Microbiological Concordance of Subglottic Secretion and Tracheal Aspirate Cultures of Critically Ill Patients with
Pritam Panigrahi1, Venkata Ganesh1, Archana Angrup2
1Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background:
Development of ventilator-associated pneumonia (VAP) is attributed to the microaspiration of pooled secretions around the cuff of airway devices. Despite the emphasis on the use of endotracheal tubes (ET) with subglottic secretion (SS) drainage ports to prevent VAP, the quality of the evidence for this recommendation remains moderate. This prospective observational study analyzed microbiological concordance between SS and endotracheal aspirate (ETA) cultures to generate further evidence in this regard.
Materials And Methods:
Paired samples (SS and ETA) of 100 consenting patients admitted to intensive care unit (ICU) were sent on day 1, 4, and 7 to the microbiology laboratory where they were transcultured and species identification was performed. The SS and ETA were considered concordant or discordant based on isolated organisms and antibiotic sensitivity profile. Clinical surveillance for VAP was done according to CDC criteria during the first week of ventilation.
Results:
For a total of 197 paired samples, the overall concordance of SS and ETA cultures was 71.5%, with day-wise concordances of 68, 76.2, and 73.5% for D1, D4, and D7, respectively. Gram-negatives bacteria were the most frequently isolated, with 125 (31.7%) samples reporting A. baumannii. Amongst 18 patients clinically diagnosed with VAP during the first week of MV, the concordance between SS and ETA was 73.5%, and day-wise concordance was 77.2, 72.2, and 76.9% on D1, D4, and D7, respectively.
Conclusion:
A fairly high microbiological concordance was observed in SS and ETA samples obtained from patients with invasive airway devices, and similar concordance was found in patients developing VAP during the first week of ventilation.
How To Cite This Article:
Panigrahi P, Ganesh V, Angrup A, Sahni N, Biswal M, Yaddanapudi L. Microbiological Concordance of Subglottic Secretion and Tracheal Aspirate Cultures of Critically Ill Patients with Invasive Airway Devices: A Prospective Observational Study. Indian J Crit Care Med 2024;28(12):1139-1146.
Insights
This study found high microbiological concordance between subglottic secretion and endotracheal aspirate cultures in patients with airway devices. This supports the use of these cultures for monitoring ventilator-associated pneumonia (VAP) risk.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) is a significant risk for critically ill patients with airway devices.
- Microaspiration of secretions is a primary cause of VAP.
- Subglottic secretion (SS) drainage ports in endotracheal tubes (ET) aim to prevent VAP, but evidence quality is moderate.
Purpose of the Study:
- To evaluate the microbiological concordance between SS and endotracheal aspirate (ETA) cultures.
- To generate further evidence on the effectiveness of ET with SS drainage for VAP prevention.
- To analyze concordance in critically ill patients with invasive airway devices.
Main Methods:
- Prospective observational study of 100 ICU patients.
- Paired SS and ETA samples collected on days 1, 4, and 7.
- Microbiological analysis including species identification and antibiotic sensitivity.
Main Results:
- Overall concordance between SS and ETA cultures was 71.5%.
- Gram-negative bacteria, particularly *A. baumannii*, were frequently isolated.
- In patients diagnosed with VAP, concordance remained high at 73.5%.
Conclusions:
- High microbiological concordance exists between SS and ETA samples.
- Findings support the utility of analyzing both secretion types for VAP surveillance.
- Further evidence is provided for the role of ET with SS drainage.
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