Risk factors for developping pneumonia associated with ventilation by Acinetobacter spp
Keywords:
PNEUMONIA, ARTIFICIAL RESPIRATION, ACINETOBACTER INFECTIONS, RISK FACTOR'SAbstract
The incidence of pneumonia associated with Acinetobacter spp.-ventilation (PAV) has risen both at national and international levels and determines high mortality rates. Risk factors for developing this hospital-acquired pneumonia vary in every centre.
We aimed at identifying specific risk factors for developing PAV.
This 24-month prospective study (May 2000-May 2002) took place in the intensive care units (IUC) of the Hospital Pasteur and the Hospital Policial. All ventilated patients for a period of 48 hours or more, suspected to carry PAV were enrolled. Only pneumonias bacterial-proved were analyzed.
Results. In a sample of 137 patients, suspected carriers of PAV, 77 PAV events were bacterial-proved: 27 for Acinetobacter spp. and 50 for other pathogens.
Logistic regression was used to analyze data, the independent variable was Acinetobacter spp. Previous use of ceftriaxone (CRE) (p = 0,0001, OR = 11,2) and flurquinolone (p=0,003, OR=7,0) significant and independently predicted PAV.
Conclusions. CRE and fluorquinolone were indentified as risk factors for developing PAV. Restriction on CRE and fluorquinolone and use of other molecules of similar spectrum in rotation.
References
1) Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial Pneumonia in Ventilated Patients: A Cohort Study Evaluating Attributable Mortality and Hospital Stay. Am J Med 1993; 94(3): 281-8.
2) Medina J, Correa H, Formento C, Pontet J, Curbelo A. ¿Cuál es la duración adecuada del tratamiento antimicrobiano en la Neumonía Asociada a la Ventilación? Pac Crít (Montevideo) 2002; 15(1-2-3): 58-66.
3) Bergogne-Bérézin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996; 9(2): 148-65.
4) Medina J, Soca A, Bazet C, Bentancourt S. Neumonía Asociada a la Ventilación. Incidencia, agentes etiológicos y evolución según tratamiento. Pac Crít (Montevideo) 2000; 13(1-2): 8-22.
5) Medina J, Formento C, Pontet J, Curbelo A, Soca A, Bazet C, et al. Neumonía Asociada a la Ventilación. Estrategia empírica precoz vs. estrategia específica en el tratamiento antibiótico. Datos preliminares. Pac Crít (Montevideo) 2001; 14(3): 30-46.
6) Lombardi R, Guerra S, Pivel L, Rodríguez C, Toja G, Pacheco L. Infección/colonización respiratoria por S. maltophilia y Acinetobacter spp. en el paciente crítico. Pac Crít (Montevideo) 2000; 13(3): 93-108.
7) Torres A, Aznar R, Gatell JM, Jiménez P, González J, Ferrer A et al. Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990; 142(3): 523-8.
8) Baraibar J, Correa H, Mariscal D, Gallego M, Valles J, Rello J. Risk factors for infection by Acinetobacter baumannii in intubated patients with nosocomial pneumonia. Chest 1997; 112(4): 1050-4.
9) Akca O, Koltka K, Uzel S, Cakar N, Pembeci K, Sayan MA, et al. Risk factors for early-onset, ventilator-associated pneumonia in critical care patients: selected multiresistant versus nonresistant bacteria. Anesthesiology 2000; 93(3): 638-45.
10) Husni RN, Goldstein LS, Arroliga AC, Hall GS, Fatica C, Stoller JK, et al. Risk Factors for an Outbreak of Multi-Drug-Resistant Acinetobacter Nosocomial Pneumonia Among Intubated Patients. Chest 1999; 115(5): 1378-82.
11) Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 1995; 20(4): 790-6.
12) Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, et al. Nosocomial Pneumonia in Patients Receiving Continuous Mechanical Ventilation: Prospective Analysis of 52 Episodes with use of a Protected Specimen Brush and Quantitative Culture Techniques. Am Rev Respir Dis 1989; 139(4): 877-84.
13) Villers D, Espaze E, Coste-Burel M, Giauffret F, Ninin E, Nicolas F, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998; 129(3): 182-9.
14) Johanson WG Jr, Pierce AK, Sanford JP, Thomas GO. Nosocomial respiratory infections with gram negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 1972: 77(5): 701-6.
15) Flanagan PG, Findlay GP, Magee JT, Ionescu A, Barnes RA, Smithies M. The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages. Intensive Care Med 2000; 26(1): 20-30.
16) Bergmans DC, Bonten MJ, Leeuw PW, Stobberingh EE. Reproducibility of quantitative cultures of endotracheal aspirates from mechanically ventilated patients. J Clin Microbiol 1997; 35(3): 796-8.
17) Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149(3 Pt 1): 818-24.
18) Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovatives therapies in sepsis. The ACCP/SCCM. (American College of Chest Physician/Society of Critical Care Medicine). Consensus Conference Comitee. Chest 1992; 101: 1644-55.
19) Ewig S, Ruiz M, Mensa J, Marcos MA, Martínez JA, Arancibia F, et al. Severe community-acquired pneumonial. Assessment of severity criteria. Am J Respir Crit Care Med 1998; 158(4): 1102-8.
20) Zwillich CW, Pierson DJ, Creagh CE, Sutton FP, Schatz E, Petty TL. Complications of Assisted Ventilation. A prospective Study of 354 consecutive Episodes. Am J Med 1974; 57(2): 161-70.
21) McCabe WR, Jackson GG. Gram-negative bacteriemia. Arch Intern Med 1962; 110: 847-64.
22) Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13(10): 818-9.
23) Marshall JC, Cook DJ, Christou NV, Bernard GR, S prung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23(10): 1638-52.
24) Vincent JL, Moreno R, Takala JS, Willatts S, De Mendonca A, Bruining H, et al. 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 1996; 22(7): 707-10.
25) Gruson D, Hilbert G, Vargas F, Valentino R, Bebear C, Allery A, et al. Rotation and Restricted use of antibiotics in a medical intensive care unit. Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistent gram-negative bacteria. Am J Respir Crit Care Med 2000; 162(3 Pt 1): 837-43.
26) Raymond DP, Pelletier SJ, Crabtree TD, Gleason TG, Hamm LL, Pruett TL, et al. Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit. Crit Care Med 2001; 29(6): 1101-8.
2) Medina J, Correa H, Formento C, Pontet J, Curbelo A. ¿Cuál es la duración adecuada del tratamiento antimicrobiano en la Neumonía Asociada a la Ventilación? Pac Crít (Montevideo) 2002; 15(1-2-3): 58-66.
3) Bergogne-Bérézin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996; 9(2): 148-65.
4) Medina J, Soca A, Bazet C, Bentancourt S. Neumonía Asociada a la Ventilación. Incidencia, agentes etiológicos y evolución según tratamiento. Pac Crít (Montevideo) 2000; 13(1-2): 8-22.
5) Medina J, Formento C, Pontet J, Curbelo A, Soca A, Bazet C, et al. Neumonía Asociada a la Ventilación. Estrategia empírica precoz vs. estrategia específica en el tratamiento antibiótico. Datos preliminares. Pac Crít (Montevideo) 2001; 14(3): 30-46.
6) Lombardi R, Guerra S, Pivel L, Rodríguez C, Toja G, Pacheco L. Infección/colonización respiratoria por S. maltophilia y Acinetobacter spp. en el paciente crítico. Pac Crít (Montevideo) 2000; 13(3): 93-108.
7) Torres A, Aznar R, Gatell JM, Jiménez P, González J, Ferrer A et al. Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990; 142(3): 523-8.
