caa a22 4500 606156305 CHVBK 20210128100608.0 cr unu---uuuuu 210128e20151201xx s 000 0 eng 10.1007/s10096-015-2495-6 doi (NATIONALLICENCE)springer-10.1007/s10096-015-2495-6 COPD patients with ventilator-associated pneumonia: implications for management [Elektronische Daten] [D. Koulenti, S. Blot, J. Dulhunty, L. Papazian, I. Martin-Loeches, G. Dimopoulos, C. Brun-Buisson, M. Nauwynck, C. Putensen, J. Sole-Violan, A. Armaganidis, J. Rello] Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12days in the duration of mechanical ventilation and >13days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP. Springer-Verlag Berlin Heidelberg, 2015 Koulenti D. 2nd Critical Care Department, Attikon University Hospital, Athens, Greece aut Blot S. Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia aut Dulhunty J. Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia aut Papazian L. Department of Intensive Care Medicine, Réanimation des Détresses Respiratoires et Infections Sévères Hôpital Nord—Assistance Publique—Hôpitaux de Marseille Aix-Marseille Université, Μarseille, France aut Martin-Loeches I. Department of Intensive Care Medicine, Corporació Sanitària Parc Taulí, Sabadell, Spain aut Dimopoulos G. 2nd Critical Care Department, Attikon University Hospital, Athens, Greece aut Brun-Buisson C. Department of Intensive Care Medicine, Henri-Mondor University Hospital, Paris, France aut Nauwynck M. Department of Intensive Care Medicine, St. Jan Hospital, Bruges, Belgium aut Putensen C. Department of Intensive Care Medicine, Bonn University Hospital, Bonn, Germany aut Sole-Violan J. Department of Intensive Care Medicine, Dr. Negrin University Hospital, Las Palmas, Gran Canaria, Spain aut Armaganidis A. 2nd Critical Care Department, Attikon University Hospital, Athens, Greece aut Rello J. Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/12(2015-12-01), 2403-2411 0934-9723 34:12<2403 2015 34 10096 https://doi.org/10.1007/s10096-015-2495-6 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-015-2495-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Koulenti D. 2nd Critical Care Department, Attikon University Hospital, Athens, Greece aut NATIONALLICENCE 700 1- Blot S. Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia aut NATIONALLICENCE 700 1- Dulhunty J. Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia aut NATIONALLICENCE 700 1- Papazian L. Department of Intensive Care Medicine, Réanimation des Détresses Respiratoires et Infections Sévères Hôpital Nord—Assistance Publique—Hôpitaux de Marseille Aix-Marseille Université, Μarseille, France aut NATIONALLICENCE 700 1- Martin-Loeches I. Department of Intensive Care Medicine, Corporació Sanitària Parc Taulí, Sabadell, Spain aut NATIONALLICENCE 700 1- Dimopoulos G. 2nd Critical Care Department, Attikon University Hospital, Athens, Greece aut NATIONALLICENCE 700 1- Brun-Buisson C. Department of Intensive Care Medicine, Henri-Mondor University Hospital, Paris, France aut NATIONALLICENCE 700 1- Nauwynck M. Department of Intensive Care Medicine, St. Jan Hospital, Bruges, Belgium aut NATIONALLICENCE 700 1- Putensen C. Department of Intensive Care Medicine, Bonn University Hospital, Bonn, Germany aut NATIONALLICENCE 700 1- Sole-Violan J. Department of Intensive Care Medicine, Dr. Negrin University Hospital, Las Palmas, Gran Canaria, Spain aut NATIONALLICENCE 700 1- Armaganidis A. 2nd Critical Care Department, Attikon University Hospital, Athens, Greece aut NATIONALLICENCE 700 1- Rello J. Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/12(2015-12-01), 2403-2411 0934-9723 34:12<2403 2015 34 10096