Citation

Reizine F, Delbove A, Tattevin P, Santos AD, Bodenes L, Bouju P, Fillatre P, Frérou A, Halley G, Lesieur O, Courouble P, Berteau F, Morin J, Delamaire F, Marnai R, Le Meur A, Aubron C, Reignier J, Gacouin A, Tadié JM. Clin. Microbiol. Infect. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, John Wiley and Sons)

DOI

10.1016/j.cmi.2022.07.027

PMID

35944877

Abstract

OBJECTIVE: Pneumonia is the most frequent infectious complication among drowning patients requiring intensive care unit (ICU) admission. We aimed to describe clinical, microbiological and therapeutic data as well as predictors and impacts on patients 'outcomes of such pneumonia.

METHODS: We conducted a retrospective multicenter study (2013-2020) of 270 consecutive patients admitted for drowning to 14 ICUs in the west of France. Baseline characteristics and outcomes were compared according to the occurrence of drowning associated pneumonia (DAP), defined as pneumonia diagnosed within 48 hours of ICU admission. A Cox model was performed to compare survival at day-28 and logistic regression to identify risk factors for DAP. Microbiological characteristics and empirical antibacterial treatment were also analyzed.

RESULTS: Among the 270 patients admitted to the ICU for drowning, 101/270 (37.4%) and 33/270 (12.2%) experienced pneumonia and microbiologically proven DAP, respectively. The occurrence of pneumonia was associated with higher severity scores at ICU admission (Median SAPS 2 score 34 ​​[Interquartile range 25-55] versus 45 ​​[28-67]; P=0.006) and longer ICU length of stay (2 days ​​[1-3] versus 4 ​​[2-7]; P<0.001). Mortality at day-28 was higher among these patients (29/101 (28.7%) versus 26/169 (15.4%); P=0.013). Microbiologically proven DAP remained associated with higher day-28 mortality after adjustments for cardiac arrest and water salinity (adjusted HR 1.86 [95%CI 1.06-3.28]; P=0.03). Microbiological analysis of respiratory samples showed a high proportion of gram-negative bacilli (23/56; 41.1%) with high prevalence of amoxicillin-clavulanate resistance (12/33; 36.4%).

CONCLUSION: Pneumonia is a common complication in patients admitted in ICU for drowning, associated with increased mortality.

Language: en