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Author Spotlight: Diatom Testing for Forensic Drowning Examination
Published on: November 10, 2023
Microbiological features of drowning-associated pneumonia: a systematic review and meta-analysis
Vladimir L Cousin1, Laure F Pittet2
1Intensive Care Unit, Department of Pediatric, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland. Vladimir.Cousin@hcuge.ch.
Background:
Drowning-associated pneumonia (DAP) is frequent in drowned patients, and possibly increases mortality. A better understanding of the microorganisms causing DAP could improve the adequacy of empirical antimicrobial therapy. We aimed to describe the pooled prevalence of DAP, the microorganisms involved, and the impact of DAP on drowned patients.
Methods:
Systematic review and meta-analysis of studies published between 01/2000 and 07/2023 reporting on DAP occurrence and microorganisms involved.
Results:
Of 309 unique articles screened, 6 were included, involving 688 patients. All were retrospective cohort studies, with a number of patients ranging from 37 to 270. Studies were conducted in Europe (France N = 3 and Netherland N = 1), United States of America (N = 1) and French West Indies (N = 1). Mortality ranged between 18 to 81%. The pooled prevalence of DAP was 39% (95%CI 29-48), similarly following freshwater (pooled prevalence 44%, 95%CI 36-52) or seawater drowning (pooled prevalence 42%, 95%CI 32-53). DAP did not significantly impact mortality (pooled odds ratio 1.43, 95%CI 0.56-3.67) but this estimation was based on two studies only. Respiratory samplings isolated 171 microorganisms, mostly Gram negative (98/171, 57%) and mainly Aeromonas sp. (20/171, 12%). Gram positive microorganisms represented 38/171 (22%) isolates, mainly Staphylococcus aureus (21/171, 12%). Water salinity levels had a limited impact on the distribution of microorganisms, except for Aeromonas sp. who were exclusively found following freshwater drowning (19/106, 18%) and never following seawater drowning (0%) (p = 0.001). No studies reported multidrug-resistant organisms but nearly 30% of the isolated microorganisms were resistant to amoxicillin-clavulanate, the drug that was the most commonly prescribed empirically for DAP.
Conclusions:
DAP are commonly caused by Gram-negative bacteria, especially Aeromonas sp. which is exclusively isolated following freshwater drowning. Empirical antimicrobial therapy should consider covering them, noting than amoxicillin-clavulanate may be inadequate in about one-third of the cases. The impact of DAP on patients' outcome is still unclear.
Insights
Drowning-associated pneumonia (DAP) affects 39% of patients and is often caused by Gram-negative bacteria like Aeromonas sp. Amoxicillin-clavulanate may be ineffective against nearly a third of these pathogens.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Drowning-associated pneumonia (DAP) is a frequent complication in drowned patients, potentially increasing mortality.
- Understanding the causative microorganisms is crucial for optimizing empirical antimicrobial therapy.
Purpose of the Study:
- To determine the pooled prevalence of DAP.
- To identify the microorganisms involved in DAP.
- To assess the impact of DAP on patient outcomes.
Main Methods:
- Systematic review and meta-analysis of studies published between January 2000 and July 2023.
- Included 6 retrospective cohort studies involving 688 patients.
Main Results:
- The pooled prevalence of DAP was 39%, with similar rates for freshwater (44%) and seawater (42%) drowning.
- Gram-negative bacteria (57%) were predominant, notably Aeromonas sp. (12%), exclusively found in freshwater drowning.
- Nearly 30% of isolated microorganisms showed resistance to amoxicillin-clavulanate.
Conclusions:
- DAP is commonly caused by Gram-negative bacteria, particularly Aeromonas sp. in freshwater drowning incidents.
- Empirical antimicrobial therapy should target these pathogens, as amoxicillin-clavulanate may be inadequate in a significant proportion of cases.
- The impact of DAP on patient mortality remains uncertain.
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