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Nusrat T, Akter N, Rahman NAA, Godman B, D Rozario DT, Haque M. Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh. Hosp Pract (1995) 2020; 48:128-136. [PMID: 32271642 DOI: 10.1080/21548331.2020.1754687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. METHOD Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. RESULTS Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients' age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E. coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin. CONCLUSION A positive culture was detected in 90% of VAP patients, but it was not associated with the patients' age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.
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Affiliation(s)
- Tanzina Nusrat
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nasima Akter
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia , Bandar Indera Mahkota, Kuantan, Malaysia
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
- Health Economics Centre, University of Liverpool , Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | | | - Mainul Haque
- Faculty of Medicine and Defense Health, Universiti Pertahanan Nasional Malaysia (National Defense University of Malaysia) , Kem Sungai Besi, Kuala Lumpur, Malaysia
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Abstract
Ventilator-associated tracheobronchitis (VAT) might represent an intermediate process between lower respiratory tract colonization and ventilator-associated pneumonia (VAP), or even a less severe spectrum of VAP. There is an urgent need for new concepts in the arena of ventilator-associated lower respiratory tract infections. Ideally, the gold standard of care is based on prevention rather than treatment of respiratory infection. However, despite numerous and sometimes imaginative efforts to validate the benefit of these measures, most clinicians now accept that currently available measures have failed to eradicate VAP. Stopping the progression from VAT to VAP could improve patient outcomes.
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Abd-Elmonsef MME, Elsharawy D, Abd-Elsalam AS. Mechanical ventilator as a major cause of infection and drug resistance in intensive care unit. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:30787-30792. [PMID: 28233206 DOI: 10.1007/s11356-017-8613-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 02/07/2017] [Indexed: 06/06/2023]
Abstract
Ventilator-associated pneumonia (VAP) is the most frequent infection in intensive care units (ICU). It is associated with high rates of long morbidity and mortality. Management of a case of VAP is often said to add $40,000 to hospital costs USA. All these data directed our interest to study the etiology, risk factors, and antibiotic susceptibility patterns of VAP in ICU of Tanta University Hospital. This study included 36 cases of VAP. Endotracheal aspirates were obtained from all cases and microbiologically analyzed. Samples were collected over 1 year. Forty-two strains were isolated from 28 cases, while eight cases showed no bacterial growth. The most frequent organism was Staphylococcus aureus (30.95%), followed by Acinetobacter baumannii and Pseudomonas aeruginosa (21.43% for each), and the least common was Staphylococcus epidermidis (2.38%). Multi-drug resistance was detected in (50%) of the isolated bacteria in this study. Imipenem, amikacin, linezolid, vancomycin, and levofloxacin are recommended to be the most effective drugs in management of VAP. VAP is a serious problem in ICU carrying many risks for the patient live. Regimens of empirical treatment should take in consideration the update in the bacterial etiology and antibiotic susceptibility patterns of VAP.
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Affiliation(s)
- Marwa M E Abd-Elmonsef
- Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Dalia Elsharawy
- Chest Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Garnacho-Montero J, Gutiérrez-Pizarraya A, Lopez-García I, Miranda JC, González-Galán V, Corcia-Palomo Y, Alonso-Araujo I, Martín-Villén L, Aznar-Martín J, Amaya-Villar R. Pneumonia in mechanically ventilated patients: no diagnostic and prognostic value of different quantitative tracheal aspirates thresholds. Infect Dis (Lond) 2017; 50:44-51. [PMID: 28776434 DOI: 10.1080/23744235.2017.1362110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Diagnosis of pneumonia in ventilated patients is challenging due to the lack of specific and definitive clinical symptoms, laboratory data or radiological abnormalities. METHODS Based on quantitative tracheal aspirate (QTA) results, three groups of patients were compared: <105 cfu/ml, ≥105 cfu/ml and <106 cfu/ml, and ≥106 cfu/ml. We recorded demographic variables, underlying diseases and severity of illness at ICU admission. On the day of pneumonia diagnosis, we registered temperature, leukocyte count, C-reactive protein, Sequential Organ Failure Assessment (SOFA) score, clinical pulmonary infection score (CPIS) and adequacy of empirical antimicrobial therapy. RESULTS In 231 episodes, clinical presentation, laboratory data, severity of illness, CPIS, the presence of bacteremia and radiological score did not differ among the three groups. ICU and hospital mortalities were also similar in the three groups. Factors independently associated with in-hospital mortality were age, SOFA score and inappropriate antimicrobial therapy. The bacterial burden in the QTA was not included in the model. CONCLUSIONS Quantification of tracheal aspirate samples may not be necessary in ventilated patients clinically suspected of having nosocomial pneumonia.
