The Many Faces of Recurrent Ventilator-Associated Pneumonia Caused by Pseudomonas aeruginosa

Neil M. Ampel, MD

Recurrence of P. aeruginosa–related VAP is common, apparently not associated with antimicrobial resistance or the number of drugs used, and apparently influenced by the timing of fluoroquinolone use.

Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), and Pseudomonas aeruginosa is a frequent cause. To explore what roles bacterial resistance and initial antimicrobial treatment play in treatment failure for P. aeruginosa–related VAP, researchers retrospectively studied 314 patients who experienced 393 episodes of P. aeruginosa–related VAP at 12 ICUs from 1977 to 2011.

The median time to onset of P. aeruginosa–related VAP was 12 days; recurrence occurred a median of 14 days after the first episode. Antimicrobial resistance was observed in about one third of cases. Adequate empiric antibiotic therapy was prescribed to 261 patients (83%), 90 of whom received only one agent.

By 14 days, 112 patients had failed treatment: 76 died before VAP recurrence, 35 experienced recurrence, and 1 died after recurrence. Neither the number of antimicrobial treatments used nor the presence of antimicrobial resistance predicted treatment failure. However, fluoroquinolone use before VAP onset was significantly associated with treatment failure; its use during a VAP episode was significantly associated with treatment success.

Citation(s):

Planquette B et al. Pseudomonas aeruginosa ventilator-associated pneumonia. Predictive factors of treatment failure. Am J Respir Crit Care Med 2013 Jul 1; 188:69.