Primeiro autor: José Rodolfo Rocco Endereço: Rua Desenhista Luiz Guimarães, 70 bloco
1 apto 602 Barra da Tijuca Cidade: Rio de Janeiro Estado: RJ
CEP 22793-260 Tel. (0xx21) 4317301 ou 3084 4213 E-mail: jrrocco@openlink.com.br
BACTERIAL PATTERNS IN CRITICALLY ILL PATIENTS WITH
VENTILATOR-ASSOCIATED PNEUMONIA
Fax (0xx21) 325 4579
Rocco,
J.R.; Guimarães, M.M.R.; Nouér, S.A.
Infection Control and
Intensive Care Unit - Hospital Universitário Clementino Fraga Filho - Federal
University of Rio de Janeiro – Rio de Janeiro - Brazil
Introduction: The
selection of antimicrobial agents for the initial empirical treatment of
ventilator-associated pneumonia (VAP) seems to be an important determinant of
clinical outcomes, especially in hospital mortality. Objective: To identify the pathogens associated with VAP in
critically ill patients. Methods:
Prospective cohort of of mechanically ventilated (MV) patients admitted at ICU
between Sep 1999 and Aug 2000. The diagnosis of VAP was done according to NNISS
definitions. Data from blood, tracheal and bronchoalveolar lavage (BAL)
cultures were collected. A two-tailed chi-square (with Yates correction) was
used to compare differences between the group of patients with VAP and the
patients mechanically ventilated without VAP (NVAP) for discrete
variables (p<0.05). Results: A
total of 193 patients were studied and 83 (43%) developed VAP. The pathogens
isolated in positive blood cultures were: S. aureus – 30.6% (MRSA=72.7%); Acinetobacter sp – 11.1%. Two pathogens were isolated 4 times. The pathogens
isolated in positive respiratory secretions were: P. aeruginosa – 27.5%; S.
aureus – 19.6% (MRSA=80%); Acinetobacter
sp - 16.7%. Cultures were polymycrobial in 27.5% of VAPs. There was no
statistical difference between organisms isolated in tracheal and BAL cultures.
Blood and respiratory secretions were collected from 59 patients (71.1%). Both
were positive with different microorganisms in 10 patients (16.9%) and in only
3 (5.1%) with the same organism. Multi-resistant (MR) organisms were more
frequent in VAP than NVAP patients (VAP - 35/83 – 42.2% vs NVAP - 10/110 –
9.1%; p<0.0001). Late VAPs (> 4 days) were associated more frequently to
MR organisms, although this difference was not significant (early VAP - 16/46 –
34.8% vs late VAP - 19/37 – 51.4%; p=0.19). Conclusions: VAP was associated with MR pathogens and polymicrobial
infections. Given the prevalence of MRSA, P.
aeruginosa and Acinetobacter sp in VAP, empirical regiments active
against this pathogens should be used.