Primeiro autor: José Rodolfo Rocco

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Barra da Tijuca      Cidade: Rio de Janeiro         Estado: RJ      CEP 22793-260 

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BACTERIAL PATTERNS IN CRITICALLY ILL PATIENTS WITH VENTILATOR-ASSOCIATED PNEUMONIA

 

Rocco, J.R.; Guimarães, M.M.R.; Nouér, S.A.

jrrocco@openlink.com.br

 

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.