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Intensive Care Medicine

Published in:

01-08-2007 | Original

Management of ventilator-associated pneumonia in a multidisciplinary intensive care unit: does trauma make a difference?

Authors: Kemal Agbaht, Thiago Lisboa, Angel Pobo, Alejandro Rodriguez, Alberto Sandiumenge, Emili Diaz, Jordi Rello

Published in: Intensive Care Medicine | Issue 8/2007

Abstract

Objective

Antibiotic exposure and timing of pneumonia onset influence ventilator-associated pneumonia (VAP) isolates. The first goal of this investigation was to evaluate whether trauma also influences prevalence of microorganisms.

Design

A retrospective, single-center, observational cohort study.

Setting

Multidisciplinary teaching ICU.

Patients

Adult patients requiring mechanical ventilation identified as having VAP.

Interventions

Retrospective evaluation of a prospective manual database.

Measurements and main results

VAP isolates in a multidisciplinary ICU documented by quantitative respiratory cultures and recorded in a 42-month database were compared, based on the presence or absence of trauma. Causative microorganisms were classified in four groups, based on mechanical ventilation duration (> 5 days), and previous antibiotic exposure. One hundred eighty-three patients developed 196 episodes of VAP (98 trauma). Methicillin-sensitive Staphylococcus aureus (MSSA) was more frequent (34.5% vs. 11.5%, p < 0.01) in trauma, whereas methicillin-resistant Staphylococcus aureus (MRSA) was more frequent (2% vs. 11.5%, p < 0.01) in non-trauma. No significant differences were found between trauma and non-trauma patients regarding prevalence of other microorganisms. In trauma patients, MSSA episodes were equally distributed between early- and late-onset VAP (51% vs. 49%), but no MRSA episode occurred in the early-onset group.

Conclusions

Trauma influences the microbiology of pneumonia and it should be considered in the initial antibiotic regimen choice. Our data demonstrate that patients with trauma had a higher prevalence of MSSA, but the overall prevalence was sufficiently high to warrant S. aureus coverage for both groups. On the other hand, since no MRSA was isolated during the first 10 days of mechanical ventilation on trauma patients, MRSA coverage in these patients becomes necessary only 10 days after admission.

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Title: Management of ventilator-associated pneumonia in a multidisciplinary intensive care unit: does trauma make a difference?
Authors: Kemal Agbaht
Thiago Lisboa
Angel Pobo
Alejandro Rodriguez
Alberto Sandiumenge
Emili Diaz
Jordi Rello
Publication date: 01-08-2007
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 8/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0729-5

At a glance: The STEP trials

Springer Medicine

Management of ventilator-associated pneumonia in a multidisciplinary intensive care unit: does trauma make a difference?

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

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