• Louis-Marie Galerneau, Sébastien Bailly, Nicolas Terzi, Stéphane Ruckly, Maité Garrouste-Orgeas, Johanna Oziel, Hong Tuan HaVivienVMedical Intensive Care Unit, Meaux Hospital, Meaux, France., Marc Gainnier, Shidasp Siami, Claire Dupuis, Jean-Marie Forel, Anaïs Dartevel, Julien Dessajan, Christophe Adrie, Dany Goldgran-Toledano, Virginie Laurent, Laurent Argaud, Jean Reignier, Jean-Louis Pepin, Michael Darmon, Jean-François Timsit, and OUTCOME R. E. A. network.
• Medical Intensive Care Unit, University Hospital of Grenoble Alpes, 10217 38043, Grenoble, CS, France. lmgalerneau@chu-grenoble.fr.
• Crit Care. 2023 Sep 19; 27 (1): 359359.

BackgroundNon-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients.MethodsData were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU.ResultsOf the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01).ConclusionWe found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD.© 2023. BioMed Central Ltd., part of Springer Nature.

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