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Affiliation(s)
- J Garnacho-Montero
- a Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen Macarena , Sevilla , Spain.,b Instituto de Biomedicina de Sevilla (IBIS) , Seville , Spain
| | - A Gutiérrez-Pizarraya
- b Instituto de Biomedicina de Sevilla (IBIS) , Seville , Spain.,c Infectious Disease, Microbiology and Preventive medicine Clinical Unit , Virgen Macarena University Hospital , Seville , Spain
| | - I Lopez-García
- d Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen del Rocío , Seville , Spain
| | - J C Miranda
- d Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen del Rocío , Seville , Spain
| | - V González-Galán
- e Infectious Disease, Microbiology and Preventive medicine Clinical Unit , Virgen del Rocío University Hospital , Seville , Spain
| | - Y Corcia-Palomo
- d Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen del Rocío , Seville , Spain
| | - I Alonso-Araujo
- d Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen del Rocío , Seville , Spain
| | - L Martín-Villén
- d Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen del Rocío , Seville , Spain
| | - J Aznar-Martín
- e Infectious Disease, Microbiology and Preventive medicine Clinical Unit , Virgen del Rocío University Hospital , Seville , Spain
| | - R Amaya-Villar
- d Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen del Rocío , Seville , Spain
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Dahyot S, Lemee L, Pestel-Caron M. [Description and role of bacteriological techniques in the management of lung infections]. Rev Mal Respir 2017; 34:1098-1113. [PMID: 28688757 PMCID: PMC7134997 DOI: 10.1016/j.rmr.2016.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/28/2016] [Indexed: 01/07/2023]
Abstract
Les pneumopathies aiguës recouvrent des contextes cliniques variés et les étiologies bactériennes impliquées le sont tout autant. Aucun outil microbiologique n’est 100 % sensible ni 100 % spécifique et malgré les investigations, plus de 30 % des pneumopathies restent sans étiologie identifiée. Si aucun prélèvement n’est indiqué pour les patients traités en ambulatoire, les prélèvements respiratoires non invasifs sont à privilégier pour les pneumopathies aiguës hospitalisées (communautaires ou associées aux soins), tandis que les prélèvements invasifs sont indiqués en seconde ligne pour les pneumopathies aiguës communautaires en réanimation, et en première ligne pour les pneumopathies aiguës de l’immunodéprimé. La culture microbiologique garde une place importante, à condition que le malade soit prélevé avant instauration de l’antibiothérapie. Certains contextes peuvent justifier le recours aux hémocultures, à la recherche d’antigènes urinaires ou aux sérologies. Les PCR rendent déjà service au quotidien mais l’avenir à court terme appartient probablement aux panels moléculaires multiplex capables de détecter de nombreux micro-organismes en quelques heures, surtout dans les pneumopathies communautaires sévères de réanimation et les pneumopathies aiguës de l’immunodéprimé. Le séquençage nucléotidique haut débit révolutionnera bientôt le diagnostic microbiologique, en pneumologie comme dans les autres domaines de l’infectiologie.
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Affiliation(s)
- S Dahyot
- UNIROUEN, GRAM EA2656, laboratoire de bactériologie, CHU de Rouen, Normandie université, 76000 Rouen, France.
| | - L Lemee
- UNIROUEN, GRAM EA2656, laboratoire de bactériologie, CHU de Rouen, Normandie université, 76000 Rouen, France
| | - M Pestel-Caron
- UNIROUEN, GRAM EA2656, laboratoire de bactériologie, CHU de Rouen, Normandie université, 76000 Rouen, France
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Use of Tracheal Aspirate Culture in Newly Intubated Patients with Community-Onset Pneumonia. Ann Am Thorac Soc 2016; 13:376-81. [PMID: 26793950 DOI: 10.1513/annalsats.201506-368bc] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Successful treatment of life-threatening community-acquired pneumonia requires appropriate empiric antibiotic coverage. But using conventional diagnostic techniques, a microbiological diagnosis is often not achieved. The diagnostic usefulness of tracheal aspirate at the time of intubation in patients with severe pneumonia has not been well studied. OBJECTIVES The purpose of this study was to evaluate the use of tracheal aspirate culture in identifying pneumonia pathogens. METHODS We identified all patients older than 18 years of age with International Classification of Disease, Ninth Revision codes and radiographic evidence of pneumonia seen in the emergency departments at 2 university-affiliated Utah hospitals from December 2009 to November 2010 and from December 2011 to November 2012. Patients intubated within 24 hours of arrival were then identified electronically. Postintubation orders instructed respiratory therapists to obtain tracheal aspirate for culture. All culture results were reviewed individually and defined as positive if a pneumonia pathogen was identified. Results of other microbiology studies were obtained from the electronic medical record. MEASUREMENTS AND MAIN RESULTS Of 2,011 patients with pneumonia, 94 were intubated and 84 had a tracheal aspirate obtained. Of these 84 patients, 47 (56%) had a pulmonary pathogen identified by tracheal aspirate culture, 80 also had blood cultures, and 71 underwent Pneumococcal and Legionella urinary antigen testing. A microbiological diagnosis was made in 55 patients (65.5%) by any diagnostic method. In 39% of patients (32 of 82), the tracheal aspirate culture was the only positive test, resulting in a unique microbiological diagnosis in patients who would have otherwise been classified as "culture negative." CONCLUSIONS Tracheal aspirate cultures obtained as part of routine care identified a plausible pneumonia pathogen in more than one-half of emergency department adult patients with severe pneumonia requiring intubation. Tracheal aspirate culture offers important additive diagnostic value to other routine tests.
