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[Pathogenic flora in the gastric juice and bronchial secretion of long-term ventilated intensive-care patients]
Abstract:
Nosocomial pneumonia is a major risk for long term ventilated ICU patients. The infection route may be hematogenic or via inhalation or aspiration of microorganisms. The source of aspiration is the oropharynx. This prospective study intended to study the role of the stomach as a reservoir of bacteria in ICU patients treated with cimetidine. Gastric juice and bronchial secretion from 34 patients ventilated for more than 4 days were examined bacteriologically. 72,8% of the gastric (G) and 79,1% of the bronchial aspirates (B) revealed significant bacterial growth (more than 10(4) microorganism/ml). Pseudomonas, Klebsiella, and Candida spp. were found in 56,7% (B) and 51,8% (G) of the positive cultures as an effect of selection caused by antibiotics. Organisms of intestinal origin were found in 17,8% (B) und 15,5% (G), respectively. In 32,5%, identical organisms or patterns of organisms were found in the gastric and bronchial aspirates. 7 of the 34 patients (20,6%) developed pneumonia; in 6 of these 7 cases, the same organisms could be identified at the same and/or at the last examination before developing pneumonia in gastric content and bronchial secretion. The pH-value of the sterile aspirates was lower than of the colonized aspirates (5,39 vs 5,99). During enteral nutrition, 31,4% of the aspirates were sterile, whereas during parenteral nutrition only 24,3% of the gastric aspirates were sterile. Therefore, enteral nutrition should be started as soon as possible, the pH-value should be checked frequently and should not exceed 4 in order to reduce bacterial overgrowth in the stomach. A further consequence is to use as few antibiotics as possible.
Insights
The stomach can harbor bacteria in long-term ventilated ICU patients, increasing pneumonia risk. Early enteral nutrition and monitoring gastric pH are crucial for prevention.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Gastroenterology
Background:
- Nosocomial pneumonia is a significant threat to patients requiring prolonged mechanical ventilation.
- The stomach's role as a bacterial reservoir in intensive care unit (ICU) patients, particularly those on cimetidine, requires further investigation.
Purpose of the Study:
- To investigate the stomach's potential as a bacterial reservoir in ICU patients on mechanical ventilation.
- To determine the correlation between gastric bacterial colonization and the development of nosocomial pneumonia.
Main Methods:
- Prospective study involving 34 mechanically ventilated ICU patients.
- Bacteriological examination of gastric juice and bronchial secretions.
- Analysis of bacterial species, antibiotic resistance patterns, and gastric pH levels.
Main Results:
- Significant bacterial growth was observed in 72.8% of gastric and 79.1% of bronchial aspirates.
- Identical or similar bacterial patterns were found in gastric and bronchial samples in 32.5% of patients.
- Of 7 patients who developed pneumonia, 6 had matching bacteria in gastric and bronchial samples prior to onset.
Conclusions:
- The stomach serves as a significant reservoir for bacteria in ventilated ICU patients.
- Maintaining a gastric pH below 4, utilizing early enteral nutrition, and minimizing antibiotic use may reduce bacterial overgrowth and pneumonia risk.