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Observational Study
. 2023 Oct;49(10):1212-1222.
doi: 10.1007/s00134-023-07210-9. Epub 2023 Oct 9.

European Network for ICU-Related Respiratory Infections (ENIRRIs): a multinational, prospective, cohort study of nosocomial LRTI

Ignacio Martin-Loeches #  1   2 , Luis Felipe Reyes #  3   4   5 , Saad Nseir  6 , Otavio Ranzani  7 , Pedro Povoa  8 , Emili Diaz  9 , Marcus J Schultz  10   11   12 , Alejandro H Rodríguez  13 , Cristian C Serrano-Mayorga  3   4 , Gennaro De Pascale  14 , Paolo Navalesi  15   16 , Mauro Panigada  17 , Luis Miguel Coelho  8 , Szymon Skoczynski  18 , Mariano Esperatti  19 , Andrea Cortegiani  20 , Stefano Aliberti  18   21   22 , Anselmo Caricato  16 , Helmut J F Salzer  23   24   25 , Adrian Ceccato  7 , Rok Civljak  26 , Paolo Maurizio Soave  27 , Charles-Edouard Luyt  28 , Pervin Korkmaz Ekren  29 , Fernando Rios  30 , Joan Ramon Masclans  31   32   33 , Judith Marin  32 , Silvia Iglesias-Moles  34 , Stefano Nava  35   36   37 , Davide Chiumello  38 , Lieuwe D Bos  10 , Antoni Artigas  9 , Filipe Froes  39 , David Grimaldi  40 , Fabio Silvio Taccone  40 , Massimo Antonelli  14 , Antoni Torres  41 ; European Network for ICU-Related Respiratory Infections (ENIRRIs) European Respiratory Society-Clinical Research Collaboration Investigators
Collaborators, Affiliations
Observational Study

European Network for ICU-Related Respiratory Infections (ENIRRIs): a multinational, prospective, cohort study of nosocomial LRTI

Ignacio Martin-Loeches et al. Intensive Care Med. 2023 Oct.

Abstract

Purpose: Lower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes.

Methods: A prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU hospital-acquired pneumonia (ICU-HAP), HAP that required invasive ventilation (VHAP), and HAP in patients transferred to the ICU without invasive mechanical ventilation were collected. The clinical diagnosis and treatments were per clinical practice and not per protocol. Descriptive statistics were used to compare the study groups.

Results: 1060 patients with LRTI (72.5% male sex, median age 64 [50-74] years) were included in the study; 160 (15.1%) developed VAT, 556 (52.5%) VAP, 98 (9.2%) ICU-HAP, 152 (14.3%) HAP, and 94 (8.9%) VHAP. Patients with VHAP had higher serum procalcitonin (PCT) and Sequential Organ Failure Assessment (SOFA) scores. Patients with VAP or VHAP developed acute kidney injury, acute respiratory distress syndrome, multiple organ failure, or septic shock more often. One thousand eight patients had microbiological samples, and 711 (70.5%) had etiological microbiology identified. The most common microorganisms were Pseudomonas aeruginosa (18.4%) and Klebsiella spp (14.4%). In 382 patients (36%), the causative pathogen shows some antimicrobial resistance pattern. ICU, hospital and 28-day mortality were 30.8%, 37.5% and 27.5%, respectively. Patients with VHAP had the highest ICU, in-hospital and 28-day mortality rates.

Conclusion: VHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study.

Trial registration: ClinicalTrials.gov NCT03183921.

Keywords: Sepsis ICU; VA-LRTI; VAP; VAT.

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Conflict of interest statement

All authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Characteristics of the ICUs stratified per study groups A Cohort distribution by ICU type. B VAT distribution by ICU type. C VAP distribution by ICU type. D ICU-HAP distribution by ICU type. E VHAP distribution by ICU type. F HAP distribution by ICU type
Fig. 3
Fig. 3
Etiological diagnosis stratified by the study groups
See this image and copyright information in PMC

References

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