Autori: Alketa-Theodora Spyrou
Ustanova zaposlenja: GREECE
Ključne riječi: infection in Coronary Care Unit, tracheobronchial colonization, risk factors for ventilator-associated pneumonia
Kongres/Simpozij: ”5. Međunarodni kongres HDMSARIST-a” i ”8. Međunarodni kongres WFCCN-a”
Mjesto i vrijeme održavanja: Šibenik, 12.-15. travnja 2012. godine
Most oral bacteria are considered to be part of patients’ normal flora. These
organisms may colonize different surfaces in the mouth and tracheobronchial
tree. Tracheobronchial tree colonization is considered an important risk factor
for the development of ventilator-associated pneumonia (VAP). The aim of the
present study was 1) to identify the risk factors for colonization with
potentially pathogen microorganism (PPM). 2) to determine the incidence of PPM
of patients who were admitted in our Cardiac Care Unit (CCU).
Methods: The study was conducted in the CCU in a tertiary care hospital from January 2009 to December 2010. All patients were intubated and lacked clinical evidence of pneumonia at the time of enrollment of the study. Cultures of bronchial excretions using tracheal aspirates were taken the first 24h of intubation and before extubation, in a total of 39 CCU patients (mean age 68.7±11.9yrs, 79,6% men). Risk factors for colonization, including APACHE II score, Clinical Pulmonary Infection Score (CPIS), placement of an invasive device as well as the duration of mechanical ventilation (MV), were recorded. Predictors of colonization were examined with univariate and multivariate analysis.
Results: A total of 39 patients were evaluated (mean age, 67.8 ±11.9 years). Thirty patients (76,9%) were men. The average duration of MV was 7 (5-11) days. The mean APACHE II score of the entire study population was 19,3±2,3, and the mean CPIS was 3,7±1,3. The patients had been admitted to the CCU because of Heart failure (n=18), AMI (n=13) and Arrhythmia (n=9).Table 1. Seven (17,9%)of the patients were colonized by potential pathogens in their lower airways during the first 24h of intubation. 14 patients (35.9%) did not have tracheal colonization before extubation, and the rest 18(46,2%) were colonized by potential pathogens microorganism before the day of extubation. The most frequently isolated organisms were Acineτobacter spp.(24%), methicillin resistant Staphylococcus aureus (24%), methicillin sensitive Staphylococcus aureus(16%), Escherichia coli(12%), Candida albicans(12%), Enterobacter spp.(8%), Serratia marcescens (4%)(Graph 1,2). Two (5,2%) of the patients that didn’t have initial colonization, developed VAP during the study period . Risk factors for colonization with potential pathogens in bronchial excretions was found to be; Duration of stay in CCU (p< 0.001); Intubated for >96h (p=0.010); Duration of ΙΑΒP (p= 0,009); Duration of Central Venus Catheter (p= 0,004); Duration of enteric nutrition (p= 0,048) and Presence of sedation for >96 h (p=0.010). (Table2).
Conclusion: In our study, two of 18 patients with tracheal colonization had VAP, compared to none of 14 patients who did not have tracheal colonization. These data support those of other authors who have found that tracheal colonization precedes pulmonary infection. On the other hand, the presence of tracheal colonization by itself does not appear to be a unique condition for VAP to occur, in as much as only a minority of patients with colonization has VAP diagnosed. The knowledge of risk factors for colonization of lower airways in cardiologic patients is necessary in order to develop strategies for prevention or interrupting colonization by potential pathogens.