التفاصيل البيبلوغرافية
| العنوان: |
Impact of piperacillin resistance on the outcome of Pseudomonas ventilator-associated pneumonia. |
| المؤلفون: |
Combes, Alain, Luyt, Charles-Edouard, Fagon, Jean-Yves, Wolff, Michel, Trouillet, Jean-Louis, Chastre, Jean |
| المصدر: |
Intensive Care Medicine; Dec2006, Vol. 32 Issue 12, p1970-1978, 9p, 4 Charts, 2 Graphs |
| مصطلحات موضوعية: |
PSEUDOMONAS, PIPERACILLIN, DRUG resistance in microorganisms, GRAM-negative bacterial diseases, HEALTH outcome assessment, ARTIFICIAL respiration, MULTIVARIATE analysis, ANTIBIOTICS, AMPICILLIN, BRONCHOSCOPY, COMPARATIVE studies, INTENSIVE care units, RESEARCH methodology, MEDICAL cooperation, PSEUDOMONAS diseases, RESEARCH, STATISTICAL sampling, LOGISTIC regression analysis, EVALUATION research, RANDOMIZED controlled trials, SEVERITY of illness index, VENTILATOR-associated pneumonia, THERAPEUTICS |
| مستخلص: |
Background: The impact of antibiotic resistance on the outcome of infections due to Gram-negative bacilli, especially Pseudomonas, remains highly controversial. STUDY OBJECTIVE, DESIGN, AND PATIENTS: We evaluated the impact of piperacillin resistance on the outcomes of Pseudomonas aeruginosa ventilator-associated pneumonia (VAP) for patients who had received appropriate empiric antibiotics before enrollment in the PNEUMA trial, a multicenter randomized study comparing 8 vs 15 days of antibiotics.Results: Despite similar characteristics at intensive care unit (ICU) admission, patients infected with piperacillin-resistant Pseudomonas strains were more acutely ill at VAP onset and had a higher 28-day mortality rate (37 vs 19%; P = 0.04) than those with piperacillin-susceptible Pseudomonas VAP. Factors associated with 28-day mortality retained by multivariable analysis were: age (OR: 1.07; 95% CI: 1.03-1.12); female gender (OR: 4.00; 95% CI: 1.41-11.11); severe underlying comorbidities (OR: 2.73; 95% CI: 1.02-7.33); and SOFA score (OR: 1.17; 95% CI: 1.03-1.32), but piperacillin resistance did not reach statistical significance (OR: 2.00; 95% CI: 0.72-5.61). The VAP recurrence rates, either superinfection or relapse, and durations of mechanical ventilation and ICU stay did not differ as a function of Pseudomonas-resistance status.Conclusions: For patients with Pseudomonas VAP benefiting from appropriate empiric antibiotics, piperacillin resistance was associated with increased disease severity at VAP onset and higher 28-day crude mortality; however, after controlling for confounders, piperacillin-resistance was no longer significantly associated with 28-day mortality. The VAP recurrence rates and durations of ICU stay and mechanical ventilation did not differ for susceptible and resistant strains. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
