Pseudomonas aeruginosa ventilator associated pneumonia: improved outcomes with earlier follow-up

Elpis Giantsou, Nikolaos Liratzopoulos, Eleni Efraimidou, Konstantinos I. Manolas, J. Duncan Young

.

DOI: 10.4236/health.2010.22014                

Abstract

It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%; p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p<0.05 ). Eighteen patients of the “day- five” group were diagnosed with super-infec tion and 22 with persistence on day five, of whom 14 and 19 had been having these patterns since day three. For patients with Pseudomonas aeruginosa VAP and Clinical Pulmonary Infe- ction Score >6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.

Keywords

Ventilator-Associated Pneumonia; Clinical Pulmonary Infection Score; Pseudomonas Aeruginosa

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Niederman, M.S. (2005) The clinical diagnosis of venti-lator-associated pneumonia. Respiratory Care, 50, 788-796.
[2]	Singh. N., Rogers, P., Atwood, C.W., Wagener, M.M., Yu, V.L. (2000) Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. Am J Respir Crit Care Med, 162, 505-511.
[3]	Luna, L.M., Blanzaco, M., Daniel, D., Niederman, M.S., Matarucco, W., Baredes, N.C., Desmery, P., Palizas, F., Menga, G., Rios, F., Apezteguia, C. (2003) Resolution of ventilator-associated pneumonia, Prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med, 31, 676-682.
[4]	Ioanas, M., Ewig, S., Torres, A. (2003) Treatment failures in patients with ventilator-associated pneumonia. Infect Dis Clin N Am,17, 753-771.
[5]	Wunderink, R.G. (1995) Ventilator-associated pneumonia, Failure to respond to antibiotic therapy. Clin Chest Med, 16, 173-193.
[6]	Menendez, R., Perpina, R., Torres (2005) A. Evaluation of non-resolving and progressive pneumonia. Semin Res-pir Infect, 18, 103-111.
[7]	Montravers, P., Fagon, J.Y., Chastre, J., Lesco, M., Domret, M.C., Trouillet, J.L., Gibert, C. (1993) Fol-low-up protected specimen brushes to assess treatment in nosokomial pneumonia. Am Rev Respir Dis, 147, 38-44.
[8]	Fagon, J. Y., Chastre, J., Wolff, M., Gervais, C., Parer-Aubas, S., Stephan, F., Similowski, T., Mercat, A., Diehl, J.L., Sollet, J.P., Tenaillon, A. (2000) Invasive and Non-invasive strategies for management of suspected ventilator-associated pneumonia. Ann Intern Med, 132, 621-30.
[9]	American Thoracic Society. (2005) Infectious Diseases Society of America, guidelines for the management of adults with hospital-acquired, ventilator-associated and healthcare associated pneumonia. Am J Respir Crit Care Med, 171, 388-416.
[10]	Tenover, F.C., Robert, D.A., Goering, R.V., Mickelsen, P.A., Murray, B.E., Persing, D.H., Swaminathan, B. (1995) Interpreting chromosomal DNA restriction frag-ments produced by pulsed field gel electrophoresis, Cri-teria for bactrerial strain typing. Clin Microbiol, 33(9), 2233-2239.
[11]	Wassenaar, T.M. (2003) Molecular typing of pathogens. Berl Munch Tierarztl Wochenschr, 116, 447-453.
[12]	Le-Gall, J.R., Lemeshow, S., Saulnier, F. (1993) A new Simplified Acute Physiology Score Based on a European/ North American study. JAMA, 270, 2957-2963.
[13]	Vincent, J.L., Moreno, R., Takala, J., Willats, S., De Mendonca, A., Bruining, H., Reinhart, C.K. Suter PM and Thijs LG. (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunc-tion/failure. On behalf of the Working Group on Sep-sis-Related Problems of the European Society of Inten-sive Care Medicine. Intensive Care Med, 22, 707-10.
[14]	Luna, CM., Vujacich, P., Niedermann, M.S., Vay, C., Gherardi, C., Matera, J., Jolly, E.C. (1997) Impact of BAL data on the therapy and outcome of ventila-tor-associated pneumonia. Chest, 111, 676-685.
[15]	Luna, C.M., Aruj, P., Niederman, M.S., Garzon, J., Violi, D., Prignoni, A., Rios, F., Baquero, S. (2008) Appropri-ateness and delay to initiate therapy in ventila-tor-associated pneumonia. Eur Respir J, 27, 158-64.
[16]	Giantsou, E., Liratzopoulos, N., Efraimidou, E., Panopoulou, M., Alepopoulou, E., Kartali-Ktenidou, S., Minopoulos, G., Manolas, K.I. (2007) De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirates. Intensive Care Med, 33, 1533-1540.
[17]	Ioanas, M., Ewig, S., Torres, A. (2003) Treatment failures in patients with ventilator-associated pneumonia. Infect Dis Clin N Am, 17, 753-771.
[18]	Kollef, M.H. (2007) Moving towards real-time anti-mi-crobial management of ventilator-associated pneumonia. Clin Infect Dis, 44, 388-390.
[19]	Prince, A.S. (2002) Biofilms, antimicrobial resistance and airway infection. N Engl J Med, 347, 847-885.
[20]	Dominguez, A.A., Arango, M.V., Torres, A. (2005) Treatment failure in patients with ventilator-associated pneumonia. Semin Respir Crit Care Med, 27, 104-12.