학술논문
European Network for ICU-Related Respiratory Infections (ENIRRIs): a multinational, prospective, cohort study of nosocomial LRTI
Document Type
Original Paper
Author
Martin-Loeches, Ignacio; Reyes, Luis Felipe; Nseir, Saad; Ranzani, Otavio; Povoa, Pedro; Diaz, Emili; Schultz, Marcus J.; Rodríguez, Alejandro H.; Serrano-Mayorga, Cristian C.; De Pascale, Gennaro; Navalesi, Paolo; Panigada, Mauro; Coelho, Luis Miguel; Skoczynski, Szymon; Esperatti, Mariano; Cortegiani, Andrea; Aliberti, Stefano; Caricato, Anselmo; Salzer, Helmut J. F.; Ceccato, Adrian; Civljak, Rok; Soave, Paolo Maurizio; Luyt, Charles-Edouard; Ekren, Pervin Korkmaz; Rios, Fernando; Masclans, Joan Ramon; Marin, Judith; Iglesias-Moles, Silvia; Nava, Stefano; Chiumello, Davide; Bos, Lieuwe D.; Artigas, Antoni; Froes, Filipe; Grimaldi, David; Taccone, Fabio Silvio; Antonelli, Massimo; Torres, Antoni
Source
Intensive Care Medicine. 49(10):1212-1222
Subject
Language
English
ISSN
0342-4642
1432-1238
1432-1238
Abstract
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.