Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients.

This study assessed the incidence, etiology, and consequences of ventilator-associated pneumonia in 1,000 consecutive patients admitted in a medical-surgical intensive care unit (ICU). A total of 264 patients were submitted to mechanical ventilation (MV) for more than 48 hours. Fifty-eight (21.9 percent) patients developed a bacterial pneumonia after a mean of 7.9 days (range, 2 to 40 days) of MV. In addition, they were ten superinfections in nine patients, raising the mean incidence to 25.7 percent. Five patients developed secondary bacteremia, and another five had septic shock. Identification of the causative agent of pneumonia was possible in 47 episodes by means of highly specific techniques (telescoping plugged catheter, blood cultures, and/or necropsy). Thirteen (27.6 percent) of these cases were polymicrobial. The predominant pathogens isolated in the first episode of pneumonia were Gram-negative bacilli (62.6 percent), but a high incidence of Staphylococcus aureus infection (23.2 percent) was detected. Gram-negative bacilli represented 66.6 percent of the total organisms isolated in superinfections. The mortality rate in the pneumonia group was 42 percent; this percentage is similar to mortality rate among MV patients without pneumonia (37 percent). We conclude that nosocomial pneumonia is a frequent complication of MV in the medical-surgical ICU. Ventilator-associated pneumonia does not appear to increase fatality in critically ill patients with a high mortality rate (38 percent); however, it significantly prolongs the length of stay in the ICU for survivors.

[1]  Henry D. Isenberg,et al.  Manual of Clinical Microbiology , 1991 .

[2]  J. Rello,et al.  Risk factors for Staphylococcus aureus nosocomial pneumonia in critically ill patients. , 1990, The American review of respiratory disease.

[3]  R. Rodríguez-Roisín,et al.  Incidence and etiology of pneumonia acquired during mechanical ventilation. , 1989, Critical care medicine.

[4]  W. Zimmerli,et al.  Role of gastric colonization in nosocomial infections and endotoxemia: a prospective study in neurosurgical patients on mechanical ventilation. , 1989, The Journal of infectious diseases.

[5]  V. Yu,et al.  Antibiotic studies in pneumonia. Pitfalls in interpretation and suggested soluions. , 1989, Chest.

[6]  M. Mandelli,et al.  Long-term Respiratory Support and Risk of Pneumonia in Critically III Patients , 1989 .

[7]  R. Rodríguez-Roisín,et al.  Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. , 1989, The American review of respiratory disease.

[8]  R. Woolson,et al.  Hospital-acquired pneumonia. Attributable mortality and morbidity. , 1989, American journal of epidemiology.

[9]  A. Torres,et al.  Pulmonary infiltrates in immunocompromised patients. Diagnostic value of telescoping plugged catheter and bronchoalveolar lavage. , 1989, Chest.

[10]  M. Niederman,et al.  Patterns and routes of tracheobronchial colonization in mechanically ventilated patients. The role of nutritional status in colonization of the lower airway by Pseudomonas species. , 1989, Chest.

[11]  J. Chastre,et al.  Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation: comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. , 1988, The American journal of medicine.

[12]  M. Guiguet,et al.  Detection of nosocomial lung infection in ventilated patients. Use of a protected specimen brush and quantitative culture techniques in 147 patients. , 1988, The American review of respiratory disease.

[13]  R. Rodríguez-Roisín,et al.  Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter. , 1988, The American review of respiratory disease.

[14]  J. Coalson,et al.  Bacteriologic diagnosis of nosocomial pneumonia following prolonged mechanical ventilation. , 1988, The American review of respiratory disease.

[15]  R. Rodríguez-Roisín,et al.  Nosocomial pneumonia. A multivariate analysis of risk and prognosis. , 1988, Chest.

[16]  B. Celli,et al.  Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. , 1987, The New England journal of medicine.

[17]  A. Esteban,et al.  ICU pneumonias: a multi-institutional study. , 1987, Critical care medicine.

[18]  K. Miller,et al.  Protected transbronchial needle aspiration and protected specimen brush in the diagnosis of pneumonia. , 1987, The American review of respiratory disease.

[19]  R. Baughman,et al.  Bronchoalveolar lavage for diagnosing acute bacterial pneumonia. , 1987, The Journal of infectious diseases.

[20]  Jeffrey M. Jones,et al.  Diagnosing bacterial respiratory infection by bronchoalveolar lavage. , 1987, The Journal of infectious diseases.

[21]  D. Zandstra,et al.  The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. , 1987, The Journal of trauma.

