The utility of endotracheal aspirate bacteriology in identifying mechanically ventilated patients at risk for ventilator associated pneumonia: a single-center prospective observational study
| العنوان: | The utility of endotracheal aspirate bacteriology in identifying mechanically ventilated patients at risk for ventilator associated pneumonia: a single-center prospective observational study |
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| المؤلفون: | Lukas Stulik, Eszter Nagy, Marie Goggin, Zoltán Magyarics, Valéria Szijártó, Jana Hudcova, Christopher Stevens, Ekaterina Kabak |
| المصدر: | BMC Infectious Diseases, Vol 19, Iss 1, Pp 1-13 (2019) BMC Infectious Diseases |
| بيانات النشر: | BMC, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Adult, Male, 0301 basic medicine, medicine.medical_specialty, Staphylococcus aureus, medicine.drug_class, medicine.medical_treatment, 030106 microbiology, Antibiotics, medicine.disease_cause, Single Center, Endotracheal aspirate, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Medical microbiology, Internal medicine, Intubation, Intratracheal, Pneumonia, Bacterial, medicine, Humans, Ventilator-associated pneumonia, lcsh:RC109-216, Prospective Studies, 030212 general & internal medicine, Prospective study, Prospective cohort study, Aged, Mechanical ventilation, Gram-negative pathogens, Bacteria, business.industry, Pneumonia, Ventilator-Associated, Length of Stay, Middle Aged, medicine.disease, bacterial infections and mycoses, Respiration, Artificial, Anti-Bacterial Agents, respiratory tract diseases, Trachea, Intensive Care Units, Pneumonia, Infectious Diseases, Female, business, Research Article |
| الوصف: | Background Ventilator-associated pneumonia (VAP) is a well-known, life-threatening disease that persists despite preventative measures and approved antibiotic therapies. This prospective observational study investigated bacterial airway colonization, and whether its detection and quantification in the endotracheal aspirate (ETA) is useful for identifying mechanically ventilated ICU patients who are at risk of developing VAP. Methods 240 patients admitted to 3 ICUs at the Lahey Hospital and Medical Center (Burlington, MA) between June 2014 and June 2015 and mechanically ventilated for > 2 days were included. ETA samples and clinical data were collected. Airway colonization was assessed, and subsequently categorized into “heavy” and “light” by semi-quantitative microbiological analysis of ETAs. VAP was diagnosed retrospectively by the study sponsor according to a pre-specified pneumonia definition. Results Pathogenic bacteria were isolated from ETAs of 125 patients. The most common species isolated was S. aureus (56.8%), followed by K. pneumoniae, P. aeruginosa, and E. coli (35.2% combined). VAP was diagnosed in 85 patients, 44 (51.7%) with no bacterial pathogen, 18 associated with S. aureus and 18 Gram-negative-only cases, and 5 associated with other Gram-positive or mixed species. A higher proportion of patients who were heavily colonized with S. aureus developed VAP (32.4%) associated with S. aureus compared to those lightly colonized (17.6%). The same tendency was seen for patients heavily and lightly colonized with Gram-negative pathogens (30.0 and 0.0%, respectively). Detection of S. aureus in the ETA preceded S. aureus VAP by approximately 4 days, while Gram-negative organisms were first detected 2.5 days prior to Gram-negative VAP. VAP was associated with significantly longer duration of mechanical ventilation and hospitalization regardless of microbiologic cause when compared to patients who did not develop VAP. Conclusions The overall VAP rate was 35%. Heavy tracheal colonization supported identification of patients at higher risk of developing a corresponding S. aureus or Gram-negative VAP. Detection of bacterial ETA-positivity tended to precede VAP. Electronic supplementary material The online version of this article (10.1186/s12879-019-4367-7) contains supplementary material, which is available to authorized users. |
| اللغة: | English |
| تدمد: | 1471-2334 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e23802942992d2732e58f984ad6304dbTest http://link.springer.com/article/10.1186/s12879-019-4367-7Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....e23802942992d2732e58f984ad6304db |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14712334 |
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