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Angaali N, Roy ND, Chitgupikar SR, Subramanian P, Pabbati JL. Ventilator Associated Pneumonia in an Infant Caused by Stenotrophomonas maltophila - A Case Report. J Clin Diagn Res 2016; 10:DD01-DD03. [PMID: 27790437 PMCID: PMC5071937 DOI: 10.7860/jcdr/2016/19822.8411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/02/2016] [Indexed: 11/24/2022]
Abstract
Stenotrophomonas maltophila (S.maltophila) is an aerobic Gram-negative bacillus that is a frequent colonizer of fluids used in the hospital setting. The organism is known to cause life threatening infections in immuno-compromised patients especially in those who are neutropenic, on chemotherapy or on broad spectrum antibiotics. We report a case of ventilator associated pneumonia caused by Stenotrophomonas maltophila in a two-month old infant who later developed multi organ dysfunction syndrome. In seriously ill paediatric patients, S.maltophila should also be considered as a possible pathogen for Ventilator-Associated Pneumonia (VAP), hence empiric antibiotic choice should include antimicrobials that are active against S. maltophila. An early identification and treatment of VAP with Multi-Drug Resistant (MDR) strains with appropriate antibiotics has a significant impact on morbidity and mortality.
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Affiliation(s)
- Neelima Angaali
- Associate Professor, Department of Microbiology, MediCiti Institute of Medical Sciences (MIMS), Hyderabad, Telangana, India
| | - Nina Dutta Roy
- Head of Department, Department of Microbiology, Pathcare Labs, Hyderabad, Telangana, India
| | | | - Preeti Subramanian
- Assistant Professor, Department of Pediatrics, MIMS, Hyderabad, Telangana, India
| | - Jaya Lakshmi Pabbati
- Assistant Professor, Department of Pediatrics, MIMS, Hyderabad, Telangana, India
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Review on the Antimicrobial Resistance of Pathogens from Tracheal and Endotracheal Aspirates of Patients with Clinical Manifestations of Pneumonia in Bacolod City in 2013. INTERNATIONAL JOURNAL OF BACTERIOLOGY 2015; 2015:942509. [PMID: 26904750 PMCID: PMC4745480 DOI: 10.1155/2015/942509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/18/2022]
Abstract
Microbiological content specifically bacterial and fungal etiologies from tracheal aspirates in a tertiary hospital in Bacolod City was reviewed for baseline information. A total of 130 tracheal aspirates were subjected for culture to isolate and identify the pathogen and determine their susceptibilities to various antibiotics. Productions of certain enzymes responsible for antibiotic resistance like ESBL (Extended Spectrum Beta-Lactamase), metallo-β-lactamase, and carbapenemase were also studied. Out of 130 specimens, 69.23% were found to be positive for the presence of microorganisms. Most infections were from male patients aging 60 years and above, confined at the Intensive Care Units (ICU). Pseudomonas aeruginosa and Klebsiella pneumoniae were found to be the most frequent bacterial isolates and non-Candida albicans for fungal isolates, respectively. Among the various antibiotics tested, most isolates were found to be resistant to third generation cephalosporins and penicillins, but susceptible to aminoglycoside Amikacin. On the other hand, production of ESBL and carbapenemase was found to be common among members of Enterobacteriaceae especially K. pneumoniae.
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Medina-Presentado JC, Seija V, Vignoli R, Pontet J, Robino L, Cordeiro NF, Bado I, García-Fulgueiras V, Berro M, Bazet C, Savio E, Rieppi G. Polyclonal endemicity of Acinetobacter baumannii in ventilated patients in an intensive care unit in Uruguay. Int J Infect Dis 2013; 17:e422-7. [PMID: 23415583 DOI: 10.1016/j.ijid.2012.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 11/21/2012] [Accepted: 12/31/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To identify the mechanisms responsible for respiratory infections by Acinetobacter baumannii in intubated patients and risk factors for digestive colonization and infection by A. baumannii. METHODS We conducted a prospective study in an intensive care unit (ICU) between May 2005 and November 2006, including 175 consecutive patients at the beginning of invasive ventilation (day 1). We performed pharyngeal and rectal swabs on days 1, 4, 7, 10, 13, and 16. Respiratory samples were taken on days 1 and 7, or on suspicion of ventilator-associated pneumonia (VAP). RESULTS We detected 62 patients with A. baumannii digestive colonization and 20 cases of A. baumannii lower respiratory infection (14 VAP and six purulent tracheobronchitis (PTB)). Digestive colonization by A. baumannii was an independent risk factor for lower respiratory tract infections with that microorganism (p<0.0001; relative risk 8.71, 95% confidence interval 2.73-27.77). Respiratory and rectal A. baumannii isolates from the same patients were compared by enterobacterial repetitive intergenic consensus (ERIC)-PCR; in 9/11 cases (eight VAP and one PTB) results suggested events of exogenous pneumonia with previous colonization, whereas the remaining two cases (two PTB) were suggestive of exogenous infection without previous colonization. CONCLUSIONS In our unit the pathogenesis of VAP by A. baumannii is mixed, most cases corresponding to exogenous pneumonia with previous colonization.
