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Original Research: CRITICAL CARE |

Early ICU Energy Deficit Is a Risk Factor for Staphylococcus aureus Ventilator-Associated PneumoniaEnergy Deficit and Ventilator-Associated Pneumonia

Christophe Faisy, MD, PhD; Maria Candela Llerena, MD; Magali Savalle, MD; Jean-Luc Mainardi, MD, PhD; Jean-Yves Fagon, MD, PhD
Author and Funding Information

From the Medical Intensive Care Unit (Drs Faisy, Savalle, and Fagon) and Department of Microbiology (Dr Mainardi), European Georges Pompidou Hospital, University Paris–Descartes, Assistance Publique−Hôpitaux de Paris, Paris, France; and the Intensive Care Unit (Dr Llerena), San Isidro Central Hospital Melchor Angel Posse, Buenos Aires, Argentina.

Correspondence to: Christophe Faisy, MD, PhD, Medical Intensive Care Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75908 Paris Cedex 15, France; e-mail: christophe.faisy@egp.aphp.fr


Funding/support: This research was funded by the Medical Intensive Care Unit and the Department of Microbiology, European Georges Pompidou Hospital, Assistance Publique−Hôpitaux de Paris, Paris, France. This study was not sponsored by any grants, gifts, or fellowships.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1254-1260. doi:10.1378/chest.11-1499
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Background:  Caloric insufficiency during the first week of ICU stay has been associated with increased infection rates. The connection between specific pathogens and host nutritional status in the ICU is not well known. This study was undertaken to determine the impact of patients’ early in-ICU energy balance on the pathogens responsible for ventilator-associated pneumonia (VAP).

Methods:  In this prospective, observational, cohort study conducted in a teaching hospital ICU, energy balance (energy delivered − calculated resting energy expenditure) was compared according to the microbiologic results of the fiber-optic BAL cultures of 76 consecutive patients receiving acute prolonged (≥ 96 h) mechanical ventilation who developed VAP during their ICU stay.

Results:  Among the 76 BAL cultures, 22 contained significant Staphylococcus aureus concentrations. The cumulated energy deficit of patients with S aureus VAP was greater than those with VAP caused by other pathogens (−10,275 ± 4,211 kcal vs −7,376 ± 4,013 kcal from ICU admission to day of BAL, P < .01). ICU admission, nutritional status, and conditions potentially limiting feeding did not differ significantly between the two groups. Patients with S aureus VAP had lower prescribed and delivered energy, causing higher energy deficits. Multivariate analysis identified energy deficit as being independently associated with S aureus VAP. More-severe energy deficit and higher rate of S aureus-positive BAL cultures (P = .01 comparing quartiles) were observed.

Conclusions:  Early ICU energy deficit is an independent determinant for acquiring S aureus VAP in patients on acute prolonged mechanical ventilation.

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