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

Anahita Rouzé,Jorge Salluh,Pedro Povoa,Saad Nseir,Pauline Boddaert,Marion Houard,Ignacio Martin-Loeches,Alejandro Rodriguez,Nassima Ramdane

doi:10.3390/microorganisms8020165

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.

Highlights

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation, associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases [1]
Percentage of men, percentage of patients with chronic diseases such as diabetes mellitus, chronic respiratory failure, chronic kidney disease, and alcohol abuse, were significantly higher in COPD patients compared with non-COPD patients
COPD patients were significantly more frequently admitted to the intensive care unit (ICU) for medical reasons, with a higher percentage of pneumonia as the main cause of admission, compared with non-COPD patients (Table 1)

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation, associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases [1]. According to the WHO, over 65 million people have moderate to severe COPD worldwide. COPD is thought to become the third cause of death in the world by 2030 [2]. In a large Austrian cohort including 194,453 critically ill patients [3], COPD was present in 8.6% of all patients, including one third admitted for acute respiratory failure due to COPD and two thirds with only comorbid COPD. Use of noninvasive ventilation in acute exacerbations of COPD has substantially reduced the need for intubation, a large proportion of COPD patients still require invasive mechanical ventilation (MV). The largest prospective international cohorts of mechanically ventilated patients reported 10% of critically ill patients receiving MV because of acute exacerbation of COPD in 1998, and still 6% in 2010 [4]

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