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Pseudomonas aeruginosa serotypes in nosocomial pneumonia: prevalence and clinical outcomes.

Abstract : INTRODUCTION: Pseudomonas aeruginosa frequently causes nosocomial pneumonia and is associated with poor outcome. The purpose of this study was to assess the prevalence and clinical outcome of nosocomial pneumonia caused by serotype specific Pseudomonas aeruginosa in critically ill patients under appropriate antimicrobial therapy management. METHODS: A retrospective, non-interventional epidemiological multicenter cohort study involving 143 patients with confirmed nosocomial pneumonia caused by Pseudomonas aeruginosa. Patients were analyzed for a period of 30 days from time of nosocomial pneumonia onset. Fourteen patients fulfilling the same criteria from a Phase IIa study conducted at the same time/centers were included in the prevalence calculations but not in the clinical outcome analysis. RESULTS: The prevalence of serotypes was: O6 (29%), O11 (23%), O10 (10%), O2 (9%) and O1 (8%). Serotypes with a prevalence < 5% were found in 13% of patients, 8% were classified as not typeable. Across all serotypes there was 19% mortality, 70% clinical resolution, 11% clinical continuation and 5% clinical recurrence. Age and higher APACHE II were predictive risk factors associated with probability of death and lower clinical resolution for Pseudomonas aeruginosa nosocomial pneumonia. Mortality tends to be higher with O1 (40%) and lower with O2 (0%); clinical resolution tends to be better with O2 (82%) compared to other serotypes. Persisting pneumonia with O6 and O11 was respectively 8% and 21%; clinical resolution with O6 and O11 was respectively 75% and 57%. CONCLUSIONS: In Pseudomonas aeruginosa nosocomial pneumonia, the most prevalent serotypes were O6 and O11. Further studies including larger group sizes are needed to correlate clinical outcome with virulence factors of Pseudomonas aeruginosa in patients with nosocomial pneumonia caused by various serotypes; and to compare O6 and O11, the 2 serotypes most frequently encountered in critically ill patients.
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Submitted on : Thursday, February 20, 2014 - 5:08:05 PM
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Qin Lu, Philippe Eggimann, Charles-Edouard Luyt, Michel Wolff, Michael Tamm, et al.. Pseudomonas aeruginosa serotypes in nosocomial pneumonia: prevalence and clinical outcomes.. Critical Care, BioMed Central, 2014, 18 (1), pp.R17. ⟨10.1186/cc13697⟩. ⟨inserm-00950094⟩



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