Journal Article

Antibiotics against Pseudomonas aeruginosa for COPD exacerbation in ICU: a 10-year retrospective study

Roujansky, Ariane, Le Monnier, Alban, Planquette, Benjamin, Peron, Julien, Laurent, Virgine, Legriel, Stephane, Dubuisson, Etienne, Chiles, Peter, Bedos, Jean Pierre, Bruneel, Fabrice, Ferre, Alexis

2015

Overview

Chronic obstructive pulmonary disease (COPD) is a frequent source of hospitalization. Antibiotics are largely prescribed during COPD exacerbation. Our hypothesis is that large broad-spectrum antibiotics are more and more frequently prescribed. Our results confirm this trend and highlight that the increase in large broad-spectrum use in COPD exacerbation is largely unexplained. Acute COPD exacerbation (AECOPD) is frequently due to respiratory tract infection, and the benefit of antipseudomonal antibiotics (APA) is still debated. Health care-associated pneumonia (HCAP) was defined in 2005 and requires broad-spectrum antibiotherapy. The main objectives are to describe the antibiotic use for AECOPD in intensive care unit and to identify factors associated with APA use and AECOPD prognosis. We conducted a monocentric, retrospective study on all AECOPDs in the intensive care unit treated by antibiotics for respiratory tract infection. Treatment failure (TF) was defined by death, secondary need for mechanical ventilation, or secondary systemic steroid treatment. A multivariate analysis was used to assess factors associated with APA prescription and TF. From January 2000 to December 2011, 111 patients were included. Mean age was 69 years (±12), mean forced expiratory volume 38% of theoretic value (±13). Thirty-five (31%) patients were intubated, and 52 (47%) were treated with noninvasive ventilation. From 107 patients, 8 (7%) cases of Pseudomonas aeruginosa were documented. APAs were prescribed in 21% of patients before 2006 versus 57% after (P=0.001). TF prevalence was 31%. Risk factors for P. aeruginosa in COPD and HCAP diagnosis did not influence APA, whereas the post-2006 period was independently associated with APA prescription (odds ratio 6.2; 95% confidence interval 1.9-20.3; P=0.0013). APA did not improve TF (odds ratio 1.09; 95% confidence interval 0.37-3.2). HCAP guidelines were followed by an increase in APA use in AECOPD, without an improvement in prognosis. HCAP prevalence cannot account for the increasing APA trend. Time effect reveals a drift in practices. The microbiological effect of such a drift must be evaluated.

• Publisher: Dove Medical Press Limited,Dove Medical Press Ltd,Dove Press,Dove Medical Press
• Subject: Age / Aged / Aged, 80 and over / Anti-Bacterial Agents - therapeutic use / Antibiotics / Bacterial infections / Body mass index / Bronchitis / Chi-Square Distribution / Chronic obstructive pulmonary disease / COPD / Critically ill / Cross Infection - diagnosis / Cross Infection - drug therapy / Cross Infection - microbiology / Cross Infection - mortality / Disease Progression / Drug therapy / exacerbation / Female / France - epidemiology / Humans / ICU / Infections / Intensive care / Life Sciences / Linear Models / Logistic Models / Lung diseases, Obstructive / Male / Middle Aged / Multivariate Analysis / Odds Ratio / Original Research / Patient outcomes / Patients / Physiological aspects / Physiology / Pneumonia / Prevalence / Pseudomonas aeruginosa / Pseudomonas aeruginosa - drug effects / Pseudomonas aeruginosa - pathogenicity / Pseudomonas aeruginosa infections / Pseudomonas aeurginosa / Pseudomonas Infections - diagnosis / Pseudomonas Infections - drug therapy / Pseudomonas Infections - microbiology / Pseudomonas Infections - mortality / Pulmonary Disease, Chronic Obstructive - diagnosis / Pulmonary Disease, Chronic Obstructive - drug therapy / Pulmonary Disease, Chronic Obstructive - microbiology / Pulmonary Disease, Chronic Obstructive - mortality / Respiratory Tract Infections - diagnosis / Respiratory Tract Infections - drug therapy / Respiratory Tract Infections - microbiology / Respiratory Tract Infections - mortality / Retrospective Studies / Risk Factors / Steroids / Time Factors / Treatment Failure / Ventilators