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Publication

Impact of Chronic Obstructive Pulmonary Disease on Incidence, Microbiology and Outcome of Ventilator-Associated Lower Respiratory Tract Infections

Abstract

Objectives: To determine the impact of chronic obstructive pulmonary disease (COPD) on incidence, microbiology, and outcomes of ventilator-associated lower respiratory tract infections (VA-LRTI).

Methods: Planned ancillary analysis of TAVeM study, including 2960 consecutive adult patients who received invasive mechanical ventilation (MV) > 48 h. COPD patients (n = 494) were compared to non-COPD patients (n = 2466). The diagnosis of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) was based on clinical, radiological and quantitative microbiological criteria.

Results: No significant difference was found in VAP (12% versus 13%, p = 0.931), or VAT incidence (13% versus 10%, p = 0.093) between COPD and non-COPD patients. Among patients with VA-LRTI, Escherichia coli and Stenotrophomonas maltophilia were significantly more frequent in COPD patients as compared with non-COPD patients. However, COPD had no significant impact on multidrug-resistant bacteria incidence. Appropriate antibiotic treatment was not significantly associated with progression from VAT to VAP among COPD patients who developed VAT, unlike non-COPD patients. Among COPD patients, patients who developed VAT or VAP had significantly longer MV duration (17 days (9-30) or 15 (8-27) versus 7 (4-12), p < 0.001) and intensive care unit (ICU) length of stay (24 (17-39) or 21 (14-40) versus 12 (8-19), p < 0.001) than patients without VA-LRTI. ICU mortality was also higher in COPD patients who developed VAP (44%), but not VAT(38%), as compared to no VA-LRTI (26%, p = 0.006). These worse outcomes associated with VA-LRTI were similar among non-COPD patients.

Conclusions: COPD had no significant impact on incidence or outcomes of patients who developed VAP or VAT.

Keywords: chronic obstructive pulmonary disease; intensive care; lower respiratory tract infections; mechanical ventilation; pneumonia; tracheobronchitis; ventilator-associated.

Conflict of interest statement

S.N.: MSD, Pfizer, Biomérieux, Gilead (lecture and advisory board). A.R.: MaatPharma (advisory board). Appendix A. Other authors declare that they have no competing interests.

Figures

Figure 1 Study flowchart. Data are presented as number of patients. Only first episodes of VA-LRTI were taken into account. COPD, Chronic Obstructive Pulmonary Disease; VA-LRTI, ventilator-associated lower respiratory tract infection; VAP, ventilator-associated pneumonia; VAT, ventilator-associated tracheobronchitis.

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