[Ventilator-associated pneumonia: follow the guidelines!]
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B Jung1, M Sebbane, G Chanques
1Unité de réanimation et de transplantation, département d'anesthésie-réanimation B, CHU de Montpellier, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
Objectives:
To compare the clinical outcomes and the causative pathogens of early-onset and late-onset ventilator-associated pneumonia (VAP) diagnosed by bronchoalveolar lavage (BAL).
Study Design:
Prospective, observational, epidemiological study.
Patients And Methods:
During a 7-years period, all first episodes of VAP were prospectively included. Diagnosis was confirmed by a BAL with a threshold of 10(4) cfu/ml. Late-onset pneumonia was defined if occurred after the seventh day after mechanical ventilation.
Results:
One hundred and thirteen VAP were studied. Fifty were early-onsets and 63 late-onsets. Thirty-four per cent of early-onset VAP and 73% of late-onset VAP were due to potential multiresistants pathogens. Pseudomonas aeruginosa was the most commonly isolated bacteria both in early-onset and late-onset VAP (16 and 39% respectively). Morbidity and mortality (29 vs 29%, ns) were not statically different between the two groups (early-onset and late-onset VAP).
Conclusion:
In our study, both early-onset and late-onset VAP were mainly caused by potentially multiresistants bacteria, most commonly Gram negative bacilli. Even for early VAP, clinicians should be aware about all risk factors for potentially multiresistants pathogens and not only the delay of onset of the VAP episode.
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