Impact of piperacillin resistance on the outcome of Pseudomonas ventilator-associated pneumonia View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2006-09-07

AUTHORS

Alain Combes, Charles-Edouard Luyt, Jean-Yves Fagon, Michel Wolff, Jean-Louis Trouillet, Jean Chastre

ABSTRACT

BackgroundThe impact of antibiotic resistance on the outcome of infections due to Gram-negative bacilli, especially Pseudomonas, remains highly controversial.Study objective, design, and patientsWe evaluated the impact of piperacillin resistance on the outcomes of Pseudomonasaeruginosa ventilator-associated pneumonia (VAP) for patients who had received appropriate empiric antibiotics before enrollment in the PNEUMA trial, a multicenter randomized study comparing 8 vs 15 days of antibiotics.ResultsDespite similar characteristics at intensive care unit (ICU) admission, patients infected with piperacillin-resistant Pseudomonas strains were more acutely ill at VAP onset and had a higher 28-day mortality rate (37 vs 19%; P = 0.04) than those with piperacillin-susceptible Pseudomonas VAP. Factors associated with 28-day mortality retained by multivariable analysis were: age (OR: 1.07; 95% CI: 1.03–1.12); female gender (OR: 4.00; 95% CI: 1.41–11.11); severe underlying comorbidities (OR: 2.73; 95% CI: 1.02–7.33); and SOFA score (OR: 1.17; 95% CI: 1.03–1.32), but piperacillin resistance did not reach statistical significance (OR: 2.00; 95% CI: 0.72–5.61). The VAP recurrence rates, either superinfection or relapse, and durations of mechanical ventilation and ICU stay did not differ as a function of Pseudomonas-resistance status.ConclusionsFor patients with Pseudomonas VAP benefiting from appropriate empiric antibiotics, piperacillin resistance was associated with increased disease severity at VAP onset and higher 28-day crude mortality; however, after controlling for confounders, piperacillin-resistance was no longer significantly associated with 28-day mortality. The VAP recurrence rates and durations of ICU stay and mechanical ventilation did not differ for susceptible and resistant strains. More... »

PAGES

1970-1978

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00134-006-0355-7

DOI

http://dx.doi.org/10.1007/s00134-006-0355-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1015051373

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/16957901


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