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- Title
Procoagulant and fibrinolytic activity in ventilator-associated pneumonia: impact of inadequate antimicrobial therapy.
- Authors
El-Solh, Ali A.; Okada, Mifue; Pietrantoni, Celestino; Aquilina, Alan; Berbary, Eileen
- Abstract
<bold>Objective: </bold>To determine the homeostatic balance of patients with ventilator-associated pneumonia (VAP) with respect to the adequacy of antimicrobial therapy.<bold>Design and Setting: </bold>Descriptive observational study in a 12-bed medical intensive care unit in a university-affiliated hospital.<bold>Patients: </bold>Twenty-nine patients with VAP documented by quantitative culture of bronchoalveolar secretions and a control group of eight mechanically ventilated patients.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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
PNEUMONIA; LUNG diseases; FIBRINOLYSIS; BLOOD coagulation; BRONCHOALVEOLAR lavage; THROMBOLYTIC therapy; ANTI-infective agents; ANTIBIOTICS; COMPARATIVE studies; CROSS infection; DRUG utilization; HEMOSTASIS; INTENSIVE care units; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PROGNOSIS; RESEARCH; MECHANICAL ventilators; EVALUATION research; TREATMENT effectiveness
- Publication
Intensive Care Medicine, 2004, Vol 30, Issue 10, p1914
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-004-2391-5