Ventilator-associated Pneumonia caused by commensal oropharyngeal a retrospective Analysis of a prospectively collected Database

BMC Pulmonary Medicine

Walther N. K. A. van Mook⁴  Paul M. H. J. Roekaerts¹  Paul H. M. Savelkoul⁴  Dennis C. J. J. Bergmans⁴  Helke A. van Dessel¹  Catharina F. M. Linssen³  Johan I. M. van der Velde⁴  Johannes B. J. Scholte² 

[1] Department of Medical Microbiology, Maastricht University Medical Centre+, P.O. box 5800, Maastricht, 6202 AZ, The Netherlands;Department of Intensive Care Medicine, Luzerner Kantonspital, Luzern 16, 6000, Switzerland;Department of Medical Microbiology, Atrium Medical Centre, P.O. box 4446, Heerlen, 6401 CX, The Netherlands;Department of Intensive Care Medicine, Maastricht University Medical Centre+, P.O. box 5800, Maastricht, 6202 AZ, The Netherlands

关键词: MALDI-TOF-MS;    Intensive care unit;    Commensal oropharyngeal flora;    Bronchoalveolar lavage;    Ventilator-associated pneumonia;   

Others  :  1222561
DOI  :  10.1186/s12890-015-0087-y

 received in 2015-03-07, accepted in 2015-07-30,  发布年份 2015

【 摘 要 】

Background

The significance of commensal oropharyngeal flora (COF) as a potential cause of ventilator-associated pneumonia (VAP) is scarcely investigated and consequently unknown. Therefore, the aim of this study was to explore whether COF may cause VAP.

Methods

Retrospective clinical, microbiological and radiographic analysis of all prospectively collected suspected VAP cases in which bronchoalveolar lavage fluid exclusively yielded ≥ 10 ⁴  cfu/ml COF during a 9.5-year period. Characteristics of 899 recent intensive care unit (ICU) admissions were used as a reference population.

Results

Out of the prospectively collected database containing 159 VAP cases, 23 patients were included. In these patients, VAP developed after a median of 8 days of mechanical ventilation. The patients faced a prolonged total ICU length of stay (35 days [P < .001]), hospital length of stay (45 days [P = .001]), and a trend to higher mortality (39 % vs. 26 %, [P = .158]; standardized mortality ratio 1.26 vs. 0.77, [P = .137]) compared to the reference population. After clinical, microbiological and radiographic analysis, COF was the most likely cause of respiratory deterioration in 15 patients (9.4 % of all VAP cases) and a possible cause in 2 patients.

Conclusion

Commensal oropharyngeal flora appears to be a potential cause of VAP in limited numbers of ICU patients as is probably associated with an increased length of stay in both ICU and hospital. As COF-VAP develops late in the course of ICU admission, it is possibly associated with the immunocompromised status of ICU patients.

【 授权许可】

   
2015 Scholte et al.

【 图 表 】

Fig. 1.

Fig. 2.

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