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Ventilator-associated pneumonia due to Pseudomonas aeruginosa.
Chest. 1996 Apr; 109(4):1019-29.Chest

Abstract

OBJECTIVE

Ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa has been associated with higher case fatality rates than VAP caused by other bacterial etiologies. The causes of this excess mortality are unclear.

DESIGN

Retrospective review of 38 consecutive ventilated patients with Pseudomonas pneumonia, documented by highly reliable methods. Charts of five additional patients were unavailable for review.

SETTING

Medical ICUs of a university-affiliated Veterans Affairs Medical Center and a university-affiliated municipal hospital.

MEASUREMENTS

Prospectively collected hospital admission acute physiologic and chronic health examination (APACHE) II scores and cause of ICU admission. Retrospectively calculated organ failure and APACHE scores, VAP score. Clinical and microbiologic variables. Antibiotic treatment and outcome. Direct cause of death by standard definitions.

RESULTS

Overall mortality was 69% (26/38), significantly higher than the APACHE II predicted mortality of 42.6% (p=0.037). At least 38% (10/26) of deaths were directly attributable to Pseudomonas VAP. Multivariate analysis of factors associated with death found infectious cause for ICU admission (odds ratio [OR]=8.67; 95% confidence interval [CI], 0.86 to 85.94) and number of organ dysfunctions on the day of diagnosis (OR=1.73, 95% CI, 1.02 to 2.92) were significant. Septic shock from Pseudomonas VAP, septic shock from subsequent infection, and multiple organ dysfunction syndrome were the most common immediate causes of death. Mortality increased linearly with increasing APACHE III score on the day of diagnosis. Of initial antibiotic regimens, 67% (26/36) were considered failures. Persistent pneumonia occurred in 35% of patients while recurrent pneumonia was unusual (1/38).

CONCLUSIONS

Development of Pseudomonas pneumonia results in a mortality rate in excess of that due to the presenting illness. The attributable mortality determined by several means appears to approach 40%. The excess mortality appears to be related to the host defense response to the pneumonia rather than any characteristic of the pneumonia. Even standard antibiotic regimens fail frequently and do not prevent the excess mortality. Since at least 38% of deaths can be directly attributable to the Pseudomonas pneumonia, improvement in therapy is needed.

Authors+Show Affiliations

Department of Medicine, University of Tennessee, Memphis, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8635325

Citation

Crouch Brewer, S, et al. "Ventilator-associated Pneumonia Due to Pseudomonas Aeruginosa." Chest, vol. 109, no. 4, 1996, pp. 1019-29.
Crouch Brewer S, Wunderink RG, Jones CB, et al. Ventilator-associated pneumonia due to Pseudomonas aeruginosa. Chest. 1996;109(4):1019-29.
Crouch Brewer, S., Wunderink, R. G., Jones, C. B., & Leeper, K. V. (1996). Ventilator-associated pneumonia due to Pseudomonas aeruginosa. Chest, 109(4), 1019-29.
Crouch Brewer S, et al. Ventilator-associated Pneumonia Due to Pseudomonas Aeruginosa. Chest. 1996;109(4):1019-29. PubMed PMID: 8635325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ventilator-associated pneumonia due to Pseudomonas aeruginosa. AU - Crouch Brewer,S, AU - Wunderink,R G, AU - Jones,C B, AU - Leeper,K V,Jr PY - 1996/4/1/pubmed PY - 2001/3/28/medline PY - 1996/4/1/entrez SP - 1019 EP - 29 JF - Chest JO - Chest VL - 109 IS - 4 N2 - OBJECTIVE: Ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa has been associated with higher case fatality rates than VAP caused by other bacterial etiologies. The causes of this excess mortality are unclear. DESIGN: Retrospective review of 38 consecutive ventilated patients with Pseudomonas pneumonia, documented by highly reliable methods. Charts of five additional patients were unavailable for review. SETTING: Medical ICUs of a university-affiliated Veterans Affairs Medical Center and a university-affiliated municipal hospital. MEASUREMENTS: Prospectively collected hospital admission acute physiologic and chronic health examination (APACHE) II scores and cause of ICU admission. Retrospectively calculated organ failure and APACHE scores, VAP score. Clinical and microbiologic variables. Antibiotic treatment and outcome. Direct cause of death by standard definitions. RESULTS: Overall mortality was 69% (26/38), significantly higher than the APACHE II predicted mortality of 42.6% (p=0.037). At least 38% (10/26) of deaths were directly attributable to Pseudomonas VAP. Multivariate analysis of factors associated with death found infectious cause for ICU admission (odds ratio [OR]=8.67; 95% confidence interval [CI], 0.86 to 85.94) and number of organ dysfunctions on the day of diagnosis (OR=1.73, 95% CI, 1.02 to 2.92) were significant. Septic shock from Pseudomonas VAP, septic shock from subsequent infection, and multiple organ dysfunction syndrome were the most common immediate causes of death. Mortality increased linearly with increasing APACHE III score on the day of diagnosis. Of initial antibiotic regimens, 67% (26/36) were considered failures. Persistent pneumonia occurred in 35% of patients while recurrent pneumonia was unusual (1/38). CONCLUSIONS: Development of Pseudomonas pneumonia results in a mortality rate in excess of that due to the presenting illness. The attributable mortality determined by several means appears to approach 40%. The excess mortality appears to be related to the host defense response to the pneumonia rather than any characteristic of the pneumonia. Even standard antibiotic regimens fail frequently and do not prevent the excess mortality. Since at least 38% of deaths can be directly attributable to the Pseudomonas pneumonia, improvement in therapy is needed. SN - 0012-3692 UR - https://www.unboundmedicine.com/medline/citation/8635325/Ventilator_associated_pneumonia_due_to_Pseudomonas_aeruginosa_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)45976-8 DB - PRIME DP - Unbound Medicine ER -