impact of ureidocarboxypenicillin resistance on the prognosis of ventilator-associated pneumonia due to pseudomonas aeruginosaureidocarboxypenicillin阻力对与机械通气相关肺炎的预后的影响由于铜绿假单胞菌.pdfVIP

Kaminski et al. Critical Care 2011, 15:R112 /content/15/2/R112 RESEARCH Open Access Impact of ureido/carboxypenicillin resistance on the prognosis of ventilator-associated pneumonia due to Pseudomonas aeruginosa 1 2,3* 2 3,4 3,5 Catherine Kaminski , Jean-François Timsit , Yohann Dubois , Jean-Ralph Zahar , Maïté Garrouste-Orgeas , 3 3,6 7 8 9 10 Aurélien Vesin , Elie Azoulay , Céline Feger , Anne-Sylvie Dumenil , Christophe Adrie , Yves Cohen , Bernard Allaouchiche1, for the OUTCOMEREA study group Abstract Introduction: Although Pseudomonas aeruginosa is a leading pathogen responsible for ventilator-associated pneumonia (VAP), the excess in mortality associated with multi-resistance in patients with P. aeruginosa VAP (PA-VAP), taking into account confounders such as treatment adequacy and prior length of stay in the ICU, has not yet been adequately estimated. Methods: A total of 223 episodes of PA-VAP recorded into the Outcomerea database were evaluated. Patients with ureido/carboxy-resistant P. aeruginosa (PRPA) were compared with those with ureido/carboxy-sensitive P. aeruginosa (PSPA) after matching on duration of ICU stay at VAP onset and adjustment for confounders. Results: Factors associated with onset of PRPA-VAP were as follows: admission to the ICU with septic shock, broad- spectrum antimicrobials at admission, prior use of ureido/carboxypenicillin, and colonization with PRPA before infection. Adequate antimicrobial therapy was more often delayed in the PRPA group. The crude ICU mortality rate and the hospital mortality r