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Affiliation(s)
- Julio Cesar Medina-Presentado
- Cátedra de Enfermedades Infecciosas, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Av. Alfredo Navarro 3051, Montevideo, 11600, Uruguay.
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Diagnosis of bacterial ventilator-associated pneumonia in children: reproducibility of blind bronchial sampling. Pediatr Crit Care Med 2013; 14:e1-7. [PMID: 23269358 DOI: 10.1097/pcc.0b013e318260129d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the reproducibility of blind bronchial sampling in patients with suspected diagnosis of bacterial ventilator-associated pneumonia. DESIGN Prospective study. SETTING Pediatric intensive care unit of a tertiary care, multidisciplinary, teaching hospital in Northern India. PATIENTS All consecutive patients on mechanical ventilation for >48 hrs were evaluated clinically for ventilator-associated pneumonia. INTERVENTIONS Children with clinical ventilator-associated pneumonia were subjected to blind bronchial sampling twice. MEASUREMENTS AND MAIN RESULTS Sixty-eight blind bronchial sampling samples from 34 patients were analyzed for polymorphonuclear cells, the presence, type, and number of bacteria. Acinetobacter baumannii was the most common organism grown from distal respiratory secretions. For polymorphonuclear cells, the concordance between two blind bronchial samples was 85.3% and kappa coefficient was 0.65. The concordance for the presence and type of bacteria in Gram staining in two samples was 85.3% and kappa coefficient was 0.68. The intraclass coefficients for bacterial index and predominant species index were 0.82 (95% confidence interval 0.65-0.91) and 0.89 (95% confidence interval 0.78-0.94), respectively. The use of prior antibiotics did not adversely affect the reproducibility of blind bronchial sampling. No major complications were recorded during the procedure. CONCLUSIONS Blind bronchial sampling of lower respiratory tract secretions in mechanically ventilated patients generates reproducible results of quantitative and qualitative cultures. We suggest that blind bronchial sampling may provide valuable clue to the bacterial etiology in ventilated child with suspected clinical ventilator-associated pneumonia.
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Prevention of ventilator-associated pneumonia through aspiration of subglottic secretions: a systematic review and meta-analysis. Dimens Crit Care Nurs 2012; 31:102-17. [PMID: 22333720 DOI: 10.1097/dcc.0b013e3182445ff3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is a subset of hospital-acquired pneumonias and is a serious, sometimes fatal, complication in patients who need mechanical ventilation. In addition, pay-for-performance initiative has placed increased emphasis on preventing nosocomial infections including VAP. Facilities may not be reimbursed for costs associated with prevalence infections. This article presents a review and meta-analysis of the prevention of VAP through the aspiration of subglottic secretion.
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Shete VB, Ghadage DP, Muley VA, Bhore AV. Multi-drug resistant Acinetobacter ventilator-associated pneumonia. Lung India 2011; 27:217-20. [PMID: 21139718 PMCID: PMC2988172 DOI: 10.4103/0970-2113.71952] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) due to a multi-drug resistant (MDR) Acinetobacter is one of the most dreadful complications, which occurs in the critical care setting. Aims and objectives: To find out the incidence of Acinetobacter infection in VAP cases, to determine various risk factors responsible for acquisition of Acinetobacter infection and to determine the antimicrobial susceptibility pattern of Acinetobacter. Materials and Methods: A total of 60 endotracheal aspirate specimens from intubated patients diagnosed clinically and microscopically as VAP were studied bacteriologically. All clinical details and prior exposure to antibiotics were recorded. Results: An incidence of 11.6% of Acinetobacter VAP cases was recorded. Various underlying conditions like head injury, cerebral hemorrhage and chronic obstructive pulmonary disease (COPD) were found to be associated with Acinetobacter VAP. Acinetobacter strains exhibited MDR pattern. Conclusion: Strict infection control measures, judicious prescribing of antibiotics, antibiotic resistance surveillance programs and antibiotic cycling should be adopted to control infections due to these bacteria in patients admitted to intensive care units.
