Open AccessDecreased incidence of ventilator‐associated pneumonia caused by Pseudomonas aeruginosa over 3 years
Author(s) -
Fiore M.,
van Nieuwenhoven C. A.,
Ramsay G.
Publication year - 2000
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2000.01544-37.x
Subject(s) - medicine , pseudomonas aeruginosa , sputum , incidence (geometry) , pneumonia , ventilator associated pneumonia , bronchoalveolar lavage , microbiology and biotechnology , staphylococcus aureus , klebsiella pneumoniae , sputum culture , colonization , pathogen , gastroenterology , immunology , lung , escherichia coli , bacteria , pathology , biology , tuberculosis , biochemistry , genetics , physics , gene , optics
Background Ventilator‐associated pneumonia (VAP) is a frequently occurring infection among critically ill patients. Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli are the most common micro‐organisms causing VAP. The aim of this study was to ascertain the incidence of VAP diagnosed with bronchoalveolar lavage (BAL) by these possible pathogenic micro‐organisms (PPMOs). Because VAP is often preceded by colonization of the oropharynx with the causative pathogen, sputum cultures were compared with the BAL cultures. Methods Over a 3‐year period, all ventilated patients in two intensive care units ( n = 1136) were reviewed for pneumonia. A VAP was present when the bacterial count of the BAL was more than 10 4 colony‐forming units ml −1 . The microbial results of all patients with a VAP (polymicrobial or monomicrobial) were recorded. Results The mean incidence of VAP was 8 per cent ( n = 92), decreasing only slightly during the period (P > 0·05). The most frequent aetiological agents were P. aeruginosa ( n = 34), S. aureus ( n = 22), E. coli ( n = 16) and K. pneumoniae ( n = 10). The percentage of VAPs due to P. aeruginosa has declined progressively from 53 to 31 per cent. Concurrently, the incidence of Pseudomonas colonizing the sputum culture has declined (from 54 to 44 per cent). On the other hand, the incidence of VAP due to E. coli has increased from 13 ( n = 2) to 36 per cent ( n = 6). Colonization of the sputum with E. coli has similarly increased (from 13 to 27 per cent). Conclusion The incidence of VAP in the intensive care unit is in accordance with the literature, when diagnosed with strict criteria. No significant change in the incidence of VAP was noted during the 3‐year period. Neither the decrease in incidence of VAP caused by P. aeruginosa nor the increase in E. coli pneumonia can be explained by a change in antibiotic regimens in the period studied. Hypothetically, cross‐colonization of PPMOs by healthcare personnel can be influenced by hand‐washing and wearing gloves. This can especially influence colonization by P. aeruginosa, thus explaining the decrease. © 2000 British Journal of Surgery Society Ltd