TY - JOUR
TI - Both early-onset and late-onset ventilator-associated pneumonia are
caused mainly by potentially multiresistant bacteria
AU - Giantsou, E
AU - Liratzopoulos, N
AU - Efraimidou, E
AU - Panopoulou, M and
AU - Alepopoulou, E
AU - Kartali-Ktenidou, S
AU - Minopoulos, GI and
AU - Zakynthinos, S
AU - Manolas, KI
JO - Intensive Care Medicine Experimental
PY - 2005
VL - 31
TODO - 11
SP - 1488-1494
PB - Springer-Verlag
SN - 2197-425X
TODO - 10.1007/s00134-005-2697-y
TODO - ventilator-associated pneumonia; resistant bacteria; mechanical
ventilation; bronchoalveolar lavage
TODO - Objective: To compare the causative pathogens of early-onset and
late-onset ventilator-associated pneumonia (VAP) diagnosed by
bronchoalveolar lavage quantitative cultures. Most previous reports have
been based on endotracheal aspirate cultures and gave uncertain
findings. Design: Prospective evaluation of consecutive patients with
clinical suspicion for VAP. Setting: Multidisciplinary intensive care
unit of a university hospital. Patients and participants: During a
3-year period 473 patients with clinical suspicion of VAP entered the
study. Diagnosis of VAP was confirmed by cultures of bronchoalveolar
lavage (>10(4) cfu/ml) specimens in 408 patients. Interventions:
Protected bronchoalveolar lavage samples were taken. Initial antibiotic
therapy was modified upon bronchoalveolar lavage culture results.
Measurements and results: Among 408 patients 191 had early-onset (<7
days mechanical ventilation) and 217 late-onset (>= 7 days) VAP.
Potentially multiresistant bacteria, mainly Pseudomonas aeruginosa and
methicillin-resistant Staphylococcus aureus (MRSA), were the most
commonly isolated pathogens in both types of VAP. No difference was
noted in the contribution of potentially multiresistant pathogens (79%
vs. 85%), P. aeruginosa (42% vs. 47%), or MRSA (33% vs. 30%)
between early-onset and late-onset VAP. Initial antibiotic therapy was
modified in 58% of early-onset VAP episodes and in 36% of late-onset
VAP episodes. No difference in mortality was found between the two types
of VAP. Conclusions: Both early-onset and late-onset VAP were mainly
caused by potentially multiresistant bacteria, most commonly P.
aeruginosa and MRSA. Antimicrobial agents against these pathogens should
be prescribed empirically, at least in our institution.
ER -