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Procoagulant and fibrinolytic activity in ventilator-associated pneumonia: impact of inadequate antimicrobial therapy.
- Source :
-
Intensive care medicine [Intensive Care Med] 2004 Oct; Vol. 30 (10), pp. 1914-20. Date of Electronic Publication: 2004 Jul 23. - Publication Year :
- 2004
-
Abstract
- Objective: To determine the homeostatic balance of patients with ventilator-associated pneumonia (VAP) with respect to the adequacy of antimicrobial therapy.<br />Design and Setting: Descriptive observational study in a 12-bed medical intensive care unit in a university-affiliated hospital.<br />Patients: Twenty-nine patients with VAP documented by quantitative culture of bronchoalveolar secretions and a control group of eight mechanically ventilated patients.<br />Methods: Serial bronchoalveolar lavage fluid (BALF) samples were assayed for prothrombin activation fragment (F1+2), thrombin-antithrombin (TAT) complex, fibrinolytic activity, urokinase-type plasminogen activator (u-PA), and plasminogen activator inhibitor type 1 (PAI-1) on days 1, 4, and 7 after VAP onset.<br />Results: Pathogens isolated from patients with inadequate empirical antimicrobial coverage included methicillin-resistant Staphylococcus aureus (n=2), Pseudomonas aeruginosa (n=4), and Acinetobacter baumannii (n=1). Compared to those who received adequate antibiotic therapy, TAT, F1+2, and PAI-1 levels increased while u-PA levels remained unchanged. Despite antibiotic adjustment on day 4, TAT levels remained elevated in those who lacked adequate antimicrobial coverage and were significantly correlated with PaO(2)/FIO(2). The procoagulant activity was accompanied by a local depression of fibrinolytic capacity that was attributed mainly to increased BALF PAI-1 levels. Nonsurvivors showed significantly higher levels of TAT and PAI-1 than survivors. No significant correlation between the bacterial burden and the homeostatic derangements was documented.<br />Conclusions: The lung inflammatory response seems to promulgate a local procoagulant activity associated with hypoxemia in those with inadequate antibiotic therapy. The homeostatic derangement seems to be independent of the lung bacterial burden.
- Subjects :
- Aged
Anti-Bacterial Agents blood
Anti-Bacterial Agents therapeutic use
Blood Coagulation drug effects
Cross Infection blood
Cross Infection etiology
Cross Infection microbiology
Female
Humans
Intensive Care Units
Male
Pneumonia blood
Pneumonia etiology
Prognosis
Prospective Studies
Treatment Outcome
Ventilators, Mechanical microbiology
Anti-Bacterial Agents administration & dosage
Cross Infection drug therapy
Drug Utilization standards
Hemostasis drug effects
Pneumonia drug therapy
Ventilators, Mechanical adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 0342-4642
- Volume :
- 30
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Intensive care medicine
- Publication Type :
- Academic Journal
- Accession number :
- 15278268
- Full Text :
- https://doi.org/10.1007/s00134-004-2391-5