The goal of this observational study is to to analyze respiratory samples performed in mechanically ventilated ICU patients and to assess whether the SRLF criteria for defining VAP were respected among patients admited to the Intensive care medicine at a regional hospital en France
Ventilator-associated pneumonia (VAP) is a lung infection that occurs after more than 48 hours of mechanical ventilation. It is of particular interest because it affects between 5-40% of ICU patients depending on the study and diagnostic criteria, with a relatively low attributable mortality (around 10%), but with increased morbidity, notably in terms of the duration of mechanical ventilation and ICU length of stay. In addition, it is the leading cause of nosocomial infection in the ICU, accounting for up to 25% of antibiotic use for hospital-acquired infections. The diagnosis of VAP is based on clinico-radiological criteria: the appearance or worsening of a radiological pulmonary infiltrate, an inflammatory syndrome, the appearance of secretions, increased oxygen dependency and/or worsening of shock, confirmed by a positive respiratory sample. The diagnostic challenge lies in the fact that the signs and symptoms are not pathognomonic of VAP and may be common to other conditions. On the other hand, patients may be colonized by pathogens without actually having VAP. For this reason, scientific societies propose criteria to better target patients for whom a respiratory sample should be taken and antibiotic therapy initiated. In 2017, the French Society of Intensive Care Medicine (SRLF) and the French Society of Anaesthesia and Intensive Care (SFAR) published recommendations on ICU-associated pneumonia, with some minor variations compared with the 2005 ATS/IDSA criteria. Our study aims to analyze respiratory samples performed in mechanically ventilated ICU patients and to assess whether the SRLF criteria for defining VAP were respected.
Study Type
OBSERVATIONAL
Enrollment
100
* Radiologic signs: 2 consecutive thorax x-ray with new onset pneumonia AND * One of the following criteria * Fever \>38,3°C without any other cause * Leucocytes \< 4000/mm3 or ≥ 12000 /mm3 * AND at least two of the following * Purulent secretions * Cough or dyspnoea * Desaturation or increase in FiO2 (+20%)
Centre Hospitalier Sud Francilien
Corbeil-Essonnes, France, France
RECRUITINGSRLF VAP criteria
Describe whether the respiratory samples obtained from ICU patients after \>48 hours of mechanical ventilation for suspected VAP met, or did not meet, the 2017 SRLF diagnostic criteria
Time frame: at day 0
microbial ecology in the ICU of CHSF
Prevalence of MDR in the respiratory samples
Time frame: at day 0
antibiotic consumption generated by VAP
To evaluate antibiotic consuming related to VAP episodes to the total antibiotic consuming in the Intensive care unit
Time frame: at day 0
morbidity and mortality associated with VAP
Mortality and mechanical ventilation duration among patients diagnosed of VAP
Time frame: at day 0
duration of antibiotic therapy for a VAP episode
Duration of antibiotherapy among patients with VAP
Time frame: at day 0
characteristics of the initial antibiotic therapy
Number and class of antibiotics of the initial antibiotic therapy
Time frame: at day 0
Evaluate the adequacy of the initial antibiotic therapy
Adequation of the initial therapy compared to the definitive therapy: maintain, increase or reduce the spectrum or number of antibiotics
Time frame: at day 0
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