Outcomes of Ventilated COPD Patients with Nosocomial Tracheobronchitis: A Case-Control Study

Byline: S. Nseir (1), C. Pompeo (2), S. Soubrier (1), P. Delour (1), T. Onimus (1), F. Saulnier (1,2), A. Durocher (1,2) Abstract: Abstract. Background: The aim of this study was to determine the impact of nosocomial tracheobronchitis (NTB) related to new bacteria on the outcome in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: A prospective observational case-control study was conducted in medical COPD patients requiring intubation and mechanical ventilation for more than 48 hours. Patients with nosocomial pneumonia were excluded. Six matching criteria were used, including the duration of mechanical ventilation before NTB occurrence. Results: 81 matched case-control pairs were studied. Although the mortality rate was similar (40% vs 34%; p = 0.48), median duration of mechanical ventilation (20 vs 12 days; p = 0.015) and intensive care unit (ICU) stay (25 vs 18 days; p = 0.022) were higher in cases than in controls. NTB was independently associated with a longer than median period of mechanical ventilation among case and control patients (OR = 4.7 [95%CI = 2--10.9]; p < 0.001). In cases with appropriate antibiotic treatment compared with those who did not receive antibiotics, a shorter median duration of mechanical ventilation (12 vs 23 days; p = 0.006) and ICU stay (16 vs 29 days; p = 0.029) were observed. Conclusion: NTB is associated with an increased duration of mechanical ventilation and ICU stays. Further studies are required to determine whether antibiotics could improve the outcome of patients with NTB. Author Affiliation: (1) Intensive Care Unit, Calmette Hospital, Regional University Center, Boulevard du Pr Leclercq, F-59037, Lille cedex, France (2) Medical Assessment Laboratory, EA 3614, Lille II, France Article History: Registration Date: 01/01/2004 Received Date: 26/11/2003 Accepted Date: 12/02/2004