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Kim, Kim, Park, Ko, Kim, Kang, Hwang, Park, Jang, Woo, Kim, Lee, Hyun, and Jung: Antimicrobial Resistance of Bacteria Isolated from Bronchoalveolar lavage (BAL) in Patients with Lung Infiltrations in Burn and Non-Burn Intensive Care Unit
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 62(6): 506-515.

Published online: 30 June 2007

DOI: https://doi.org/10.4046/trd.2007.62.6.506

Antimicrobial Resistance of Bacteria Isolated from Bronchoalveolar lavage (BAL) in Patients with Lung Infiltrations in Burn and Non-Burn Intensive Care Unit

Jong-Yeop Kim, M.D., Cheol-Hong Kim, M.D., Su-Hee Park, M.D., You-Sang Ko, M.D., Mi-Jeong Kim, M.D., Hye-Ryun Kang, M.D., Yong Il Hwang, M.D., Yong-Bum Park, M.D., Seung-Hun Jang, M.D., Heungjeong Woo, M.D., Dong-Gyu Kim, M.D., Myung-Goo Lee, M.D., In-Gyu Hyun, M.D., Ki-Suck Jung, M.D.

Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

Address for correspondence: In-Gyu Hyun, M.D. Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, 94-200 Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul, 150-719, Korea. Phone: 82-2-2639-5001, Fax: 82-2-2677-9756, ighyun@hallym.ac.kr

Received 26 March 2007       Accepted 16 May 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Nosocomial pneumonia in an intensive care unit (ICU) is associated with a high mortality rate. Diagnosing a respiratory tract infection in critically ill patients is still difficult but detailed information for the pathogens is needed to establish an adequate antimicrobial treatment. This study examined the causative organisms and their antimicrobial resistance using bronchoalveolar lavage (BAL) from patients suspected of having pneumonia in the ICU.

Methods

From January 2004 to June 2006, ICU patients with diffuse lung infiltration were prospectively enrolled. The BAL was used to diagnose the respiratory infection, with 104 ≥ organisms considered a positive result. The most common organisms and their antimicrobial resistances were analyzed from the quantitative BAL cultures in the burn ICU and non-burn ICU.

Results

A total 72 patients were included, 35 (M 29, F 6) in the burn ICU and 37 (M 26, F 11) in the non-burn ICU. 27 patients (77.1%) in the burn ICU and 22 patients (59.5%) in the non-burn ICU met the criteria for a positive BAL culture. The major pathogens were Staphylococcus aureus, Acinetobacter species and Pseudomonas aeruginosa. All strains (100%) of Staphylococcus aureus isolated from BAL (9 cases) were methicillin-resistant (MRSA) in the burn ICU, but 5 strains (71.4%, 7 cases) were MRSA in the non-burn ICU. Regarding Pseudomonas aeruginosa, the rate of resistance to amikacin, ciprofloxacin, cefepime, imipenem, ceftazidime, piperacillin/tazobactam in the burn and non-burn ICU ranged from 45.5% to 90% and 25% to 50%, respectively. In addition, the rate of resistance of Acinetobacter species to the above drugs in the burn and non-burn ICU ranged from 81.8% to 100% and 62.5% to 100%, respectively.

Conclusions

These results are expected to provide useful guidelines for choosing the effective empirical antimicrobial therapy in patients with lung infiltrations in the burn and non-burn ICU.

Keywords: Bronchoalveolar lavage, Burns, Intensive care unit, Pneumonia

Figures and Tables

Table 1
Demographic characteristics in Burn ICU and Non-Burn ICU Patients
trd-62-506-i001

Values are presented as mean±standard deviation or No. (%) unless otherwise stated.

ICU: intensive care unit; TBSA: total body surface area; APACHE: acute physiology and chronic health evaluation.

*p<0.05.

Table 2
Reasons for BAL and other parameters at the time of bronchoscopy
trd-62-506-i002

Values are presented as mean±standard deviation or No. (%) unless otherwise stated.

BAL: bronchoalveolar lavage; ICU: intensive care unit; VAP: ventilator-associated pneumonia; TBc: tuberculosis.

Table 3
Frequent organisms isolated from quantitative BAL cultures
trd-62-506-i003

Values are presented as No. (%) unless otherwise stated.

BAL: bronchoalveolar lavage.

*p<0.05.

Table 4
Comparisons of antimicrobial resistance for major organisms from quantitative BAL cultures
trd-62-506-i004

Values are presented as No. (%) unless otherwise stated.

BAL: bronchoalveolar lavage; TS: trimethoprime/sulfamethoxazole; Pipera/Tazo: piperacillin/tazobactam; ESBL: extended spectrum β-lactamase.

*p<0.05, †Escherichia coli, ‡Klebsiella pneumoniae.

Table 5
Other results from BAL study
trd-62-506-i005

Values are presented as No. (%) unless otherwise stated.

BAL: bronchoalveolar lavage; CMV: cytomegalovirus; HSV: herpes simplex virus.

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