Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Sep 4;10(9):e0137262.
doi: 10.1371/journal.pone.0137262. eCollection 2015.

Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection

François Philippart  1 , Gaëlle Bouroche  2 , Jean-François Timsit  3 , Maité Garrouste-Orgeas  4 , Elie Azoulay  5 , Michael Darmon  6 , Christophe Adrie  7 , Bernard Allaouchiche  8 , Claire Ara-Somohano  9 , Stéphane Ruckly  10 , Anne-Sylvie Dumenil  11 , Bertrand Souweine  12 , Dany Goldgran-Toledano  13 , Lila Bouadma  14 , Benoît Misset  15 ; Outcomerea study group
Collaborators, Affiliations
Observational Study

Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection

François Philippart et al. PLoS One. .

Abstract

Rationale: Experimental studies suggest that intra-abdominal infection (IAI) induces biological alterations that may affect the risk of lung infection.

Objectives: To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP).

Methods: We used data entered into the French prospective multicenter Outcomerea database in 1997-2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included.

Measurements and main results: Of 2623 database patients meeting the inclusion criteria, 290 (11.1%) had IAI and 2333 (88.9%) had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01) and longer time to VAP (5.0 vs.10.5 days; P<0.01). After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46-0.83; P<0.0017). The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively). Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16).

Conclusions: In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow Chart.
Fig 2
Fig 2. Occurrence of ventilator-associated pneumonia in patients admitted to the ICU for severe sepsis and/or septic shock related to intra-abdominal infections (IAIs) or to infections at other sites.
Cumulative incidence plot.
Fig 3
Fig 3. Cumulative incidence plot for death in patients with and without intra-abdominal infections (IAIs).
See this image and copyright information in PMC

References

    1. Morris AC, Hay AW, Swann DG, Everingham K, McCulloch C, McNulty J, et al. Reducing ventilator-associated pneumonia in intensive care: impact of implementing a care bundle. Crit Care Med 2011;39(10):2218–24. 10.1097/CCM.0b013e3182227d52 - DOI - PubMed
    1. Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vesin A, Garrouste-Orgeas M, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med 2011;184(10):1133–9. 10.1164/rccm.201105-0867OC - DOI - PubMed
    1. van der Poll T, Opal SM. Host-pathogen interactions in sepsis. Lancet Infect Dis 2008;8(1):32–43. - PubMed
    1. Boomer JS, To K, Chang KC, Takasu O, Osborne DF, Walton AH, et al. Immunosuppression in patients who die of sepsis and multiple organ failure. Jama 2011;306(23):2594–605. 10.1001/jama.2011.1829 - DOI - PMC - PubMed
    1. Weijer S, Lauw FN, Branger J, van den Blink B, van der Poll T. Diminished interferon-gamma production and responsiveness after endotoxin administration to healthy humans. J Infect Dis 2002;186(12):1748–53. - PubMed

Publication types

MeSH terms