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Natural History, Outcomes and Antibiotic Treatment for Ventilator-Associated Tracheobronchitis in Critical Ill Patients

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Modern Research in Inflammation 2016年第1期5卷 1-11页

作者： Yuxiu Lei jana hudcova Jawad Rashid Akmal Sarwar Wendy Gillespie Carol Finn Marie Goggin Mohamed B. Omran Edward Boroda Donald E. Craven Pulmonary and Critical Care Medicine Lahey Hospital and Medical Center Burlington MA USA Center for Infectious Diseases and Prevention Lahey Clinic Hospital and Medical Center Burlington MA USA Surgical & Medical Critical Care Lahey Hospital and Medical Center Burlington MA USA Tufts University School of Medicine Boston MA USA Lab Medicine—Microbiology Lahey Hospital and Medical Center Burlington MA USA Respiratory Care Lahey Hospital and Medical Center Burlington MA USA

We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventilator days. We also examined pathogens, rate of progression from VAT to VAP, and impact of antibiotic therapy for VAT. Data analysis included 234 patients, 100 patients (43%) had at least moderate (+++) bacterial growth in their semi-quantitative endotracheal aspirate (SQ-ETA) cultures. VAT and VAP were each diagnosed in 34 (15%) patients. Staphylococcus aureus was the most common pathogen isolated and had the highest rate of progression from VAT to VAP. Seven (21%) of the 34 patients were diagnosed with VAT that later progressed to VAP in averaged 3 days. Patients diagnosed with VAT had significantly more ventilator days (9 vs 6, p p < 0.001) and hospital days (22 vs 17, p < 0.001). No significant difference was observed in the clinical outcomes of the 25 VAT patients with timely, appropriate antibiotics compared to the 9 VAT patients who did not receive timely appropriate antibiotics. VAT was a risk factor for increased ventilator days, longer length of ICU and hospital stay. The time window from VAT to VAP allowed physicians to identify the pathogens and sensitivity profile needed to treat VAT with appropriate antibiotics. Data from well-designed studies were needed to assess the impact of early, appropriate antibiotic therapy for VAT, the choice of antibiotics, as well as the duration and route of administration.

关键词： Ventilator-Associated Tracheobronchitis (VAT) and Pneumonia (VAP) Bacterial Pathogens Semi-Quantitative Endotracheal Aspirate (SQ-ETA) Cultures Antibiotic Therapy

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