PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit.

Bergin, Stephen P

Coles, Adrian

Calvert, Sara B

Farley, John

Powers, John H

Zervos, Marcus J

Sims, Matthew

Kollef, Marin H

Durkin, Michael J

Kabchi, Badih A

Donnelly, Helen K

Bardossy, Ana Cecilia

Greenshields, Claire

Rubin, Daniel

Sun, Jie-Lena

Chiswell, Karen

Santiago, Jonas

Gu, Peidi

Tenaerts, Pamela

Fowler, Vance G

Holland, Thomas L

2020-08-02T17:47:34Z

2020-08-02T17:47:34Z

2020-06-29

2020-08-02T17:47:34Z

BACKGROUND:Pneumonia is the leading infection-related cause of death. Using simple clinical criteria and contemporary epidemiology to identify patients at high risk of nosocomial pneumonia should enhance prevention efforts and facilitate development of new treatments in clinical trials. RESEARCH QUESTION:What are the clinical criteria and contemporary epidemiology trends helpful in identifying patients at high risk of nosocomial pneumonia? STUDY DESIGN AND METHODS:Within the intensive care units of 28 United States hospitals, we conducted a prospective cohort study among adults hospitalized more than 48 hours and considered high risk for pneumonia (defined as treatment with invasive or noninvasive ventilatory support or high levels of supplemental oxygen). We estimated the proportion of high-risk patients developing nosocomial pneumonia. Using multivariable logistic regression, we identified patient characteristics and treatment exposures associated with increased risk of pneumonia development during the intensive care unit admission. RESULTS:Between February 6, 2016 and October 7, 2016, 4613 high-risk patients were enrolled. Among 1464/4613 (32%) high-risk patients treated for possible nosocomial pneumonia, 537/1464 (37%) met the study pneumonia definition. Among high-risk patients, a multivariable logistic model was developed to identify key patient characteristics and treatment exposures associated with increased risk of nosocomial pneumonia development (c-statistic 0.709, 95% confidence interval 0.686 to 0.731). Key factors associated with increased odds of nosocomial pneumonia included an admission diagnosis of trauma or cerebrovascular accident, receipt of enteral nutrition, documented aspiration risk, and receipt of systemic antibacterials within the preceding 90 days. INTERPRETATION:Treatment for nosocomial pneumonia is common among intensive care unit patients receiving high levels of respiratory support, yet more than half of patients treated do not fulfill standard diagnostic criteria for pneumonia. Application of simple clinical criteria may improve the feasibility of clinical trials of pneumonia prevention and treatment by facilitating prospective identification of patients at highest risk.

S0012-3692(20)31825-0

0012-3692

1931-3543

https://hdl.handle.net/10161/21267

eng

Elsevier BV

Chest

10.1016/j.chest.2020.06.034

PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit.

Journal article

Bergin, Stephen P|0000-0001-5517-9456

Chiswell, Karen|0000-0002-0279-9093

Fowler, Vance G|0000-0002-8048-0897

Holland, Thomas L|0000-0001-7745-9010

School of Medicine

Medicine, Pulmonary, Allergy, and Critical Care Medicine

Duke

Medicine

Clinical Science Departments

Duke Clinical Research Institute

Molecular Genetics and Microbiology

Medicine, Infectious Diseases

Institutes and Centers

Basic Science Departments

Staff

Published