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Uncertain relevance of gastric colonization in the seriously ill
J F Cade1, E McOwat, R Siganporia
1Intensive Care Unit, Royal Melbourne Hospital, Victoria, Australia.
Abstract:
We have studied the temporal relationship for the same micro-organisms between gastric colonization and both nasopharyngeal colonization and major clinical infections in 100 consecutive, long-stay, intensive care patients. 67% of patients developed positive gastric cultures, mainly with aerobic Gram-negative bacilli and C. albicans; 33% developed positive nasopharyngeal cultures with similar organisms, but in only 8% was the same organism previously cultured from the stomach; 48% of patients developed infections, mainly respiratory, but commonly with different organisms. The presence of a positive gastric culture was not associated with gastric pH, bleeding, severity of illness, or mortality. The results fail to confirm that an ascending migration of organisms from the stomach is.frequent or that there is a relationship between gastric colonization and clinical infections. Firm therapeutic recommendation in these areas may be premature.
Insights
Gastric colonization by microorganisms did not correlate with nasopharyngeal colonization or clinical infections in intensive care patients. Findings suggest a weak link between stomach colonization and subsequent infections, questioning therapeutic recommendations.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Gastric colonization is common in intensive care unit (ICU) patients.
- The relationship between gastric colonization and subsequent nasopharyngeal colonization or clinical infections remains unclear.
Purpose of the Study:
- To investigate the temporal relationship between gastric colonization and nasopharyngeal colonization.
- To determine the association between gastric colonization and the development of major clinical infections in ICU patients.
Main Methods:
- Prospective study of 100 consecutive, long-stay ICU patients.
- Regular gastric and nasopharyngeal cultures were performed.
- Clinical infections were monitored throughout the study period.
Main Results:
- 67% of patients had positive gastric cultures (aerobic Gram-negative bacilli, C. albicans).
- 48% developed clinical infections, often with different organisms than those found in the stomach.
- No association was found between gastric colonization and gastric pH, bleeding, illness severity, or mortality.
Conclusions:
- Ascending migration of organisms from the stomach does not appear to be a frequent cause of infection in ICU patients.
- A direct relationship between gastric colonization and clinical infections was not confirmed.
- Therapeutic recommendations targeting gastric colonization in this context may be premature.