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Affiliation(s)
- Vishal B Shete
- Department of Microbiology, BJ Medical College and Sassoon General Hospital, Pune, India
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Shin YM, Oh YM, Kim MN, Shim TS, Lim CM, Lee SD, Koh Y, Kim WS, Kim DS, Hong SB. Usefulness of quantitative endotracheal aspirate cultures in intensive care unit patients with suspected pneumonia. J Korean Med Sci 2011; 26:865-9. [PMID: 21738337 PMCID: PMC3124714 DOI: 10.3346/jkms.2011.26.7.865] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 04/21/2011] [Indexed: 11/29/2022] Open
Abstract
It is difficult to differentiate pathogens responsible for pneumonia or colonization in patients with an endotracheal tube or in patients that have undergone tracheostomy. We evaluated the clinical usefulness of quantitative endotracheal aspirates cultures and sought to determine the result threshold level for positivity. The authors performed this retrospective cohort study between December 1, 2004 and January 31, 2006. Forty-five suspected pneumonia patients admitted to an intensive care unit (ICU) with quantitative bronchoalveolar lavage (BAL) and endotracheal aspirate (EA) culture results were enrolled. Using a threshold of 10(5) cfu/mL, 10 of the 45 (22.2%) quantitative EA cultures were positive, as compared with 7 (15.6%) BAL cultures. When BAL culture findings were used as the reference, the sensitivity and specificity of quantitative EA cultures were 85.7% and 89.5%, respectively, at a threshold of 10(5) cfu/mL, and 85.7% and 94.7%, respectively, at a threshold of 10(6) cfu/mL. Of the 10 EA culture positive patients, 2 patients with a result of -10(5) cfu/mL were BAL culture negative. The quantitative EA culture is a useful non-invasive tool for the diagnosis of pneumonia pathogens. It is suggested that a threshold level of 10(6) cfu/mL is appropriate.
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Affiliation(s)
- Yoon Mi Shin
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Cheongju St. Mary Hospital, Cheongju, Korea
| | - Yeon-Mok Oh
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Mi Na Kim
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Sun Shim
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chae-Man Lim
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Soon Kim
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang-Bum Hong
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia: a review. Eur J Intern Med 2010; 21:360-8. [PMID: 20816584 DOI: 10.1016/j.ejim.2010.07.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/24/2010] [Accepted: 07/08/2010] [Indexed: 01/08/2023]
Abstract
Ventilator-associated pneumonia (VAP) is the most frequent intensive-care-unit (ICU)-acquired infection, with an incidence ranging from 6 to 52% [1,2,3,4]. Several studies have shown that critically ill patients are at high risk for getting such nosocomial infections [3,4]. VAP continues to be a major cause of morbidity, mortality and increased financial burden in ICUs [5,6,7,8]. Over the years there has been a significant advance in our understanding of ventilator associated pneumonia. This article reviews the various aspects of VAP such as definition, risk factors, etiological agents, diagnosis, treatment and prevention with emphasis on the recent advances.
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Affiliation(s)
- Noyal Mariya Joseph
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
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15
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Visscher S, Schurink CAM, Melsen WG, Lucas PJF, Bonten MJM. Effects of systemic antibiotic therapy on bacterial persistence in the respiratory tract of mechanically ventilated patients. Intensive Care Med 2008; 34:692-9. [DOI: 10.1007/s00134-007-0984-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 12/03/2007] [Indexed: 11/24/2022]
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Abstract
In Osier’s time, bacterial pneumonia was a dreaded event, so important that he borrowed John Bunyan’s characterization of tuberculosis and anointed the pneumococcus, as the prime pathogen, “Captain of the men of death.”1 One hundred years later much has changed, but much remains the same. Pneumonia is now the sixth most common cause of death and the most common lethal infection in the United States. Hospital-acquired pneumonia is now the second most common nosocomial infection.2 It was documented as a complication in 0.6% of patients in a national surveillance study,3 and has been reported in as many as 20% of patients in critical care units.4 Furthermore, it is the leading cause of death among nosocomial infections.5 Leu and colleagues6 were able to associate one third of the mortality in patients with nosocomial pneumonia to the infection itself. The increase in hospital stay, which averaged 7 days, was statistically significant. It has been estimated that nosocomial pneumonia produces costs in excess of $500 million each year in the United States, largely related to the increased length of hospital stay.
