Tracheal colonisation within 24 h of intubation in patients with head trauma: risk factor for developing early-onset ventilator-associated pneumonia

Objective:To investigate if tracheal colonisation within 24 h of intubation is a risk factor for developing early-onset ventilator-associated pneumoni a (EP) in patients with head trauma. Design: A prospective study in an intensive care unit of a university hospi tal. Population: One hundred intubated patients were included with head trauma a nd Glasgow coma score at admission less than or equal to 12. Methods: We took tracheal aspirate samples within 24 h of intubationand per formed a protected bronchoalveolar mini-lavage when clinical diagnosis of p neumonia was made. Measurements and results: On admission time 68 patients (68 %) were colonis ed in trachea, 22 patients were colonised by Staphylococcus aureus, 20 by H aemophilus influenzae, six by Streptococcus pneumoniae and 20 by gram-negat ive bacilli. The incidence of EP was 26%, and the microorganisms involved w ere Staph. aureus (44 %), H. influenzae (31%), Strep. pneumoniae (12 %), an d gram-negative bacilli (13 %). A multivariate logistic regression analysis showed that the tracheal colonization by Staph. aureus, H. influenzae or S trep. pneumoniae within 24 h of intubation was an independent risk factor f or developing EP (odds ratio: 28.9; 95 % confidence interval: 1.59-52.5). Conclusion: Colonisation of the trachea within 24 h of intubation by Staphy lococcus aureus, Haemophilus influenzae or Streptococcus pneumoniae is a ri sk factor for developing EP in patients with head trauma.