620–1628. https://doi.org/10.1007/s00134-015-3906-y CrossRefPubMed

26.

Rhodes A, Evans LE, Alhazzani W et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377. https://doi.org/10.1007/s00134-017-4683-6 CrossRef

27.

Klompas M, Calandra T, Singer M (2018) Antibiotics for sepsis-finding the equilibrium. JAMA 320:1433–1434. https://doi.org/10.1001/jama.2018.12179 CrossRefPubMed

28.

Kumar AA, Zarychanski R, Light B et al (2010) Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis. Crit Care Med 38:1773–1785. https://doi.org/10.1097/CCM.0b013e3181eb3ccd CrossRefPubMed

29.

Coopersmith CM, de Backer D, Deutschman CS et al (2018) Surviving sepsis campaign: research priorities for sepsis and septic shock. Intensive Care Med. https://doi.org/10.1007/s00134-018-5175-z CrossRefPubMed

30.

Martin-Loeches I, Martinez M, de Haro C, et al (2012) Impact Of Time To Broad-Spectrum Antibiotic On Mortality Of Severe Sepsis And Septic Shock. Results From The Surviving Sepsis Campaign. Am J Respir Crit Care Med 185:A4004

31.

Feemster LC, Saft HL, Bartlett SJ et al (2018) Patient-centered outcomes research in pulmonary, critical care, and sleep medicine. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 15:1005–1015. https://doi.org/10.1513/AnnalsATS.201806-406WS CrossRefPubMedPubMedCentral

32.

Warren MM, Gibb AP, Walsh TS (2005) Antibiotic prescription practice in an intensive care unit using twice-weekly collection of screening specimens: a prospective audit in a large UK teaching hospital. J Hosp Infect 59:90–95. https://doi.org/10.1016/j.jhin.2004.09.014 CrossRefPubMed

33.

Kalanuria AA, Ziai W, Zai W, Mirski M (2014) Ventilator-associated pneumonia in the ICU. Crit Care 18:208. https://doi.org/10.1186/cc13775 CrossRefPubMedPubMedCentral

34.

Forel J-M, Voillet F, Pulina D et al (2012) Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy. Crit Care 16:R65. https://doi.org/10.1186/cc11312 CrossRefPubMedPubMedCentral

35.

Melsen WG, Rovers MM, Koeman M, Bonten MJM (2011) Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med 39:2736–2742. https://doi.org/10.1097/CCM.0b013e3182281f33 CrossRefPubMed

36.

https://clinicaltrials.gov/ct2/show/NCT03012360. Accessed 23 July 2019

37.

Perner A, Gordon AC, De Backer D et al (2016) Sepsis: frontiers in diagnosis, resuscitation and antibiotic therapy. Intensive Care Med 42:1958–1969. https://doi.org/10.1007/s00134-016-4577-z CrossRefPubMed

Title: The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection
Authors: Ignacio Martin-Loeches
Antoni Torres
Pedro Povoa
Fernando G. Zampieri
Jorge Salluh
Saad Nseir
Miquel Ferrer
Alejandro Rodriguez
TAVeM study Group
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Septicemia
Septicemia
Antibiotic
Pneumonia
Published in: Intensive Care Medicine / Issue 12/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05797-6

At a glance: The STEP trials

Springer Medicine

The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection

Abstract

Purpose

Methods

Results

Conclusions

Trial registry

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Trial registry

Please log in to get access to this content

Other articles of this Issue 12/2019

Short-term dialysis catheter versus central venous catheter infections in ICU patients: a post hoc analysis of individual data of 4 multi-centric randomized trials

The urea-creatinine ratio as a novel biomarker of critical illness-associated catabolism

Chest X-ray in acute pulmonary embolism: forgiven but not forgotten

Leptospirosis: one of the forgotten diseases

Less is more: catecholamine-sparing strategies in septic shock

Echo-guided air-filled endotracheal tube cuff visualization