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Trends in use and impact on outcome of empiric antibiotic therapy and non-invasive ventilation in COPD patients with acute exacerbation.

Ouanes I, Ouanes-Besbes L, Ben Abdallah S, Dachraoui F, Abroug F - Ann Intensive Care (2015)

Bottom Line: Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.These figures were associated with a trend toward lower ICU mortality rate (p = 0.058).Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively].

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. ouanes.islem@gmail.com.

ABSTRACT

Background: Empiric antibiotic therapy is routinely prescribed in patients with acute COPD exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated. Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.

Methods: In a cohort of ICU patients admitted between 2000 and 2012 for AECOPD, we analyzed the trends in empiric antibiotic therapy and in primary ventilatory support strategy, and their respective impact on patients' outcome.

Results: 440 patients admitted for 552 episodes were included; primary NIV use increased from 29 to 96.7 % (p < 0.001), whereas NIV failure rate decreased significantly (p = 0.004). In parallel, ventilator-associated pneumonia (VAP) rate, VAP density and empiric antibiotic therapy use decreased (p = 0.037, p = 0.002, and p < 0.001, respectively). These figures were associated with a trend toward lower ICU mortality rate (p = 0.058). Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively]. Empiric antibiotic therapy was associated with decreased VAP rate (log rank; p < 0.001), but had no effect on mortality (log rank; p = 0.793).

Conclusions: The sustained increase in NIV use allowed a decrease in empiric antibiotic prescriptions in AECOPD requiring ventilatory support. Primary NIV use and its success, but not empiric antibiotic therapy, were associated with a favorable impact on patients' outcome.

No MeSH data available.


Related in: MedlinePlus

Impact of empiric antibiotic therapy on VAP and ICU mortality: analysis with Kaplan–Meier survival method shows that empiric antibiotic therapy was associated with a decrease in VAP occurrence (b) (log rank test, p < 0.001), but had no effect on mortality (a) (log rank test, p = 0.793)
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Fig3: Impact of empiric antibiotic therapy on VAP and ICU mortality: analysis with Kaplan–Meier survival method shows that empiric antibiotic therapy was associated with a decrease in VAP occurrence (b) (log rank test, p < 0.001), but had no effect on mortality (a) (log rank test, p = 0.793)

Mentions: Overall, empiric antibiotic therapy was administrated in 325 out of 552 AECOPD (58.9 %). The multivariate analysis showed that the empiric antibiotic therapy had no impact on the ICU mortality rate which occurred in 15.3 % of patients who received empiric antibiotics versus 16.1 % in those who did not (Chi square p = 0.895 and 0.793 by log rank for the Kaplan–Meier analysis; Fig. 3). Conversely, VAP was diagnosed more frequently in the group of patients who did not receive antibiotics at admission (16.3 %) than in those who received antibiotics (8 %, Chi square p = 0.004, <0.0001 by log rank test analysis) (Fig. 3).Fig. 3


Trends in use and impact on outcome of empiric antibiotic therapy and non-invasive ventilation in COPD patients with acute exacerbation.

Ouanes I, Ouanes-Besbes L, Ben Abdallah S, Dachraoui F, Abroug F - Ann Intensive Care (2015)

Impact of empiric antibiotic therapy on VAP and ICU mortality: analysis with Kaplan–Meier survival method shows that empiric antibiotic therapy was associated with a decrease in VAP occurrence (b) (log rank test, p < 0.001), but had no effect on mortality (a) (log rank test, p = 0.793)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591222&req=5

Fig3: Impact of empiric antibiotic therapy on VAP and ICU mortality: analysis with Kaplan–Meier survival method shows that empiric antibiotic therapy was associated with a decrease in VAP occurrence (b) (log rank test, p < 0.001), but had no effect on mortality (a) (log rank test, p = 0.793)
Mentions: Overall, empiric antibiotic therapy was administrated in 325 out of 552 AECOPD (58.9 %). The multivariate analysis showed that the empiric antibiotic therapy had no impact on the ICU mortality rate which occurred in 15.3 % of patients who received empiric antibiotics versus 16.1 % in those who did not (Chi square p = 0.895 and 0.793 by log rank for the Kaplan–Meier analysis; Fig. 3). Conversely, VAP was diagnosed more frequently in the group of patients who did not receive antibiotics at admission (16.3 %) than in those who received antibiotics (8 %, Chi square p = 0.004, <0.0001 by log rank test analysis) (Fig. 3).Fig. 3

Bottom Line: Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.These figures were associated with a trend toward lower ICU mortality rate (p = 0.058).Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively].

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. ouanes.islem@gmail.com.

ABSTRACT

Background: Empiric antibiotic therapy is routinely prescribed in patients with acute COPD exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated. Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.

Methods: In a cohort of ICU patients admitted between 2000 and 2012 for AECOPD, we analyzed the trends in empiric antibiotic therapy and in primary ventilatory support strategy, and their respective impact on patients' outcome.

Results: 440 patients admitted for 552 episodes were included; primary NIV use increased from 29 to 96.7 % (p < 0.001), whereas NIV failure rate decreased significantly (p = 0.004). In parallel, ventilator-associated pneumonia (VAP) rate, VAP density and empiric antibiotic therapy use decreased (p = 0.037, p = 0.002, and p < 0.001, respectively). These figures were associated with a trend toward lower ICU mortality rate (p = 0.058). Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively]. Empiric antibiotic therapy was associated with decreased VAP rate (log rank; p < 0.001), but had no effect on mortality (log rank; p = 0.793).

Conclusions: The sustained increase in NIV use allowed a decrease in empiric antibiotic prescriptions in AECOPD requiring ventilatory support. Primary NIV use and its success, but not empiric antibiotic therapy, were associated with a favorable impact on patients' outcome.

No MeSH data available.


Related in: MedlinePlus