Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 9/2004

01-09-2004 | Original

Patterns of colonization by Pseudomonas aeruginosa in intubated patients: a 3-year prospective study of 1,607 isolates using pulsed-field gel electrophoresis with implications for prevention of ventilator-associated pneumonia

Authors: Jordi Vallés, Dolors Mariscal, Pilar Cortés, Pere Coll, Ana Villagrá, Emili Díaz, Antonio Artigas, Jordi Rello

Published in: Intensive Care Medicine | Issue 9/2004

Login to get access

Abstract

Objective

To identify routes and patterns of colonization with Pseudomonas aeruginosa in intubated patients to design strategies of prevention for respiratory infection.

Design and setting

Prospective and observational study in the 16-bed intensive care unit of a teaching hospital.

Patients and participants

Ninety-eight intubated patients were investigated over a 3-year period. Those ventilated less than 72 h were excluded.

Measurements and results

Samples from the tap water from each patient’s room, stomach, oropharynx, subglottic secretions, trachea, and rectum were collected when the patient was intubated, and then three times per week. Pulsed-field gel electrophoresis was performed to type the strains. We identified 1,607 isolates pertaining to 35 different pulsotypes. Overall 54.2% of patients presented colonization, and tracheal colonization was present in 30.5%. Ten patients had colonization at intubation, and four of these developed ventilator-associated pneumonia (VAP) after a mean of 4±2 days. ICU-acquired colonization occurred in 31 patients, and 4 of these developed VAP after a median of 10±5 days. P. aeruginosa was isolated from the room’s tap water in 62.4% of samples. More than 90% of tap water samples had pulsotypes 1 and 2, which were frequently isolated in the stomach (59%) but were only rarely associated with VAP.

