Tuberculosis and Respiratory Diseases

  • 제72권1호
  • /
  • Pages.30-36
  • /
  • 2012
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
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인공호흡기연관 폐렴의 경험적 항생제 선택 시 이전 호흡기검체의 유용성

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

  • 김지혜 (건양대학교 의과대학 내과학교실) ;
  • 윤성철 (건양대학교 의과대학 내과학교실) ;
  • 이유미 (건양대학교 의과대학 내과학교실) ;
  • 손지웅 (건양대학교 의과대학 내과학교실) ;
  • 최유진 (건양대학교 의과대학 내과학교실) ;
  • 나문준 (건양대학교 의과대학 내과학교실) ;
  • 권선중 (건양대학교 의과대학 내과학교실)
  • Kim, Ji-Hye (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Yoon, Sung-Chul (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Lee, Yu-Mi (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Son, Ji-Woong (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Choi, Eu-Gene (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Na, Moon-Jun (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kwon, Sun-Jung (Department of Internal Medicine, Konyang University College of Medicine)
  • 투고 : 2011.08.22
  • 심사 : 2011.11.18
  • 발행 : 2012.01.30
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초록

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.

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참고문헌

  1. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992-April 2000, issued June 2000. Am J Infect Control 2000;28: 429-48.
  2. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-92.
  3. Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996;275: 866-9.
  4. Papazian L, Bregeon F, Thirion X, Gregoire R, Saux P, Denis JP, et al. Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:91-7.
  5. Rello J, Quintana E, Ausina V, Castella J, Luquin M, Net A, et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 1991;100:439-44.
  6. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 2002;122:262-8.
  7. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.
  8. Bouza E, Perez A, Munoz P, Jesus Perez M, Rincon C, Sanchez C, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med 2003;31:1964-70.
  9. Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia: role of colonizers and value of routine endotracheal aspirate cultures. Int J Infect Dis 2010;14:e723-9.
  10. Jung B, Sebbane M, Chanques G, Courouble P, Verzilli D, Perrigault PF, et al. Previous endotracheal aspirate allows guiding the initial treatment of ventilator-associated pneumonia. Intensive Care Med 2009;35:101-7.
  11. Sanders KM, Adhikari NK, Friedrich JO, Day A, Jiang X, Heyland D, et al. Previous cultures are not clinically useful for guiding empiric antibiotics in suspected ventilator- associated pneumonia: secondary analysis from a randomized trial. J Crit Care 2008;23:58-63.
  12. Michel F, Franceschini B, Berger P, Arnal JM, Gainnier M, SaintyJM, et al. Early antibiotic treatment for BAL- confirmed ventilator-associated pneumonia: a role for routine endotracheal aspirate cultures. Chest 2005;127:589-97.
  13. Hayon J, Figliolini C, Combes A, Trouillet JL, Kassis N, Dombret MC, et al. Role of serial routine microbiologic culture results in the initial management of venti lator-associated pneumonia. Am J Respir Crit Care Med 2002;165:41-6.
  14. Lucet JC, Decré D, Fichelle A, Joly-Guillou ML, Pernet M, Deblangy C, et al. Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing enterobacteriaceae in a university hospital. Clin Infect Dis 1999;29:1411-8.
  15. Meduri GU, Chastre J. The standardization of bronchoscopic techniques for ventilator-associated pneumonia. Chest 1992;102(5 Suppl 1):557S-564S.
  16. Delclaux C, Roupie E, Blot F, Brochard L, Lemaire F, Brun-Buisson C. Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome: incidence and diagnosis. Am J Respir Crit Care Med 1997;156:1092-8.
  17. Sirvent JM, Torres A, Vidaur L, Armengol J, de Batlle J, Bonet A. Tracheal colonisation within 24 h of intubation in patients with head trauma: risk factor for developing early-onset ventilator-associated pneumonia. Intensive Care Med 2000;26:1369-72.
  18. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med 1996;153:1711-25.
  19. Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med 1999;159:1249-56.
  20. Garnacho-Montero J, Ortiz-Leyba C, Fernández- Hinojosa E, Aldabó-Pallás T, Cayuela A, Marquez-Vácaro JA, et al. Acinetobacter baumannii ventilator-associated pneumonia: epidemiological and clinical findings. Intensive Care Med 2005;31:649-55.
  21. Rahal JJ, Urban C, Horn D, Freeman K, Segal-Maurer S, Maurer J, et al. Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA 1998;280:1233-7.
  22. rouillet JL, Chastre J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998;157:531-9.
  23. Kollef MH, Fraser VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med 2001;134:298-314.