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Kim, Yoon, Lee, Son, Choi, Na, and Kwon: Role of Microbiologic Culture Results of Specimens Prior to Onset of Ventilator-Associated Pneumonia in the Patients Admitted to Intensive Care Unit
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2012; 72(1): 30-36.

Published online: 30 January 2012

DOI: https://doi.org/10.4046/trd.2012.72.1.30

Role of Microbiologic Culture Results of Specimens Prior to Onset of Ventilator-Associated Pneumonia in the Patients Admitted to Intensive Care Unit

Ji Hye Kim, M.D., Sung-Chul Yoon, M.D., Yu-Mi Lee, M.D., Ji-Woong Son, M.D., Ph.D., Eu-Gene Choi, M.D., Ph.D., Moon-Jun Na, M.D., Ph.D., Sun-Jung Kwon, M.D.

Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea.

Address for correspondence: Sun-Jung Kwon, M.D. Department of Internal Medicine, Konyang University Hospital, 685, Gasuwon-dong, Seo-gu, Daejeon 302-718, Korea. Phone: 82-42-600-8820, Fax: 82-42-600-9090, sjoongkwon@hanmail.net

Received 22 August 2011       Revised 31 October 2011       Accepted 18 November 2011

Copyright © 2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Patients with ventilator-associated pneumonia (VAP) in intensive care unit (ICU) have a high mortality rate. The routine surveillance cultures obtained previously or an ATS guideline for hospital-acquired pneumonia was used in selecting initial antimicrobials. The object of this study was to compare the respiratory samples before VAP and bronchoalveolar lavage (BAL) culture.

Methods

54 patients underwent fiberoptic bronchoscopy to obtain BAL samples. We reviewed microbiologic specimen results of prior respiratory specimens (pre-VAP) and BAL.

Results

Among 51 patients with 54 VAP episodes, 52 microorganisms of pre-VAP and 56 BAL samples were isolated. Pre-VAP included 21.2% of MRSA, and 32.6% of multidrug resistant-Acinetobacter baumannii (MDR-AB). BAL samples comprised 25.0% of MRSA, 26.7% of MDR-AB, 14.3% of Stenotrophomonas maltophilia and 3.6% of Klebsiella pneumonia in order. In pre-VAP samples compared to BAL samples, only 35.2% were identical. In BAL samples compared to pre-VAP samples obtained in 5 days before the onset of VAP, only 43.6% were identical. However, among BAL samples compared to pre-VAP samples obtained after more than 5 days, 13.3% were identical (p=0.037).

Conclusion

Based on these data, pre-VAP samples obtained prior to 5 day onset of VAP may help to predict the causative microorganisms and to select appropriate initial antimicrobials.

Keywords: Pneumonia, Ventilator-Associated, Bronchoalveolar Lavage, Anti-Bacterial Agents

Figures and Tables

Figure 1
Contribution of prior microbiologic respiratory specimensn to identification of causative microorganisms in VAP. Black bars correspond to 54 episodes for which prior respiratory specimen was obtained before VAP onset. VAP: ventilator-associated pneumonia.
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Figure 2
Pre-VAP had been obtained within 5 d was the more identical than it had been obtained greater than 5 d (43.6% vs. 13.3%, p=0.037). VAP: ventilator-associated pneumonia; BAL: bronchoalveolar lavage.
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Table 1
ICU admission characteristics of 51 patients with 54 VAP episodes retrospectively studied for comparing microorganisms
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Data are presented as number (%) unless otherwise indicated.

*Data are presented as mean±SD. †Anti-pseudomonal penicillin/cephalosporin; Piperacillin/Tazobactam, Ceftazidime, Cefepime. ‡Second/Third-generation cephalosporin; Cefoxitin, Cefotetan, Ceftriaxone, Cefotaxime, Cefbuperazon. §Fluoroquinolone; Ciprofloxacn, Levofloxacin, Moxifloxacin. ∥Others; Clarithromycin, Colistin, Trimethoprim/sulfamethoxazole, Amphotericin-B.

ICU: intensive care unit; VAP: ventilator-associated pneumonia; SD: standard deviation.

Table 2
Microbiologic results of BAL fluid and prior respiratory specimens
trd-72-30-i002

Data are presented as number of isolated pathogen (%) unless otherwise indicated.

*p-value; calculated by McNemar test. Kappa index was statistically significant. †MDR-Acinetobacter baumannii was defined as resistant to all antibiotic agents excluding polymyxin E (colistin).

VAP: ventilator-associated pneumonia; BAL: bronchoalveolar lavage; ESBL: extended-spectrum β-lactamase; MDR: multidrug resistant.

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