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Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation
Julia D Michels-Zetsche1, Vicky Gassmann2, Jasmin K Jasuja3
1Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany. Julia.Michels@med.uni-heidelberg.de.
Background:
Although multidrug-resistant bacteria (MDR) are common in patients undergoing prolonged weaning, there is little data on their impact on weaning and patient outcomes.
Methods:
This is a retrospective analysis of consecutive patients who underwent prolonged weaning and were at a university weaning centre from January 2018 to December 2020. The influence of MDR colonisation and infection on weaning success (category 3a and 3b), successful prolonged weaning from invasive mechanical ventilation (IMV) with or without the need for non-invasive ventilation (NIV) compared with category 3c (weaning failure 3cI or death 3cII) was investigated. The pathogen groups considered were: multidrug-resistant gram-negative bacteria (MDRGN), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. (VRE).
Results:
A total of 206 patients were studied, of whom 91 (44.2%) showed evidence of MDR bacteria (32% VRE, 1.5% MRSA and 16% MDRGN), with 25 patients also meeting the criteria for MDR infection. 70.9% of the 206 patients were successfully weaned from IMV, 8.7% died. In 72.2% of cases, nosocomial pneumonia and other infections were the main cause of death. Patients with evidence of MDR (infection and colonisation) had a higher incidence of weaning failure than those without evidence of MDR (48% vs. 34.8% vs. 21.7%). In multivariate analyses, MDR infection (OR 4.9, p = 0.004) was an independent risk factor for weaning failure, along with male sex (OR 2.3, p = 0.025), Charlson Comorbidity Index (OR 1.2, p = 0.027), pH (OR 2.7, p < 0.001) and duration of IMV before admission (OR 1.01, p < 0.001). In addition, MDR infection was the only independent risk factor for death (category 3cII), (OR 6.66, p = 0.007).
Conclusion:
Patients with MDR infection are significantly more likely to die during the weaning process. There is an urgent need to develop non-antibiotic approaches for the prevention and treatment of MDR infections as well as clinical research on antibiotic stewardship in prolonged weaning as well as in ICUs.
Insights
Multidrug-resistant (MDR) infections significantly increase the risk of weaning failure and death in patients undergoing prolonged mechanical ventilation. Developing non-antibiotic strategies is crucial for managing these infections and improving patient outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonary Medicine
Background:
- Multidrug-resistant bacteria (MDR) are prevalent in patients requiring prolonged mechanical ventilation.
- Limited data exists on the specific impact of MDR on weaning success and patient mortality.
- Understanding this relationship is vital for optimizing patient care in weaning centers.
Purpose of the Study:
- To investigate the influence of MDR colonization and infection on weaning outcomes.
- To identify risk factors associated with weaning failure and mortality in prolonged weaning.
- To evaluate the impact of specific MDR pathogen groups (MDRGN, MRSA, VRE) on patient prognosis.
Main Methods:
- Retrospective analysis of 206 patients undergoing prolonged weaning from January 2018 to December 2020.
- Categorization of weaning success (3a, 3b) versus failure/death (3c).
- Multivariate analysis to determine independent risk factors for weaning failure and mortality.
Main Results:
- 44.2% of patients had evidence of MDR bacteria, with 25 meeting criteria for MDR infection.
- MDR infection was an independent risk factor for weaning failure (OR 4.9) and death (OR 6.66).
- Other risk factors for failure included male sex, higher Charlson Comorbidity Index, lower pH, and longer duration of invasive mechanical ventilation.
Conclusions:
- MDR infections are a significant independent risk factor for mortality during prolonged weaning.
- Urgent need for non-antibiotic strategies for MDR infection prevention and treatment.
- Further research on antibiotic stewardship in prolonged weaning and ICUs is recommended.
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