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Bronchopulmonary superinfections in the critically ill
Abstract:
Bacterial colonization of the airways can lead to nosocomial respiratory infections. The emergence of Gram-negative bacteria in the upper airways is usual in critical conditions. Antimicrobial therapy and especially bacterial adherence to the airways mucosa have been incriminated in the selection of Gram-negative bacteria becoming ultimately multiresistant. Transmission of bacteria by the hands of the ICU-personnel and aspiration of bacteria represent two important factors in the airway colonization. Bacterial clearance can simultaneously be impaired by debility and altered mental state. Pulmonary infections are especially common in peritonitis or after abdominal surgery. In a series of 30 patients who had a complicated course after abdominal surgery, we observed that in all patients with acute respiratory failure, sputum cultus yielded at least one microorganism also recovered from cultus of the abdominal secretions. Acute respiratory failure was most commonly due to respiratory infection and carried a worse prognosis. Aspiration of bacteria from the gastrointestinal tract appears to represent the most common source of nosocomial bronchopulmonary superinfection in the critically ill.
Insights
Critically ill patients often develop airway infections from Gram-negative bacteria. Aspiration of gastrointestinal bacteria is a primary cause of these nosocomial bronchopulmonary infections, leading to worse outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Nosocomial respiratory infections are common in critically ill patients.
- Gram-negative bacteria frequently colonize the airways, contributing to multidrug resistance.
- Factors like antimicrobial therapy, bacterial adherence, and impaired clearance facilitate colonization.
Purpose of the Study:
- To investigate the source of nosocomial bronchopulmonary superinfections in critically ill patients.
- To determine the relationship between abdominal secretions and respiratory infections post-abdominal surgery.
Main Methods:
- A series of 30 patients with complicated courses after abdominal surgery were studied.
- Sputum and abdominal secretion cultures were performed.
- Microorganisms from sputum were compared with those from abdominal secretions.
Main Results:
- All patients with acute respiratory failure had at least one microorganism in sputum also found in abdominal secretions.
- Acute respiratory failure was primarily attributed to respiratory infection.
- Respiratory infection in this context was associated with a poorer prognosis.
Conclusions:
- Aspiration of bacteria from the gastrointestinal tract is the most frequent source of nosocomial bronchopulmonary superinfections in the critically ill.
- Early identification and management of gastrointestinal-to-pulmonary bacterial translocation are crucial.
- Understanding bacterial sources aids in preventing and treating severe respiratory infections in intensive care units.