Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicentre study.
Crit Care. 2011 Feb 16;15(1):R62
Authors: Magret M, Lisboa T, Martin-Loeches I, Manez R, Nauwynck M, Wrigge H, Cardellino S, Diaz E, Koulenti D, Rello J
ABSTRACT: INTRODUCTION: Since positive blood cultures are uncommon in patients with nosocomial pneumonia (NP), the responsible pathogens are usually isolated from respiratory samples. Studies on bacteremia associated with hospital acquired pneumonia (HAP) have reported fatality rates of up to 50%. The purpose of the study is to compare risk factors, pathogens and outcomes between bacteremic nosocomial pneumonia (B-NP) and non-bacteremic nosocomial pneumonia (NB-NP) episodes. METHODS: This is a prospective, observational and multicenter study (27 intensive care units in nine European countries). Consecutive patients requiring invasive mechanical ventilation (MV) for an admission diagnosis of pneumonia or on mechanical ventilation for >48 hours irrespective of admission diagnosis were recruited. RESULTS: A total of 2436 patients were evaluated; 689 intubated patients presented with NP, 224 of them developed HAP and 465 ventilation acquired pneumonia (VAP). Blood samples were extracted in 479 (69.5%) patients, 70 (14.6%) being positive. B-NP patients had higher SAPS II score (51.5 +/- 19.8 vs 46.6 +/- 17.5, p=0.03) and were more frequently medical patients (77.1% vs 60.4%, p=0.01). Mortality in the intensive care unit was higher in B-NP patients compared to NB-NP patients (57.1% vs 33%, p<0.001). B-NP patients had a more prolonged mean intensive care unit length of stay after pneumonia onset than NB-NP patients (28.5 +/- 30.6 vs 20.5 +/- 17.1 days, p=0.03). Logistic regression analysis confirmed that medical patients (OR=5.72; 95%CI 1.93-16.99, p=0.002), Methicillin-resistant Staphylococcus aureus (MRSA) etiology (OR=3.42; 95%CI 1.57-5.81, p=0.01), A. baumannii etiology (OR= 4.78; 95%CI 2.46-9.29, p<0.001) and days of MV (OR=1.02; 95%CI 1.01-1.03, p<0.001) were independently associated with B-NP episodes. Bacteremia (OR=2.01; 95%CI 1.22-3.55, p=0.008), diagnostic category (medical patients (OR=3.71; 95%CI 2.01-6.95, p=0.02) and surgical patients (OR=2.32; 95%CI 1.10-4.97, p=0.03) and higher SAPS II score (OR=1.02; 95%CI 1.01-1.03, p=0.008) were independent risk factors for mortality. CONCLUSIONS: B-NP episodes are more frequent in patients with medical admission, MRSA and A. baumannii etiology and prolonged MV, and is independently associated with higher mortality rates.
PMID: 21324159 [PubMed - as supplied by publisher]