European Network for ICU-Related Respiratory Infections (ENIRRIs): a multinational, prospective, cohort study of nosocomial LRTI.

Autor: Martin-Loeches I; St James's University Hospital, Trinity College, Dublin 8, D08 NHY, Ireland. drmartinloeches@gmail.com.; Universidad de Barcelona, CIBERes, Barcelona, Spain. drmartinloeches@gmail.com., Reyes LF; Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia.; Clinica Universidad de La Sabana, Chia, Colombia.; Pandemic Sciences Institute, University of Oxford, Oxford, UK., Nseir S; University Hospital of Lille, Lille, France., Ranzani O; Hospital Clinic of Barcelona, Barcelona, Spain., Povoa P; Hospital de Sao Francisco Xavier, Lisbon, Portugal., Diaz E; Corporacio Sanitaria Parc Tauli, Sabadell, Spain., Schultz MJ; Academic Medical Center, Amsterdam, The Netherlands.; Department of Intensive Care Laboratory for Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam, The Netherlands.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK., Rodríguez AH; Hospital Joan XXIII de Tarragona, Tarragona, Spain., Serrano-Mayorga CC; Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia.; Clinica Universidad de La Sabana, Chia, Colombia., De Pascale G; Department of Intensive Care Policlinico Gemelli, Rome, Italy., Navalesi P; Magna Graecia University, Catanzaro, Italy.; Sant'Andrea (ASL VC), Vercelli, Italy., Panigada M; Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Coelho LM; Hospital de Sao Francisco Xavier, Lisbon, Portugal., Skoczynski S; Medical University of Silesia, Katowice, Poland., Esperatti M; Hospital Privado de Comunidad, Mar del Plata, Argentina., Cortegiani A; Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy., Aliberti S; Medical University of Silesia, Katowice, Poland.; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy., Caricato A; Sant'Andrea (ASL VC), Vercelli, Italy., Salzer HJF; Department of Internal Medicine 4-Pneumology, Kepler University Hospital, Linz, Austria.; Medical Faculty, Johannes Kepler University Linz, Linz, Austria.; Division of Infectious Diseases and Tropical Medicine, Kepler University Hospital, Linz, Austria., Ceccato A; Hospital Clinic of Barcelona, Barcelona, Spain., Civljak R; 'Dr. Fran Mihaljevic' University Hospital for Infectious Diseases, Zagreb, Croatia., Soave PM; Department of Surgical Intensive Care Policlinico Gemelli, Rome, Italy., Luyt CE; Groupe Hospitalier Pitie-Salpitriere, Paris, France., Ekren PK; Ege University Medical Faculty, Izmir, Turkey., Rios F; Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina., Masclans JR; Hospital del Mar, Barcelona, Spain.; Intensive Care Medicine, Hospital del Mar & IMIM, Barcelona, Spain.; Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain., Marin J; Intensive Care Medicine, Hospital del Mar & IMIM, Barcelona, Spain., Iglesias-Moles S; Hospital Arnau de Vilanova de Lleida, Lleida, Spain., Nava S; S. Orsola-Malpighi Hospital, Bologna, Italy.; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.; Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy., Chiumello D; ASST Santi Paolo e Carlo, Milan, Italy., Bos LD; Academic Medical Center, Amsterdam, The Netherlands., Artigas A; Corporacio Sanitaria Parc Tauli, Sabadell, Spain., Froes F; Hospital Pulido Valente, Lisbon, Portugal., Grimaldi D; Hospital Erasme Universit Libre de Bruxelles, Brussels, Belgium., Taccone FS; Hospital Erasme Universit Libre de Bruxelles, Brussels, Belgium., Antonelli M; Department of Intensive Care Policlinico Gemelli, Rome, Italy., Torres A; Hospital Clinic of Barcelona, Barcelona, Spain. ATORRES@clinic.cat.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2023 Oct; Vol. 49 (10), pp. 1212-1222. Date of Electronic Publication: 2023 Oct 09.
DOI: 10.1007/s00134-023-07210-9
Abstrakt: Purpose: Lower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes.
Methods: A prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU hospital-acquired pneumonia (ICU-HAP), HAP that required invasive ventilation (VHAP), and HAP in patients transferred to the ICU without invasive mechanical ventilation were collected. The clinical diagnosis and treatments were per clinical practice and not per protocol. Descriptive statistics were used to compare the study groups.
Results: 1060 patients with LRTI (72.5% male sex, median age 64 [50-74] years) were included in the study; 160 (15.1%) developed VAT, 556 (52.5%) VAP, 98 (9.2%) ICU-HAP, 152 (14.3%) HAP, and 94 (8.9%) VHAP. Patients with VHAP had higher serum procalcitonin (PCT) and Sequential Organ Failure Assessment (SOFA) scores. Patients with VAP or VHAP developed acute kidney injury, acute respiratory distress syndrome, multiple organ failure, or septic shock more often. One thousand eight patients had microbiological samples, and 711 (70.5%) had etiological microbiology identified. The most common microorganisms were Pseudomonas aeruginosa (18.4%) and Klebsiella spp (14.4%). In 382 patients (36%), the causative pathogen shows some antimicrobial resistance pattern. ICU, hospital and 28-day mortality were 30.8%, 37.5% and 27.5%, respectively. Patients with VHAP had the highest ICU, in-hospital and 28-day mortality rates.
Conclusion: VHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study.
(© 2023. The Author(s).)
Databáze: MEDLINE
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