Open AccessThe multistep road to ventilator-associated lung abscess: A retrospective study of S.aureus ventilator-associated pneumonia
Author(s) -
R Mounier,
David Lobo,
Julia Voulgaropoulos,
Mathieu Martin,
Bouziane Aït-Mamar,
Valérie Bitot,
Paul-Henri Jost,
Ron Birnbaum,
Biba Nebbad,
Fabrice Cook,
Gilles Dhonneur
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0189249
Subject(s) - medicine , glasgow coma scale , ventilator associated pneumonia , pneumonia , pneumothorax , retrospective cohort study , staphylococcus aureus , abscess , surgery , lung abscess , anesthesia , lung , head injury , injury severity score , emergency department , emergency medicine , poison control , injury prevention , bacteria , genetics , psychiatry , biology
Object We observed some cases of lung abscess (LA) in ICU patients suffering S . aureus ventilator-associated pneumonia ( S . aureus -VAP). We aimed to assess which of the host and/or bacteria-related features are associated with LA. Methods We conducted a retrospective study from January 2009 to July 2013 in a trauma surgical ICU within a teaching hospital. All adult patients presenting with S . aureus -VAP were included. We compared two groups of patients according to the formation or not of LA concomitantly to S . aureus -VAP. Results Seventy-nine S . aureus -VAP patients, predominantly males (85%) of rather young age (mean [SD]: 35yr [21–64]) with severe trauma (initial Simplified Acute Score II = 42 [32–52]) related-ICU admission, were included. Among them, 10 (14%) developed LA. Patient’s characteristics significantly associated with LA development were: a younger age (p = 0.003), road traffic accidents admission (p = 0.017), head injury (p = 0.002), lower Glasgow Coma Scale (p = 0.009), blunt chest trauma (p = 0.01) pneumothorax (p = 0.01) and lung contusions (p = 0.002). No microbiological factors were significantly associated with LA formation. Abscesses were mostly bilateral, ≥5 cm of diameter and with a posterior location. Conclusions Our results do not favor a specific virulence of S . aureus , but rather highlight the role of multiple insults to the lung, promoting LA formation. Despite a similar severity score, patients with LA had more serious trauma, combining severe both chest and head insults.