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Medina J, Formento C, Pontet J, Curbelo A, Bazet C, Gerez J, Larrañaga E. Prospective study of risk factors for ventilator-associated pneumonia caused by Acinetobacter species. J Crit Care 2007; 22:18-26. [PMID: 17371739 DOI: 10.1016/j.jcrc.2006.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 01/27/2006] [Accepted: 06/06/2006] [Indexed: 11/30/2022]
Abstract
UNLABELLED The incidence of ventilator-associated pneumonia (VAP) by Acinetobacter spp (VAPA) is increasing and has high morbidity and mortality. It is imperative to identify risk factors to be able to use prevention policies. OBJECTIVE The aim of this study was to identify specific risk factors for VAPA. DESIGN Prospective cohort study. INTERVENTIONS None. SETTING Two medical-surgical intensive care units. MEASUREMENTS During a period of 36 months, all patients with more than 48 hours on mechanical ventilation and suspected of having a VAP were enrolled. Only VAP with microbiological confirmation was analyzed. RESULTS Two hundred eighteen consecutive patients with clinical suspicion of VAP were enrolled. One hundred twenty-five VAPs were confirmed by culture--46 by Acinetobacter spp and 79 by other pathogens. The 36 potential risk factors for Acinetobacter spp were analyzed by univariate analysis. Logistic regression identified previous use of ceftriaxone (relative risk, 5.1; 95% confidence interval, 1.47-17.82) and previous use of ciprofloxacin (relative risk, 9.1; 95% confidence interval, 2.29-36.63) as significant independent predictors for the development of VAPA. CONCLUSIONS Previous use of ceftriaxone and ciprofloxacin are independent risk factors for the development of VAPA.
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Affiliation(s)
- Julio Medina
- Cátedra de Enfermedades Infecciosas, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo CP 11600, Uruguay.
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18
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Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbiol Rev 2006; 19:637-57. [PMID: 17041138 PMCID: PMC1592694 DOI: 10.1128/cmr.00051-05] [Citation(s) in RCA: 261] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.
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Affiliation(s)
- Steven M Koenig
- Pulmonary and Critical Care Medicine, P.O. Box 800546, UVa HS, Charlottesville, VA 22908, USA.
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19
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Koeman M, van der Ven AJAM, Hak E, Joore HCA, Kaasjager K, de Smet AGA, Ramsay G, Dormans TPJ, Aarts LPHJ, de Bel EE, Hustinx WNM, van der Tweel I, Hoepelman AM, Bonten MJM. Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia. Am J Respir Crit Care Med 2006; 173:1348-55. [PMID: 16603609 DOI: 10.1164/rccm.200505-820oc] [Citation(s) in RCA: 285] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Ventilator-associated pneumonia (VAP) is the most frequently occurring nosocomial infection associated with increased morbidity and mortality. Although oral decontamination with antibiotics reduces incidences of VAP, it is not recommended because of potential selection of antibiotic-resistant pathogens. We hypothesized that oral decontamination with either chlorhexidine (CHX, 2%) or CHX/colistin (CHX/COL, 2%/2%) would reduce and postpone development of VAP, and oral and endotracheal colonization. OBJECTIVES To determine the effect of oral decontamination with CHX or CHX/COL on VAP incidence and time to development of VAP. METHODS Consecutive patients needing mechanical ventilation for 48 h or more were enrolled in a randomized, double-blind, placebo-controlled trial with three arms: CHX, CHX/COL, and placebo (PLAC). Trial medication was applied every 6 h into the buccal cavity. Oropharyngeal swabs were obtained daily and quantitatively analyzed for gram-positive and gram-negative microorganisms. Endotracheal colonization was monitored twice weekly. RESULTS Of 385 patients included, 130 received PLAC, 127 CHX and 128 CHX/COL. Baseline characteristics were comparable. The daily risk of VAP was reduced in both treatment groups compared with PLAC: 65% (hazard ratio [HR]=0.352; 95% confidence interval [CI], 0.160, 0. 791; p=0.012) for CHX and 55% (HR=0.454; 95% CI, 0.224, 0. 925; p=0.030) for CHX/COL. CHX/COL provided significant reduction in oropharyngeal colonization with both gram-negative and gram-positive microorganisms, whereas CHX mostly affected gram-positive microorganisms. Endotracheal colonization was reduced for CHX/COL patients and to a lesser extent for CHX patients. No differences in duration of mechanical ventilation, intensive care unit stay, or intensive care unit survival could be demonstrated. CONCLUSIONS Topical oral decontamination with CHX or CHX/COL reduces the incidence of VAP.
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Affiliation(s)
- Mirelle Koeman
- University Medical Center Utrecht, Department of Internal Medicine and Dermatology, and Department of Internal Medicine and Intensive Care Medicine, Rijnstate Hospital Arnhem, The Netherlands.
