• Ignacio Martin-Loeches, Luis Felipe Reyes, Saad Nseir, Otavio Ranzani, Pedro Povoa, Emili Diaz, Marcus J Schultz, Alejandro H Rodríguez, Cristian C Serrano-Mayorga, Gennaro De Pascale, Paolo Navalesi, Mauro Panigada, Luis Miguel Coelho, Szymon Skoczynski, Mariano Esperatti, Andrea Cortegiani, Stefano Aliberti, Anselmo Caricato, SalzerHelmut J FHJFDepartment of Internal Medicine 4-Pneumology, Kepler University Hospital, Linz, Austria.Medical Faculty, Johannes Kepler University Linz, Linz, Austria.Division of Infectious Diseases and Tropical Medicine, Kepler University Hospital, L, Adrian Ceccato, Rok Civljak, Paolo Maurizio Soave, Charles-Edouard Luyt, Pervin Korkmaz Ekren, Fernando Rios, Joan Ramon Masclans, Judith Marin, Silvia Iglesias-Moles, Stefano Nava, Davide Chiumello, Lieuwe D Bos, Antoni Artigas, Filipe Froes, David Grimaldi, Fabio Silvio Taccone, Massimo Antonelli, Antoni Torres, and European Network for ICU-Related Respiratory Infections (ENIRRIs) European Respiratory Society-Clinical Research Collaboration Investigators.
• St James's University Hospital, Trinity College, Dublin 8, D08 NHY, Ireland. drmartinloeches@gmail.com.
• Intensive Care Med. 2023 Oct 1; 49 (10): 121212221212-1222.

PurposeLower 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.MethodsA 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.Results1060 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.ConclusionVHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study.© 2023. The Author(s).

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