[Antibiotic therapy of pneumopathies in intensive care and protected distal bronchial samples]

Bacteriology was performed on 57 specimens collected by the Wimberley protected catheter bronchoscopy technique (PCB) from 42 ventilated patients with severe head trauma hospitalized in the neurosurgical intensive care unit to determine the etiology of their pneumopathy. All patients had a nasotracheal tube upon arrival at the intensive care unit. For each sample, smears were examined and cultures under aerobic and anaerobic conditions as well as with CO2 were performed. In 34 (59%) of the 57 cases, examination of smears allowed rapid diagnosis and appropriate chemotherapy. In 47 (82%) cases, culture was positive, with a single pathogen being recovered in half of cases. The most prevalent organisms among the 75 species isolated were S. aureus (38%), P. aeruginosa (15%), Klebsiella (12%), Haemophilus (8%), and Pneumococcus (9%). Consistency with positive cultures of blood or pleural effusion samples was recorded in 92% of cases. Narrow spectrum antibiotic therapy can be chosen according to the results of PCB bacteriology and rapid automated antibiotic sensitivity testing obtained within 24 hours. PCB is therefore recommended in pulmonary infections in intensive care units.