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20
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Bouza E, Torres MV, Burillo A. Aportación del laboratorio de microbiología al diagnóstico de la neumonía asociada a la ventilación mecánica. Enferm Infecc Microbiol Clin 2005; 23 Suppl 3:2-9. [PMID: 16854335 DOI: 10.1157/13091214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The etiologic diagnosis of ventilator-associated pneumonia (VAP) should be considered as a microbiological emergency due to its impact on morbidity and mortality. Sampling of the lower respiratory tract (LRT) must be performed before starting or modifying antimicrobial therapy. Surveillance cultures in patients without criteria of VAP are not recommended. There is no evidence of any superiority of bronchoscopic over non-bronchoscopic sampling procedures, but quantitative bacterial cultures are essential to allow colonization to be differentiated from true infection of the LRT. Under these conditions, negative cultures practically rule out bacterial infection or, at least, identify patients who will not benefit from antibiotic therapy or who will require a very short course of treatment. Given that identification and antimicrobial susceptibility testing of microorganisms usually takes up to 3 or 4 days, rapid procedures that provide the clinician with useful information are essential. Rapid information, even if partial or less than perfect, is clearly better for the patient than a perfect but delayed report. Gram stain of LRT secretions is an immediate procedure that can guide management and it has a reasonable correlation with culture results. At present, new antibiogram procedures, performed on direct clinical samples, allow presumptive identification and information on susceptibility to commonly used antibiotics in less than 24 hours after sampling. The impact of using this procedure in clinical practice is currently under research.
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Affiliation(s)
- Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, España.
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21
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Alqurashi AM. Antibiotic susceptibility patterns of different bacteria isolated from patients with ventilator associated pneumonia (vap). J Family Community Med 2005; 12:139-44. [PMID: 23012092 PMCID: PMC3410109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE Ventilator associated pneumonia (VAP) is a frequent complication of mechanical ventilation (MV) and it is a leading cause of death in MV patients. The development of VAP has been demonstrated as being due to aspiration of oropharyngeal secretion, ventilator tubing condensate, or gastric contents that are colonized with pathogenic microorganisms. The aim of the present study is to isolate and identify bacteria that cause VAP and to study antibiotic susceptibility. MATERIAL AND METHODS This study was carried out on 95 patients who fulfilled the diagnostic criteria for VAP. Quantitative cultures of endotracheal aspirates (EA) using a cut-off point of 10(6) cfu/ml was done. RESULTS The microbiological results revealed that gram negative bacilli were the most common bacterial agents responsible for VAP and accounted for 78.8% of all the causative agents. The most common isolated organisms were Klebsiella pnemouniae (30.9 %) followed by Pseudomonas aeruginosa (22.5%), Staphylococcus aureus (21.2%), Eschericia coli (12.8 %), Proteus spp. (9.8%), and Citrobacter spp. (2.8%). Blood cultures were positive in 25.9% of patients with Klebsiella pnemouniae in about 33.3%. CONCLUSION From this study, it can be concluded that VAP is an important nosocomial infection. EA is a simple procedure to obtain respiratory samples and perform sensitivity testing in patients with VAP. Also, the commonest cause of VAP is gram negative bacilli.
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Affiliation(s)
- Abdulrahman M. Alqurashi
- Department of Microbiology, College of Medicine, King Faisal University, Dammam, Saudi Arabia,Correspondence to:Dr. Abdulrahman M. Alqurashi, Department of Microbiology, College of Medicine, King Faisal University, P.O. Box 2114, Dammam 31451, Saudi Arabia E-mail:
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Dennesen P, van der Ven A, Vlasveld M, Lokker L, Ramsay G, Kessels A, van den Keijbus P, van Nieuw Amerongen A, Veerman E. Inadequate salivary flow and poor oral mucosal status in intubated intensive care unit patients. Crit Care Med 2003; 31:781-6. [PMID: 12626984 DOI: 10.1097/01.ccm.0000053646.04085.29] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate salivary flow and frequency of oral mucositis in intensive care unit patients compared with patients admitted because of elective coronary artery bypass graft (CABG) surgery. In addition, the pattern of oropharyngeal colonization was investigated in these patients. DESIGN Prospective study. SETTING Mixed intensive care unit and cardiosurgical ward. PATIENTS In this study, 24 ventilated intensive care unit patients and 20 CABG patients were included. MEASUREMENTS AND MAIN RESULTS Two dental hygienists examined intensive care unit patients for the presence of periodontal disease and mucositis at admission and subsequently every week during their stay in the intensive care unit. At the same time, stimulated salivary flow and salivary total immunoglobulin A output were measured. Oropharyngeal cultures were obtained as well. CABG patients were examined the day before the operation, 1 day, 1 wk, and 2 wks after the operation. The following results were obtained: a) temporarily reduced postoperative stimulated salivary flow and total salivary immunoglobulin A output in CABG patients and nearly absent stimulated salivary flow in intensive care unit patients; b) oropharyngeal colonization with potentially pathogenic microorganisms in intensive care unit and not in CABG patients; and c) the increase in mucositis index in intensive care unit patients paralleled the increase in potentially pathogenic microorganism oropharyngeal colonization, especially and. CONCLUSIONS Absence of adequate salivary flow in intubated intensive care unit patients causes severe xerostomia, which may contribute to the development of mucositis and oropharyngeal colonization with Gram-negative bacteria.
