Impact of Chronic Obstructive Pulmonary Disease on Incidence, Microbiology and Outcome of Ventilator-Associated Lower Respiratory Tract Infections

• Main Authors: Anahita Rouzé, Pauline Boddaert, Ignacio Martin-Loeches, Pedro Povoa, Alejandro Rodriguez, Nassima Ramdane, Jorge Salluh, Marion Houard, Saad Nseir
• Format: Article
• Language: English
• Published: MDPI AG 2020-01-01
• Series: Microorganisms
• Subjects: chronic obstructive pulmonary disease; ventilator-associated; lower respiratory tract infections; pneumonia; tracheobronchitis; mechanical ventilation; intensive care
• Online Access: https://www.mdpi.com/2076-2607/8/2/165

Objectives: To determine the impact of chronic obstructive pulmonary disease (COPD) on incidence, microbiology, and outcomes of ventilator-associated lower respiratory tract infections (VA-LRTI). Methods: Planned ancillary analysis of TAVeM study, including 2960 consecutive adult patients who received invasive mechanical ventilation (MV) &gt; 48 h. COPD patients (<i>n</i> = 494) were compared to non-COPD patients (<i>n</i> = 2466). The diagnosis of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) was based on clinical, radiological and quantitative microbiological criteria. Results: No significant difference was found in VAP (12% versus 13%, <i>p</i> = 0.931), or VAT incidence (13% versus 10%, <i>p</i> = 0.093) between COPD and non-COPD patients. Among patients with VA-LRTI, <i>Escherichia coli</i> and <i>Stenotrophomonas maltophilia</i> were significantly more frequent in COPD patients as compared with non-COPD patients. However, COPD had no significant impact on multidrug-resistant bacteria incidence. Appropriate antibiotic treatment was not significantly associated with progression from VAT to VAP among COPD patients who developed VAT, unlike non-COPD patients. Among COPD patients, patients who developed VAT or VAP had significantly longer MV duration (17 days (9&#8722;30) or 15 (8&#8722;27) versus 7 (4&#8722;12), <i>p</i> &lt; 0.001) and intensive care unit (ICU) length of stay (24 (17&#8722;39) or 21 (14&#8722;40) versus 12 (8&#8722;19), <i>p</i> &lt; 0.001) than patients without VA-LRTI. ICU mortality was also higher in COPD patients who developed VAP (44%), but not VAT(38%), as compared to no VA-LRTI (26%, <i>p</i> = 0.006). These worse outcomes associated with VA-LRTI were similar among non-COPD patients. Conclusions: COPD had no significant impact on incidence or outcomes of patients who developed VAP or VAT.