Abstract
BackgroundEmpiric antibiotic therapy is routinely prescribed in patients with acute COPD exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated. Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.MethodsIn a cohort of ICU patients admitted between 2000 and 2012 for AECOPD, we analyzed the trends in empiric antibiotic therapy and in primary ventilatory support strategy, and their respective impact on patients’ outcome.Results440 patients admitted for 552 episodes were included; primary NIV use increased from 29 to 96.7 % (p < 0.001), whereas NIV failure rate decreased significantly (p = 0.004). In parallel, ventilator-associated pneumonia (VAP) rate, VAP density and empiric antibiotic therapy use decreased (p = 0.037, p = 0.002, and p < 0.001, respectively). These figures were associated with a trend toward lower ICU mortality rate (p = 0.058). Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03–0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29–58.93), 11.5 (95 %CI 5.17–25.45), and 3 (95 %CI 1.37–6.63), respectively]. Empiric antibiotic therapy was associated with decreased VAP rate (log rank; p < 0.001), but had no effect on mortality (log rank; p = 0.793).ConclusionsThe sustained increase in NIV use allowed a decrease in empiric antibiotic prescriptions in AECOPD requiring ventilatory support. Primary NIV use and its success, but not empiric antibiotic therapy, were associated with a favorable impact on patients’ outcome.
Highlights
Empiric antibiotic therapy is routinely prescribed in patients with acute Chronic obstructive pulmonary disease (COPD) exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated
The results suggested that the beneficial effects of antibiotic administration might have resulted from its selective digestive decontamination-like effect, with a substantial reduction in the ventilator-associated pneumonia (VAP) rate
Data collection The present study is a retrospective analysis of a database with prospective collection of the following data: Baseline characteristics Characteristics related to COPD: time course, forced expiratory volume in one second (FEV1) base, regular treatments, and home oxygen therapy. Comorbidities: diabetes, hypertension, and heart failure
Summary
Empiric antibiotic therapy is routinely prescribed in patients with acute COPD exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated. Whether this prac‐ tice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear. Respiratory infections are the most frequent causes of COPD exacerbations, accounting for 50–80 % of all Ouanes et al Ann. Intensive Care (2015) 5:30 exacerbations, and antibiotics are commonly administered [15,16,17,18,19] and still recommended especially by the last GOLD guidelines, in the setting of severe COPD exacerbations [4]. Approximately one-third of severe exacerbation episodes remain without identified cause [22, 28,29,30,31,32]
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