Tuberc Respir Dis.  2012 Jan;72(1):30-36.

Role of Microbiologic Culture Results of Specimens Prior to Onset of Ventilator-Associated Pneumonia in the Patients Admitted to Intensive Care Unit

• Kim JH
• Yoon SC
• Lee YM
• Son JW
• Choi EG
• Na MJ
• Kwon SJ

Abstract

BACKGROUND
Patients with ventilator-associated pneumonia (VAP) in intensive care unit (ICU) have a high mortality rate. The routine surveillance cultures obtained previously or an ATS guideline for hospital-acquired pneumonia was used in selecting initial antimicrobials. The object of this study was to compare the respiratory samples before VAP and bronchoalveolar lavage (BAL) culture.
METHODS
54 patients underwent fiberoptic bronchoscopy to obtain BAL samples. We reviewed microbiologic specimen results of prior respiratory specimens (pre-VAP) and BAL.
RESULTS
Among 51 patients with 54 VAP episodes, 52 microorganisms of pre-VAP and 56 BAL samples were isolated. Pre-VAP included 21.2% of MRSA, and 32.6% of multidrug resistant-Acinetobacter baumannii (MDR-AB). BAL samples comprised 25.0% of MRSA, 26.7% of MDR-AB, 14.3% of Stenotrophomonas maltophilia and 3.6% of Klebsiella pneumonia in order. In pre-VAP samples compared to BAL samples, only 35.2% were identical. In BAL samples compared to pre-VAP samples obtained in 5 days before the onset of VAP, only 43.6% were identical. However, among BAL samples compared to pre-VAP samples obtained after more than 5 days, 13.3% were identical (p=0.037).
CONCLUSION
Based on these data, pre-VAP samples obtained prior to 5 day onset of VAP may help to predict the causative microorganisms and to select appropriate initial antimicrobials.

Keyword

Pneumonia, Ventilator-Associated; Bronchoalveolar Lavage; Anti-Bacterial Agents

MeSH Terms

Anti-Bacterial Agents
Bronchoalveolar Lavage
Bronchoscopy
Humans
Critical Care
Intensive Care Units
Klebsiella
Methicillin-Resistant Staphylococcus aureus
Pneumonia
Pneumonia, Ventilator-Associated
Stenotrophomonas maltophilia
Anti-Bacterial Agents

Figure

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  Figure 1 Contribution of prior microbiologic respiratory specimensn to identification of causative microorganisms in VAP. Black bars correspond to 54 episodes for which prior respiratory specimen was obtained before VAP onset. VAP: ventilator-associated pneumonia.

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  Figure 2 Pre-VAP had been obtained within 5 d was the more identical than it had been obtained greater than 5 d (43.6% vs. 13.3%, p=0.037). VAP: ventilator-associated pneumonia; BAL: bronchoalveolar lavage.

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