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Affiliation(s)
- Paul Dennesen
- Department of Medical Microbiology, University Hospital of Maastricht, The Netherlands
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23
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Fangio P, Rouquette-Vincenti I, Rousseau JM, Soullié B, Brinquin L. [Diagnosis of ventilator-associated pneumonia: a prospective comparison of the telescoping plugged catheter with the endotracheal aspirate]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21:184-92. [PMID: 11963381 DOI: 10.1016/s0750-7658(02)00584-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Quantitative culture of endotracheal aspirates (EA) is widely accepted for the diagnosis of ventilator-associated pneumonia (VAP). The aim of the study was to compare the diagnostic accuracy of the EA with the blinded plugged telescoping catheter (PTC) in patients suspected of VAP. STUDY DESIGN Prospective non-randomised observational study. PATIENTS AND METHODS 31 patients suspected of having VAP underwent 46 bronchial samplings. An EA and a blinded PTC were performed successively in each case; the PTC result was taken as the reference standard. The EA and PTC cultures were defined positive if the result of bacterial cultures yielding were > or = 10(5) cfu.mL-1 and > or = 10(3) cfu.mL-1 respectively. RESULTS The diagnosis of VAP could be established in 19 cases when PTC was taking as gold test. The overall agreement between the two techniques was 76%. EA had a sensitivity of 89.5%, a specificity of 66.7%, a negative predictive value of 90% and a positive predictive value of 65.4%. CONCLUSION EA is a good diagnostic test when a non-invasive test has been chosen. The diagnosis of VAP could be excluded in 90% of cases when the EA cultures yielding were < 10(5) cfu.mL-1. His low specificity could drive in an over treatment of bronchopulmonar bacterial colonization. The accuracy of the EA compares well with that of the TPC for the diagnostic of VAP.
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Affiliation(s)
- P Fangio
- Département d'anesthésie-réanimation, hôpital d'instruction des Armées du Val-de-Grâce, 74, Bd Port Royal, 75005 Paris, France
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Dennesen PJ, van der Ven AJ, Kessels AG, Ramsay G, Bonten MJ. Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med 2001; 163:1371-5. [PMID: 11371403 DOI: 10.1164/ajrccm.163.6.2007020] [Citation(s) in RCA: 209] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although recommended durations of antimicrobial therapy for ventilator-associated pneumonia (VAP) range from 7 to 21 d, these are not based on prospective studies and little is known about the resolution of symptoms after start of antibiotics. Resolution of these symptoms was investigated in 27 patients. VAP was diagnosed on clinical, radiographic, and microbiological criteria, including quantitative cultures of bronchoalveolar lavage. All patients received appropriate antibiotic therapy. Highest temperatures, leukocyte counts, Pa(O(2))/FI(O(2)) ratios, and semiquantitative cultures of endotracheal aspirates were recorded from start of therapy until Day 14. Resolution was defined as the first day that these parameters fulfilled the following definition: temperature < or = 38 degrees C, leukocytes < or = 10 x 10(9)/L, Pa(O(2))/FI(O(2)) ratio > or = 25 kPa, and no or +1 of bacterial growth of etiologic pathogens in cultures of endotracheal aspirate. VAP was caused by Enterobacteriaceae (n = 14), P. aeruginosa (n = 7), S. aureus (n = 6), H. influenzae (n = 3), and S. pneumoniae (n = 1). H. influenzae and S. pneumoniae were eradicated from tracheal aspirates, whereas Enterobacteriaceae, S. aureus, and P. aeruginosa persisted, despite in vitro susceptibility to antibiotics administered. Significant improvements were observed for all clinical parameters, most apparently within the first 6 d after start of antibiotics. Newly acquired colonization, especially with P. aeruginosa and Enterobacteriaceae, occurred in the second week of therapy. Six patients developed a recurrent episode of VAP, four of them with P. aeruginosa. Clinical responses to therapy for VAP occur within the first 6 d of therapy, endotracheal colonization with Gram-negative bacteria persists despite susceptibility to therapy, and acquired colonization usually occurs in the second week of therapy and frequently precedes a recurrent episode.
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Affiliation(s)
- P J Dennesen
- Department of Medical Microbiology, Medical Technology Assessment and Surgery, University Hospital Maastricht, Maastricht, The Netherlands
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25
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Abstract
Nosocomial pneumonia poses a major threat to the recovery of patients receiving mechanical ventilation. In addition, nosocomial pneumonia is often difficult to diagnose. This article examines the extent of the threat and some of the difficulties facing the critical care physician when diagnosing nosocomial pneumonia.
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Affiliation(s)
- H M Lode
- Department of Chest and Infectious Diseases, City Hospital Heckeshorn/Zehlendorf, Berlin, Germany
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