Conclusions

Although colonization/infection with P. aeruginosa in intubated patients tends to be endogenous, exogenous sources should not be ruled out. A combination of early identification (and eradication) of airways colonization by P. aeruginosa plus infection control measures targeted to reduce cross-contamination should be the basis to prevent pulmonary infection.
Literature
1.
Rello J, Rué M, Jubert P, Muses G, Soñora R, Vallés J, Niederman MS (1997) Survival in patients with nosocomial pneumonia: impact of the severity of illness and the etiologic agent. Crit Care Med 25:1862–1867CrossRefPubMed
2.
Brewer SC, Wunderink RG, Jones CB, Leeper KV (1996) Ventilator-associated pneumonia due to Pseudomonas aeruginosa. Chest 109:1019–1029PubMed
3.
National Nosocomial Infections Surveillance System (1999) Data summary from January 1990–May 1999, issued June 1999. Am J Infect Control 27:520–532PubMed
4.
Talon D, Mulin B, Rouget C, Bailly P, Thouverez M, Viel JF (1998) Risks and routes for ventilator-associated pneumonia with Pseudomonas aeruginosa. Am J Respir Crit Care Med 157:978–984PubMed
5.
Bergmans DC, Bonten MJ, van Tiel FH, Gaillard CA, van der GS, Wilting RM, de Leeuw PW, Stobberingh EE (1998) Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit. Thorax 53:1053–1058PubMed
6.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed
7.
Chastre J, Fagon JY, Trouillet JL (1995) Diagnosis and treatment of nosocomial pneumonia in patients in intensive care units. Clin Infect Dis 21 [Suppl 3]:S226–S237
8.
El-Ebiary M, Torres A, González J, Puig de la Bellacasa J, García C, Jiménez de Anta MT, Ferrer M, Rodríguez-Roisin R (1993) Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator-associated pneumonia. Am Rev Respir Dis 148:1552–1557PubMed
9.
Gilchrist MJR (1992) Microbiological culturing of environmental and medical-device surfaces. In: Isenberg HD (ed) Clinical microbiology procedures handbook. American Society for Microbiology, Washington
10.
Cortés P, Mariscal D, Vallés J, Rello J, Coll P (2001) Implications of the presence of polyclonal Pseudomonas aeruginosa in an intensive care unit. A 27-month prospective study on molecular epidemiology. Infect Control Hosp Epidemiol 22:720–723PubMed
11.
Tenover FC, Arbeit RD, Goring RV, Mickelsen PA, Murray BE, Persing DH, Swaminathan B (1995) Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 33:2233–2239PubMed
12.
Döring G, Hörz M, Ortelt J, Grupp H, Wolz C (1995) Molecular epidemiology of Pseudomonas aeruginosa in an intensive care unit. Epidemiol Infect 110:427–436
13.
Olson B, Weinstein RA, Nathan C, Chamberlin W, Kabins SA (1984) Epidemiology of endemic Pseudomonas aeruginosa: why infection control efforts have failed. J Infect Dis 150:808–816PubMed
14.
Speijer H, Savelkoul PH, Bonten MJ, Stobberingh EE, Tjhie JH (1999) Application of different genotyping methods for Pseudomonas aeruginosa in a setting of endemicity in an intensive care unit. J Clin Microbiol 37:3654–3661PubMed
15.
Bertrand X, Thouverez M, Talon D, Boillot A, Capellier G, Floriot C, Helias JP (2001) Endemicity, molecular diversity and colonisation routes of Pseudomonas aeruginosa in intensive care units. Intensive Care Med 27:1263–1268CrossRefPubMed
16.
Bonten MJ, Bergmans DC, Speijer H, Stobberingh EE (1999) Characteristics of polyclonal endemicity of Pseudomonas aeruginosa colonization in intensive care units. Implications for infection control. Am J Respir Crit Care Med 160:1212–1219PubMed
17.
Trautmann M, Michalsky T, Wiedeck H, Radosavljevic V, Ruhnke M (2001) Tap water colonization with Pseudomonas aeruginosa in a surgical intensive care unit (ICU) and relation to Pseudomonas infections of ICU patients. Infect Control Hosp Epidemiol 22:49–52PubMed
18.
Bert F, Maubec E, Bruneau B, Berry P, Lambert-Zechovsky N (1998) Multi-resistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. J Hosp Infect 39:53–62CrossRefPubMed
19.
Ferroni A, Nguyen L, Pron B, Quesne G, Brusset MC, Berche P (1998) Outbreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a pediatric surgical unit associated with ta-water contamination. J Hosp Infect 39:301–307CrossRefPubMed
20.
Reuter S, Sigge A, Wiedeck H, Trautmann M (2002) Analysis of transmission pathways of Pseudomonas aeruginosa between patients and tap water outlets. Crit Care Med 30:2222–2228CrossRefPubMed
21.
Bonten MJ, Gaillard CA, van Tiel FH, Smeets HGW, van der Geest S, Stobberingh EE (1994) The stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients. Chest 105:878–884PubMed
22.
Hauser AR, Cobb E, Bodí M, Mariscal D, Vallés J, Engel JN, Rello J (2002) Type III protein secretion is associated with poor clinical outcomes in patients with ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Crit Care Med 30:521–528CrossRefPubMed
23.
Roy-Burman A, Savel RH, Racine S, Swanson BL, Revadigar NS, Fujimoto J, Sawa T, Frank DW, Wiener-Kronish JP (2001) Type III protein secretion is associated with death in lower respiratory and systemic Pseudomonas aeruginosa infections. J Infect Dis 183:1767–1774CrossRefPubMed
24.
Pittet D (2001) Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 48 [Suppl A]:S40–S46
25.
Feldman C, Kassel M, Cantrell J, Kaka S, Morar R, Goolam MA, Philips JI (1999) The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation. Eur Respir J 13:546–551CrossRefPubMed
26.
Foca M, Jakob K, Whittier S, Della LP, Factor S, Rubenstein D, Saiman L (2000) Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 343:695–700CrossRefPubMed
Metadata
Title
Patterns of colonization by Pseudomonas aeruginosa in intubated patients: a 3-year prospective study of 1,607 isolates using pulsed-field gel electrophoresis with implications for prevention of ventilator-associated pneumonia
Authors
Jordi Vallés
Dolors Mariscal
Pilar Cortés
Pere Coll
Ana Villagrá
Emili Díaz
Antonio Artigas
Jordi Rello
Publication date
01-09-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2382-6

Other articles of this Issue 9/2004

Intensive Care Medicine 9/2004 Go to the issue

Original

Bedside estimation of absolute renal blood flow and glomerular filtration rate in the intensive care unit

Readers’ survey

Readers’ survey

Physiological Note

Intracranial pressure

Editorial

Brain death

Correspondence

Author’s reply to the comment by Dr. Bendjelid

Experimental

A novel approach for selective brain cooling: implications for hypercapnia and seizure activity