Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures
| Autor: | B. Darchy, K. Djedaini, J. J. Lanore, François Coste, P. Brun, Laurence Mier, Didier Dreyfuss, P. Weber |
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| Rok vydání: | 1993 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class Digestive System Diseases Antibiotics Comorbidity Aspiration pneumonia Critical Care and Intensive Care Medicine medicine.disease_cause Pneumonia Aspiration Gastroenterology Specimen Handling Internal medicine Intensive care Digestive disorder medicine Humans Hospital Mortality Prospective Studies Infusions Intravenous Aged Asepsis Cross Infection Streptococcus business.industry Age Factors Drug Resistance Microbial Penicillin G Length of Stay Middle Aged medicine.disease Prognosis Respiration Artificial Surgery Penicillin Community-Acquired Infections Regimen Bronchoscopes Protected specimen brush Female business medicine.drug |
| Zdroj: | Intensive care medicine. 19(5) |
| ISSN: | 0342-4642 |
| Popis: | To evaluate the bacteriology of early aspiration pneumonia using a protected specimen brush and quantitative culture techniques, and whether penicillin G is adequate as initial treatment pending culture results.52 patients (of which 45 required mechanical ventilation) meeting usual clinical criteria for aspiration pneumonia were prospectively included. On admission, patients were given intravenous penicillin G and a protected specimen brush was performedor = 48 h after.Cultures of the brush were negative (10(3) CFU/ml) in 33 patients (1 had blood cultures positive with S. pneumoniae) and positive (or = 10(3) CFU/ml) for S. pneumoniae in 2 patients. Seventeen patients had a positive culture (or = 10(3) CFU/ml) for at least one penicillin G resistant microorganism, with a total of 20 organisms (S. aureus: 6; H. influenzae: 2; Enterobacteriaceae: 8; P. aeruginosa: 3; C. albicans: 1). In 4 of these patients, a penicillin-sensitive pathogen was also recovered in significant concentrations (S. pneumoniae: 2; Streptococcus sp.: 2). These 17 patients with a resistant pathogen did not differ from the 35 other patients with respect to need for ventilatory support and mortality rate. By contrast, they were older (61.1 +/- 21.9 vs. 42.9 +/- 18.8 years; p0.005) and required longer mechanical ventilation (6.1 +/- 4.6 vs. 3.5 +/- 2.7 days; p0.03) and hospitalization (11.2 +/- 8.8 vs. 6.7 +/- 4.7 days; p0.02). Of 17 patients 12 with penicillin G resistant organisms versus 0/35 without, were in-hospital patients and/or had a digestive disorder (p0.001).The broad range of offending organisms seen in early aspiration pneumonia precludes use of any single empiric regimen, making protected specimen brush mandatory in many patients. Nevertheless, the involvement of S.pneumoniae in a notable proportion of our patients suggests that routine penicillin prophylaxis after early aspiration (at least in most patients with community-acquired aspiration) is warranted given the potential severity of pneumococcal sepsis in such patients. |
| Databáze: | OpenAIRE |
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