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Management of ventilator-associated pneumonia in a multidisciplinary intensive care unit: does trauma make a
Kemal Agbaht1, Thiago Lisboa, Angel Pobo
1CIBER - Enfermedades Respiratorias, University of Rovira & Virgili, Critical Care Department, Joan XXIII University Hospital, Institut Pere Virgili, Carrer Dr. Mallafre Guasch 4, 43007 Tarragona, Spain.
Objective:
Antibiotic exposure and timing of pneumonia onset influence ventilator-associated pneumonia (VAP) isolates. The first goal of this investigation was to evaluate whether trauma also influences prevalence of microorganisms.
Design:
A retrospective, single-center, observational cohort study.
Setting:
Multidisciplinary teaching ICU.
Patients:
Adult patients requiring mechanical ventilation identified as having VAP.
Interventions:
Retrospective evaluation of a prospective manual database.
Measurements And Main Results:
VAP isolates in a multidisciplinary ICU documented by quantitative respiratory cultures and recorded in a 42-month database were compared, based on the presence or absence of trauma. Causative microorganisms were classified in four groups, based on mechanical ventilation duration (> 5 days), and previous antibiotic exposure. One hundred eighty-three patients developed 196 episodes of VAP (98 trauma). Methicillin-sensitive Staphylococcus aureus (MSSA) was more frequent (34.5% vs. 11.5%, p < 0.01) in trauma, whereas methicillin-resistant Staphylococcus aureus (MRSA) was more frequent (2% vs. 11.5%, p < 0.01) in non-trauma. No significant differences were found between trauma and non-trauma patients regarding prevalence of other microorganisms. In trauma patients, MSSA episodes were equally distributed between early- and late-onset VAP (51% vs. 49%), but no MRSA episode occurred in the early-onset group.
Conclusions:
Trauma influences the microbiology of pneumonia and it should be considered in the initial antibiotic regimen choice. Our data demonstrate that patients with trauma had a higher prevalence of MSSA, but the overall prevalence was sufficiently high to warrant S. aureus coverage for both groups. On the other hand, since no MRSA was isolated during the first 10 days of mechanical ventilation on trauma patients, MRSA coverage in these patients becomes necessary only 10 days after admission.
Insights
Trauma influences the types of bacteria causing ventilator-associated pneumonia (VAP). Trauma patients had more methicillin-sensitive Staphylococcus aureus (MSSA), while non-trauma patients had more methicillin-resistant Staphylococcus aureus (MRSA).
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) is a significant complication in intensive care units.
- The causative microorganisms in VAP are influenced by factors such as antibiotic exposure and timing of onset.
- The impact of trauma on VAP microbiology remains less understood.
Purpose of the Study:
- To investigate the influence of trauma on the prevalence of microorganisms causing VAP.
- To compare VAP isolates between trauma and non-trauma patient cohorts.
- To inform antibiotic selection for VAP in trauma patients.
Main Methods:
- Retrospective, single-center, observational cohort study.
- Analysis of a 42-month database of adult patients with VAP requiring mechanical ventilation.
- Comparison of VAP isolates based on the presence or absence of trauma, mechanical ventilation duration, and prior antibiotic exposure.
Main Results:
- Methicillin-sensitive Staphylococcus aureus (MSSA) was significantly more frequent in trauma patients (34.5%) compared to non-trauma patients (11.5%).
- Methicillin-resistant Staphylococcus aureus (MRSA) was significantly more frequent in non-trauma patients (11.5%) compared to trauma patients (2%).
- No significant differences in other microorganisms were observed; MSSA was equally distributed in early- and late-onset VAP in trauma patients, with no early-onset MRSA.
Conclusions:
- Trauma significantly influences the microbiology of VAP, with a higher prevalence of MSSA in trauma patients.
- Initial antibiotic regimens for VAP should consider the potential for MSSA in trauma patients.
- MRSA coverage may be deferred in trauma patients until after 10 days of mechanical ventilation, as no early-onset MRSA was observed in this group.
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