Nosocomial pneumonia with isolation of anaerobic bacteria in ICU patients:Therapeutic considerations and outcome

Purpose: Evaluate the influence of the anti-anaerobic antimicrobial therapy in the outcome of patients with nosocomial pneumonia. Materials and Methods:The population study included 53 intensive care unit patients with nosocomial pneumonia in whom, using a protected specimen brus h, anaerobic bacteria were isolated, which were associated or not with aero bes. Current and empirical antibiotherapies were retrospectively analyzed, regarding their efficacy against anaerobic bacteria. Since it was debated, sensitivity to cefotaxime, ceftazidime, and ciprofloxacin was determined in 38 strains of Prevotella species. Outcome was evaluated 10 days after the day of protected specimen brushes. Improvement was defined as a decrease of Murray score or ventilator weaning. Results: The most frequently isolated bacteria were Prevotella species, whi ch were more frequently resistant to cefotaxime (37%), ceftazidime (50%), a nd ciprofloxacine (32%) than usually reported in the literature. Sixty-six percent of these strains produced beta-lactamase. The effect of empirical a nti-anaerobic antibiotherapy on the outcome at day 10 was evaluable in 39 p atients. Twenty-nine patients were improved and 10 patients worsened. inter estingly, patients who had received well-adapted antibiotics against anaero bes had a better outcome after 10 days (P < .02). Conclusions: This study suggests that specific antianaerobic therapy may be considered in the choice of empirical antibiotherapy in patients with noso comial pneumonia. Copyright (C) 1999 by W.B. Saunders Company.