Mortality associated with late-onset pneumonia in the intensive care unit: results of a multi-center cohort study

Intensive Care Medicine
Pierre MoineOUTCOMEREA study group

Abstract

To evaluate the attributable mortality associated with late-onset nosocomial pneumonia (LOP) while taking into account the severity at admission, the evolution of the patients during the first 4 days after admission to the ICU and the appropriateness of initial empiric antibiotic treatment. Multicenter cohort study with prospective standardization of diagnostic interventions when nosocomial pneumonia develops. Medical and surgical ICUs of four university-affiliated teaching hospitals. Seven hundred sixty-four consecutive patients requiring ICU hospitalization for at least 4 days. The clinical and biological data as well as the therapeutic data and the outcome were prospectively recorded from the day of admission to ICU discharge. Simplified Acute Physiologic Score (SAPS II) and Logistic Organ Dysfunction (LOD) score were collected and computed within the first 4 calendar days of ICU admission. Variables associated with the outcome were selected using a stepwise Cox model. The time to acquisition of the first LOP was then introduced in the final model as a time-dependent covariate. The analysis was stratified by ICU center. Finally, as initial antibiotic therapy could have an impact on the increased risk of death induced by LOP,...Continue Reading

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