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Updated: Aug 16, 2026
Studying Microbial Communities In Vivo: A Model of Host-mediated Interaction Between Candida Albicans and Pseudomonas Aeruginosa in the Airways
Published on: January 13, 2016
Microbial airway colonization is associated with noninvasive ventilation failure in exacerbation of chronic
Miquel Ferrer1, Malina Ioanas, Francisco Arancibia
1Servei de Pneumologia, Unitat de Cures Intensives i Intermèdies, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. miferrer@clinic.ub.es
Objective:
Abnormal airway colonization in patients with chronic obstructive pulmonary disease (COPD) needing invasive mechanical ventilation (IMV) is considered a first step in the acquisition of nosocomial pneumonia. Noninvasive ventilation (NIV) could potentially avoid this, but airway colonization has not been studied in patients who undergo NIV. We hypothesized that patients undergoing NIV would have lower rates of colonization than patients undergoing IMV. The aim of the study was to assess the microbial airway colonization in patients with exacerbated COPD needing NIV and IMV.
Design:
A 2-yr prospective cohort study.
Setting:
Respiratory intensive and intermediate care unit.
Patients:
Eighty-six patients with exacerbated COPD undergoing NIV on admission (64 successes and 22 failures, according to subsequent intubation), and 51 patients undergoing IMV on admission.
Interventions:
Quantitative culture specimens of sputum or tracheal aspirate were collected on admission and at follow-up (day 3) during NIV or IMV, respectively. Clinical assessment, including severity scores, and arterial blood gas measurements were also determined.
Measurements And Main Results:
Compared with the NIV-success group, colonization by potentially pathogenic microorganisms was greater in the NIV-failure group on admission (13 [59%] vs. 14 [22%]; p < .001) and at follow-up while patients still underwent NIV (14 [93%] vs. 7 [14%]; p < .001), and it was even higher than during IMV at follow-up (20 [50%]; p = .027). Colonization by nonfermenting Gram-negative bacilli, mainly Pseudomonas aeruginosa, was significantly associated with NIV failure on admission (OR, 5.6; p = .016) and at follow-up (OR, 23.5; p < .001). Moreover, colonization by these microorganisms at follow-up (OR, 8.8; p = .008) and inadequate antimicrobial treatment (OR 11.3; p = .001) were associated with increased hospital mortality.
Conclusions:
Airway colonization by nonfermenting Gram-negative bacilli is strongly associated with NIV failure. Because it occurs before intubation, this would be a marker rather than just a consequence of NIV failure necessitating intubation. The efficacy of decreasing airway colonization in preventing NIV failure needs to be assessed.
Insights
Airway colonization by specific bacteria is linked to noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients. This colonization may predict the need for invasive mechanical ventilation (IMV).
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Diseases
Background:
- Abnormal airway colonization in chronic obstructive pulmonary disease (COPD) patients requiring invasive mechanical ventilation (IMV) is a precursor to nosocomial pneumonia.
- Noninvasive ventilation (NIV) may prevent this, but its impact on airway colonization is not well-studied.
Purpose of the Study:
- To assess and compare microbial airway colonization in patients with exacerbated COPD undergoing NIV versus IMV.
- To test the hypothesis that NIV patients exhibit lower colonization rates than IMV patients.
Main Methods:
- A 2-year prospective cohort study involving 86 patients on NIV and 51 on IMV in a respiratory intensive care unit.
- Quantitative sputum or tracheal aspirate cultures were collected on admission and at day 3 follow-up.
- Clinical assessments, severity scores, and arterial blood gas measurements were also performed.
Main Results:
- Higher potentially pathogenic microorganism colonization was observed in NIV failure patients compared to NIV success and IMV groups, particularly at follow-up.
- Colonization by nonfermenting Gram-negative bacilli, including Pseudomonas aeruginosa, significantly correlated with NIV failure.
- Follow-up colonization and inadequate antimicrobial treatment were associated with increased hospital mortality.
Conclusions:
- Airway colonization by nonfermenting Gram-negative bacilli is a strong predictor of NIV failure in exacerbated COPD.
- This colonization appears to be a marker preceding the need for intubation, rather than solely a consequence.
- Further research is needed to evaluate the effectiveness of reducing airway colonization in preventing NIV failure.
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