Jl. Trouillet et al., VENTILATOR-ASSOCIATED PNEUMONIA CAUSED BY POTENTIALLY DRUG-RESISTANT BACTERIA, American journal of respiratory and critical care medicine, 157(2), 1998, pp. 531-539
Citations number
33
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
To determine risk factors for ventilator-associated pneumonia (VAP) ca
used by potentially drug-resistant bacteria such as methicillin-resist
ant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter bauma
nnii, and/or Stenotrophomonas maltophilia, 135 consecutive episodes of
VAP observed in a single ICU over a 25-mo period were prospectively s
tudied. For all patients, VAP was diagnosed based on results of bronch
oscopic protected specimen brush (greater than or equal to 10(3) cfu/m
l) and bronchoalveolar lavage (greater than or equal to 10(4) cfu/ml)
specimens. Seventy-seven episodes were caused by ''potentially resista
nt'' bacteria and 58 episodes were caused by ''other'' organisms. Acco
rding to logistic regression analysis, three variables among potential
factors remained significant: duration of mechanical ventilation (MV)
greater than or equal to 7 d (odds ratio [OR] = 6.0), prior antibioti
c use (OR = 13.5), and prior use of broad-spectrum drugs (third-genera
tion cephalosporin, fluoroquinolone, and/or imipenem) (OR = 4.1). Dist
ribution of the 245 causative bacteria was analyzed according to four
groups defined by prior duration of MV (< 7 or greater than or equal t
o 7 d) and prior use or lack of use (within 15 d) of antibiotics. Alth
ough 22 episodes of early-onset VAP in patients receiving no prior ant
ibiotics were caused by antibiotic-susceptible bacteria, 84 episodes o
f late-onset VAP in patients receiving prior antibiotics were mainly c
aused by potentially resistant bacteria. Differences in the potential
efficacies (ranging from 100% to 11%) against microorganisms of 15 ant
imicrobial regimens were studied according to classification into thes
e four groups. These findings may provide a more rational basis for se
lecting the initial therapy of patients suspected of having VAP.