Frequency of transient streptococcal bacteremia following urgent orotracheal intubation in critically ill patients

Objectives: To examine whether urgent orotracheal intubation (OI) can induc e bacteremia. To find predictive factors for post-intubation bacteremia. Design: Prospective observational study. Setting: Seventeen-bed medical intensive care unit in a university hospital . Patients: Sixty-eight adult intensive care patients undergoing urgent OI. Measurements and results: Patients in need of OI could be included if no ca rdiopulmonary resuscitation was performed. A blood culture was taken immedi ately before, as soon as possible after, and 60 min after intubation. The i ndication for intubation, ease of intubation, and the antibiotics used befo re intubation were registered. Six patients (6/68 or 9%) had streptococcal bacteremia immediately (mean 10.8 min) after intubation. No patient (0/62) had streptococcal bacteremia 60 min after intubation (P = 0.01). Four of th e six patients showing streptococcal bacteremia after intubation were intub ated by a second doctor because of difficulties during intubation, whereas this was the case in only 9/62 in those without streptococcal bacteremia (P = 0.01). Four of the 13 patients (31%) who needed to be intubated by a sec ond doctor showed transient streptococcal bacteremia. Of the 20 patients no t receiving antibiotics at the time of intubation, four (20 %) had streptoc occal bacteremia compared with 2/47 (4.2 %) patients receiving antibiotics (P = 0.06). Conclusions: Urgent intubation can cause transient bacteremia with streptoc occi in a significant proportion of intensive care patients. The observed f requency of bacteremia is higher than previously reported after elective in tubation. The difficulty of intubation is probably a predisposing factor.