Critical Care (Sep 2023)

Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort

  • Louis-Marie Galerneau,
  • Sébastien Bailly,
  • Nicolas Terzi,
  • Stéphane Ruckly,
  • Maité Garrouste-Orgeas,
  • Johanna Oziel,
  • Vivien Hong Tuan Ha,
  • Marc Gainnier,
  • Shidasp Siami,
  • Claire Dupuis,
  • Jean-Marie Forel,
  • Anaïs Dartevel,
  • Julien Dessajan,
  • Christophe Adrie,
  • Dany Goldgran-Toledano,
  • Virginie Laurent,
  • Laurent Argaud,
  • Jean Reignier,
  • Jean-Louis Pepin,
  • Michael Darmon,
  • Jean-François Timsit,
  • OUTCOME R. E. A. network

DOI
https://doi.org/10.1186/s13054-023-04631-2
Journal volume & issue
Vol. 27, no. 1
pp. 1 – 10

Abstract

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Abstract Background Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients. Methods Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU. Results Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01). Conclusion We found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD.

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