Multidrug-resistant Pseudomonas aeruginosa and mortality inmechanically ventilated ICU patients

Jean-Baptiste Denis (1) , Samuel Lehingue (1) , Vanessa Pauly (2, 3) , Nadim Cassir (4, 5) , Marc Gainnier (2, 6, 7) , Marc Léone (8, 9) , Florence Daviet (10) , Benjamin Coiffard (11) , Sophie Baron (9) , Jean-Marie Forel (1) , Antoine Roch (2) , Laurent Papazian (1, 2)

1 DRIS - Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM]
2 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
3 SSPIM - Service de Santé Publique et d'Information Médicale
4 M.I.T - Service des Maladies Infectieuses et Tropicales [CHU Hôpital Nord - Marseille]
5 IHU Marseille - Institut Hospitalier Universitaire Méditerranée Infection
6 Service de Réanimation des Urgences
7 TIMONE - Hôpital de la Timone [CHU - APHM]
8 APHM - Assistance Publique - Hôpitaux de Marseille
9 MEPHI - Microbes évolution phylogénie et infections
10 Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM]
11 Hôpital Nord [CHU - APHM]

Background: The link between bacterial resistance and prognosis remains controversial. Predominant pathogen causing ventilator-associated pneumonia (VAP) is Pseudomonas aeruginosa (Pa), which has increasingly become multidrug resistant (MDR). The aim of this study was to evaluate the relationship between MDR VAP Pa episodes and 30-day mortality. Methods: From a longitudinal prospective French multicenter database (2010-2016), Pa VAP onset and physiological data were recorded. MDR was defined as non-susceptibility to at least 1 agent in 3 or more antimi-crobial categories. To analyze if MDR episodes were associated with greater in-hospital 30-day mortality, we performed a multivariate survival analysis using the multivariate nonlinear frailty model. Results: A total of 230 patients presented 286 Pa VAP. A maximum of 3 episodes per patient was observed; 73 episodes were MDR and 213 were susceptible. In the multivariate model, factors independently associated with 30-day mortality included hospitalization in the 6 months preceding the first episode (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.50-3.60; P = .0002), chronic renal failure (HR, 2.34; 95% CI, 1.15-4.77; P = .0196), and Pa VAP recurrence (HR, 2.29; 95% CI, 1.79-4.87; P = .032). Finally, MDR Pa VAP was not associated with death (HR, 0.87; 95% CI; 0.52-1.45; P = .59). Conclusions: This study did not identify a relationship between the resistance profile of Pseudomonas aerugi-nosa and mortality.

Mots clés: Multidrug resistance; Nosocomial pneumonia; Recurrence; Ventilator-associated pneumonia; Intensive care medicine; Empirical antiobiotic

Domaines: Bactériologie; Virologie; Parasitologie; Cardiologie et système cardiovasculaire; Maladies émergentes; Maladies infectieuses

Jean-Baptiste Denis, Samuel Lehingue, Vanessa Pauly, Nadim Cassir, Marc Gainnier, et al.. Multidrug-resistant Pseudomonas aeruginosa and mortality inmechanically ventilated ICU patients. American Journal of Infection Control, 2019, ⟨10.1016/j.ajic.2019.02.030⟩. ⟨hal-02159275⟩