Tuberc Respir Dis.  2007 Jun;62(6):506-515.

Antimicrobial Resistance of Bacteria Isolated from Bronchoalveolar lavage (BAL) in Patients with Lung Infiltrations in Burn and Non-Burn Intensive Care Unit

Affiliations
  • 1Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea. ighyun@hallym.ac.kr

Abstract

Background
Nosocomial pneumonia in an intensive care unit (ICU) is associated with a high mortality rate. Diagnosing a respiratory tract infection in critically ill patients is still difficult but detailed information for the pathogens is needed to establish an adequate antimicrobial treatment. This study examined the causative organisms and their antimicrobial resistance using bronchoalveolar lavage (BAL) from patients suspected of having pneumonia in the ICU. Methods: From January 2004 to June 2006, ICU patients with diffuse lung infiltration were prospectively enrolled. The BAL was used to diagnose the respiratory infection, with 104 > or = organisms considered a positive result. The most common organisms and their antimicrobial resistances were analyzed from the quantitative BAL cultures in the burn ICU and non-burn ICU. Results: A total 72 patients were included, 35 (M 29, F 6) in the burn ICU and 37 (M 26, F 11) in the non-burn ICU. 27 patients (77.1%) in the burn ICU and 22 patients (59.5%) in the non-burn ICU met the criteria for a positive BAL culture. The major pathogens were Staphylococcus aureus, Acinetobacter species and Pseudomonas aeruginosa. All strains (100%) of Staphylococcus aureus isolated from BAL (9 cases) were methicillin-resistant (MRSA) in the burn ICU, but 5 strains (71.4%, 7 cases) were MRSA in the non-burn ICU. Regarding Pseudomonas aeruginosa, the rate of resistance to amikacin, ciprofloxacin, cefepime, imipenem, ceftazidime, piperacillin/tazobactam in the burn and non-burn ICU ranged from 45.5% to 90% and 25% to 50%, respectively. In addition, the rate of resistance of Acinetobacter species to the above drugs in the burn and non-burn ICU ranged from 81.8% to 100% and 62.5% to 100%, respectively. Conclusions: These results are expected to provide useful guidelines for choosing the effective empirical antimicrobial therapy in patients with lung infiltrations in the burn and non-burn ICU.

Keyword

Bronchoalveolar lavage; Burns; Intensive care unit; Pneumonia

MeSH Terms

Acinetobacter
Amikacin
Bacteria*
Bronchoalveolar Lavage*
Burns*
Ceftazidime
Ciprofloxacin
Critical Illness
Humans
Imipenem
Intensive Care Units*
Critical Care*
Lung*
Methicillin Resistance
Methicillin-Resistant Staphylococcus aureus
Mortality
Pneumonia
Prospective Studies
Pseudomonas aeruginosa
Respiratory Tract Infections
Staphylococcus aureus
Amikacin
Ceftazidime
Ciprofloxacin
Imipenem

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