8) Baraibar J, Correa H, Mariscal D, Gallego M, Valles J, Rello J. Risk factors for infection by Acinetobacter baumannii in intubated patients with nosocomial pneumonia. Chest 1997; 112(4): 1050-4.
9) Akca O, Koltka K, Uzel S, Cakar N, Pembeci K, Sayan MA, et al. Risk factors for early-onset, ventilator-associated pneumonia in critical care patients: selected multiresistant versus nonresistant bacteria. Anesthesiology 2000; 93(3): 638-45.
10) Husni RN, Goldstein LS, Arroliga AC, Hall GS, Fatica C, Stoller JK, et al. Risk Factors for an Outbreak of Multi-Drug-Resistant Acinetobacter Nosocomial Pneumonia Among Intubated Patients. Chest 1999; 115(5): 1378-82.
11) Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 1995; 20(4): 790-6.
12) Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, et al. Nosocomial Pneumonia in Patients Receiving Continuous Mechanical Ventilation: Prospective Analysis of 52 Episodes with use of a Protected Specimen Brush and Quantitative Culture Techniques. Am Rev Respir Dis 1989; 139(4): 877-84.
13) Villers D, Espaze E, Coste-Burel M, Giauffret F, Ninin E, Nicolas F, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998; 129(3): 182-9.
14) Johanson WG Jr, Pierce AK, Sanford JP, Thomas GO. Nosocomial respiratory infections with gram negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 1972: 77(5): 701-6.
15) Flanagan PG, Findlay GP, Magee JT, Ionescu A, Barnes RA, Smithies M. The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages. Intensive Care Med 2000; 26(1): 20-30.
16) Bergmans DC, Bonten MJ, Leeuw PW, Stobberingh EE. Reproducibility of quantitative cultures of endotracheal aspirates from mechanically ventilated patients. J Clin Microbiol 1997; 35(3): 796-8.
17) Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149(3 Pt 1): 818-24.
18) Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovatives therapies in sepsis. The ACCP/SCCM. (American College of Chest Physician/Society of Critical Care Medicine). Consensus Conference Comitee. Chest 1992; 101: 1644-55.
19) Ewig S, Ruiz M, Mensa J, Marcos MA, Martínez JA, Arancibia F, et al. Severe community-acquired pneumonial. Assessment of severity criteria. Am J Respir Crit Care Med 1998; 158(4): 1102-8.
20) Zwillich CW, Pierson DJ, Creagh CE, Sutton FP, Schatz E, Petty TL. Complications of Assisted Ventilation. A prospective Study of 354 consecutive Episodes. Am J Med 1974; 57(2): 161-70.
21) McCabe WR, Jackson GG. Gram-negative bacteriemia. Arch Intern Med 1962; 110: 847-64.
22) Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13(10): 818-9.
23) Marshall JC, Cook DJ, Christou NV, Bernard GR, S prung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23(10): 1638-52.
24) Vincent JL, Moreno R, Takala JS, Willatts S, De Mendonca A, Bruining H, et al. 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 1996; 22(7): 707-10.
25) Gruson D, Hilbert G, Vargas F, Valentino R, Bebear C, Allery A, et al. Rotation and Restricted use of antibiotics in a medical intensive care unit. Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistent gram-negative bacteria. Am J Respir Crit Care Med 2000; 162(3 Pt 1): 837-43.
26) Raymond DP, Pelletier SJ, Crabtree TD, Gleason TG, Hamm LL, Pruett TL, et al. Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit. Crit Care Med 2001; 29(6): 1101-8.
Downloads
Published
2002-12-31
How to Cite
1.
Medina J, Formento C, Pontet J, Curbelo A, Savio E. Risk factors for developping pneumonia associated with ventilation by Acinetobacter spp. Rev. Méd. Urug. [Internet]. 2002 Dec. 31 [cited 2024 Nov. 24];18(3):256-64. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/969
Issue
Section
Original Articles