[22]  D. Craven,et al.  Nosocomial pneumonia in the intubated patient. , 1987, Seminars in respiratory infections.

[23]  M. Lederman,et al.  Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. , 1987, The American review of respiratory disease.

[24]  R. Baughman,et al.  Use of the protected specimen brush in patients with endotracheal or tracheostomy tubes. , 1987, Chest.

[25]  W. Johanson,et al.  Incidence, site, and outcome of infections in patients with the adult respiratory distress syndrome. , 1986, The American review of respiratory disease.

[26]  B. Make,et al.  Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. , 1986, The American review of respiratory disease.

[27]  D. Villers,et al.  Reliability of the bronchoscopic protected catheter brush in intubated and ventilated patients. , 1985, Chest.

[28]  P. Torzillo,et al.  Use of protected telescoping brush system in the management of bacterial pulmonary infection in intubated patients. , 1985, British journal of diseases of the chest.

[29]  M. Dauge,et al.  Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients. , 1984, The American review of respiratory disease.

[30]  A. Zucker,et al.  Blind use of the double‐lumen plugged catheter for diagnosis of respiratory tract infections in critically ill children , 1984, Critical care medicine.

[31]  D. Stover,et al.  Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. , 1984, Annals of internal medicine.

[32]  J. Hopkin,et al.  Pulmonary infiltrates in immunocompromised patients: diagnosis by cytological examination of bronchoalveolar lavage fluid. , 1984, Journal of clinical pathology.

[33]  C. Thomas,et al.  The use of quantitative cultures and antibody coating of bacteria to diagnose bacterial pneumonia by fiberoptic bronchoscopy. , 2015, The American review of respiratory disease.

[34]  M. A. de la Cal,et al.  Radiographic findings for the adult respiratory distress syndrome in patients with peritonitis. , 1983, Critical care medicine.

[35]  P. Legrand,et al.  The telescoping plugged catheter in suspected anaerobic infections. A controlled series. , 1983, The American review of respiratory disease.

[36]  J. Bass,et al.  Diagnosis of bacterial pulmonary infections with quantitative protected catheter cultures obtained during bronchoscopy , 1983, Journal of clinical microbiology.

[37]  R. Kronenberg,et al.  The value of bronchoscopy in establishing the etiology of pneumonia in renal transplant recipients. , 1982, The American review of respiratory disease.

[38]  P. Wiernik,et al.  A comparative evaluation of two fiberoptic bronchoscopy catheters: the plugged telescoping catheter versus the single sheathed nonplugged catheter. , 1982, The American review of respiratory disease.

[39]  J. Bass,et al.  Use of a bronchoscopic protected catheter brush for the diagnosis of pulmonary infections. , 1982, Chest.

[40]  A. Lisbon,et al.  ASPIRATION OF GASTRIC BACTERIA IN ANTACID-TREATED PATIENTS: A FREQUENT CAUSE OF POSTOPERATIVE COLONISATION OF THE AIRWAY , 1982, The Lancet.

[41]  G. Schild,et al.  IDENTIFICATION OF THE ORIGIN OF POLIOVIRUS ISOLATES Report of World Health Organisation informal meetings 1979-80 , 1981, The Lancet.

[42]  P. Edelstein.  Improved semiselective medium for isolation of Legionella pneumophila from contaminated clinical and environmental specimens , 1981, Journal of clinical microbiology.

[43]  F. Espersen,et al.  Pneumonia due to Staphylococcus aureus during mechanical ventilation. , 1981, The Journal of infectious diseases.

[44]  D. Zavala,et al.  Ultrathin needle aspiration of the lung in infectious and malignant disease. , 1981, The American review of respiratory disease.

[45]  J. Bartlett,et al.  A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. , 2015, The American review of respiratory disease.

[46]  D. White,et al.  STOMACH AS SOURCE OF BACTERIA COLONISING RESPIRATORY TRACT DURING ARTIFICIAL VENTILATION , 1978, The Lancet.

[47]  J. Bartlett,et al.  Should fiberoptic bronchoscopy aspirates be cultured? , 2015, The American review of respiratory disease.

[48]  J. Graybill,et al.  Nosocomial pneumonia. A continuing major problem. , 1973, The American review of respiratory disease.

[49]  G. D. Thomas,et al.  Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. , 1972, Annals of internal medicine.

[50]  G. Jackson,et al.  Gram-Negative Bacteremia: I. Etiology and Ecology , 1962 .

[51]  Yasargil Ec.  Prescribing in General Practice , 1899 .