Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort
Authors: Galerneau Louis-Marie , Bailly Sébastien , Terzi Nicolas , Ruckly Stéphane , Garrouste-Orgeas Maité , Oziel Johanna , Hong Tuan Ha Vivien , Gainnier Marc , Siami Shidasp , Dupuis Claire , Forel Jean-Marie , Dartevel Anaïs , Dessajan Julien , Adrie Christophe , Goldgran-Toledano Dany , Laurent Virginie , Argaud Laurent , Reignier Jean , Pepin Jean-Louis , Darmon Michael , Timsit Jean-François ,   OUTCOME R. E. A. network, Timsit Jean-François , Azoulay Elie , Garrouste-Orgeas Maïté , Zahar Jean-Ralph , Mourvillier Bruno , Darmon Michael , Alberti Corinne , Ruckly Stephane , Bailly Sébastien , Vannieuwenhuyze Aurélien , Adrie Christophe , Agasse Carole , Allaouchiche Bernard , Andremont Olivier , Andreu Pascal , Argaud Laurent , Ara-Somohano Claire , Azoulay Elie , Barbier Francois , Bedos Jean-Pierre , Baudry Thomas , Bohé Julien , Bouadma Lila , Bourenne Jeremy , Brule Noel , Chemouni Frank , Coupez Julien Carvelli Elisabeth , Darmon Michael , Dupuis Claire , de Montmollin Etienne , Dopeux Loa , Dumenil Anne-Sylvie , Dupuis Claire , Forel Jean-Marc , Gainnier Marc , Garret Charlotte , Goldgran-Tonedano Dany , Grangé Steven , Gros Antoine , Hammed Hédia , Haouache Akim , Hissem Tarik , Ha Vivien Hong Tuan , Jochmans Sébastien , Joffredo Jean-Baptiste , Kallel Hatem , Lacave Guillaume , Laurent Virgine , Lautrette Alexandre , Le bihan Clément , Lemiale Virgine , Luis David , Marcotte Guillaume , Lebut Jordane , Mourvillier Bruno , Misset Benoît , Mourvillier Bruno , Neuville Mathild , Nicolet Laurent , Oziel Johanna , Papazian Laurent , Patrier Juliette , Planquette Benjamin , Radjou Aguila , Simon Marie , Sonneville Romain , Reignier Jean , Souweine Bertrand , Schwebel Carole , Siami Shidasp , Sonneville Romain , Terzi Nicolas , Troché Gilles , Thiollieres Fabrice , Thierry Guillaume , Van Der Meersch Guillaume , Venot Marion , Wallet Florent , Yaacoubi Sondes , Zambon Olivier , Zarka Jonathan , Adda Mireille , Vindrieux Vanessa , Provent Marion , de la Salle Sylvie , Enguerrand Pauline , Gobert Vincent , Guessens Stéphane , Merle Helene , Kaddour Nadira , Berthe Boris , Bekkhouche Samir , Mellouk Kaouttar , Lebrazic Mélaine , Ouisse Carole , Maugars Diane , Aparicio Christelle , Theodose Igor , Nouacer Manal , Deiler Veronique , Lamara Fariza , Moussa Myriam , Mouaci Atika , Viguier Nassima 
Published: September 2023

Abstract
Background
Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients.

Methods
Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU.

Results
Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01).

Conclusion
We found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD.