Epidemiology of Ventilator-acquired Pneumonia Based on Protected Bronchoscopic Sampling

Autor: David L. George, C. Glen Mayhall, G. Umberto Meduri, Pamela S. Falk, Cathy E. Corbett, Kenneth V. Leeper, Elaine L. Steere, Richard G. Wunderink
Rok vydání: 1998
Předmět:
Time Factors
medicine.medical_treatment
Oropharynx
Critical Care and Intensive Care Medicine
medicine.disease_cause
Bronchoalveolar Lavage
Cohort Studies
Positive-Pressure Respiration
Risk Factors
Pneumonia
Staphylococcal
Odds Ratio
Cumulative incidence
Prospective Studies
Cross Infection
medicine.diagnostic_test
Incidence
Incidence (epidemiology)
Smoking
Stomach
Respiratory disease
Enterobacteriaceae Infections
Tennessee
Anti-Bacterial Agents
Trachea
Bronchoscopes
Pseudomonas aeruginosa
Pulmonary and Respiratory Medicine
Artificial ventilation
medicine.medical_specialty
Haemophilus Infections
Critical Care
Nose
Enterobacteriaceae
Internal medicine
Bronchoscopy
Streptococcus pneumoniae
Confidence Intervals
Pneumonia
Bacterial
medicine
Humans
Pseudomonas Infections
Serum Albumin
Mechanical ventilation
Ventilators
Mechanical
business.industry
Pneumonia
Pneumococcal
medicine.disease
Surgery
Pneumonia
Logistic Models
Bronchoalveolar lavage
business
Zdroj: American Journal of Respiratory and Critical Care Medicine. 158:1839-1847
ISSN: 1535-4970
1073-449X
DOI: 10.1164/ajrccm.158.6.9610069
Popis: We performed a prospective observational cohort study of the epidemiology and etiology of nosocomial pneumonia in 358 medical ICU patients in two university-affiliated hospitals. Protected bronchoscopic techniques (protected specimen brush and bronchoalveolar lavage) were used for diagnosis to minimize misclassification. Risk factors for ventilator-associated pneumonia were identified using multiple logistic regression analysis. Twenty-eight cases of pneumonia occurred in 358 patients for a cumulative incidence of 7.8% and incidence rates of 12.5 cases per 1, 000 patient days and 20.5 cases per 1,000 ventilator days. Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Hemophilus species made up 65% of isolates from the lower respiratory tract, whereas only 12.5% of isolates were enteric gram-negative bacilli. Daily surveillance cultures of the nares, oropharynx, trachea, and stomach demonstrated that tracheal colonization preceded ventilator-associated pneumonia in 93.5%, whereas gastric colonization preceded tracheal colonization for only four of 31 (13%) eventual pathogens. By multiple logistic regression, independent risk factors for ventilator- associated pneumonia were admission serum albumin= 2.2 g/dl (odds ratio [OR] 5.9; 95% confidence interval [CI] 2.0-17.6; p = 0.0013), maximum positive end-expiratory pressure= 7.5 cm H2O (OR, 4.6; 95% CI, 1.4 to 15.1; p = 0.012), absence of antibiotic therapy (OR, 6.7; 95% CI, 1.8 to 25.3; p = 0.0054), colonization of the upper respiratory tract by respiratory gram-negative bacilli (OR, 3.4; 95% CI, 1.1 to 10.1; p = 0.028), pack-years of smoking (OR, 2.3 for 50 pack-years; 95% CI, 1. 2 to 4.2; p = 0.012), and duration of mechanical ventilation (OR, 3. 4 for 14 d; 95% CI, 1.5 to 7.8; p = 0.0044). Several of these risk factors for ventilator-associated pneumonia appear amenable to intervention.
Databáze: OpenAIRE
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