Lipid kinetics in patients with non-fermenting Gram-negative bacterial ventilator-associated pneumonia.

Abstract

In non-fermenting Gram-negative bacilli (NFGNB) infections, the interaction between the immune system of the host and the bacteria plays a more important role in determining the pathogenesis than the virulence factors of bacteria per se. We aimed to evaluate the sequential changes in the inflammatory response, including the lipid profile, antimicrobial susceptibility, and outcomes in NFGNB ventilator-associated pneumonia (VAP). A total of 81 patients who developed NFGNB VAP were divided into two groups, namely multi-drug resistant (MDR) (n=51) and non-MDR (n=30) groups. When compared with the control group, the cholesterol levels of VAP patients decreased, while the levels of C-reactive protein and procalcitonin (PCT) levels significantly increased (p<0.05). The best sensitivity (93 %) corresponds to PCT levels on day 4, and the best specificity (89 %) corresponds to the levels of high-density lipoprotein (HDL) on day 4, which makes the latter parameters suitable candidates for predicting the 30-day mortality. The impact of resistant NFGNB isolates on early and late mortality rates was similar. In NFGNB VAP patients, the change relative to antimicrobial resistance was not appreciated in either the systemic inflammatory response or disease severity. MDR NFGNB isolates were not associated with greater mortality in VAP patients. The decrease in serum HDL and increase in PCT on day 4 indicated a poor prognosis (Tab. 5, Fig. 2, Ref. 30).