Incidence, Etiology, and Outcome of Nosocomial Pneumonia in ICU Patients Requiring Percutaneous Tracheotomy for Mechanical Ventilation

• Published in: Chest Vol. 124; no. 6; pp. 2239 - 2243
• Main Authors: Rello, Jordi, Lorente, Carmen, Diaz, Emili, Bodi, Maria, Boque, Carmen, Sandiumenge, Albert, Santamaria, Josep Maria
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.12.2003; American College of Chest Physicians
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibiotics; Antimicrobial agents; APACHE; Biological and medical sciences; Cardiology. Vascular system; Critical Care; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - therapy; Epidemiology; Female; Hospital Mortality; Humans; Hypotheses; Incidence; Intensive Care Units; Male; Medical sciences; Middle Aged; Mortality; outcome; Pathogens; Physiology; Pneumology; Pneumonia; Pneumonia - epidemiology; Pneumonia - microbiology; Pneumonia - therapy; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas aeruginosa - isolation & purification; Pseudomonas aeruginosa - pathogenicity; Respiration, Artificial - adverse effects; Staphylococcus infections; Tracheotomy; Variables; ventilator-associated pneumonia; Ventilators; MSSA; epidemiology; tracheotomy; VAP; MRSA; Pseudomonas aeruginosa; ventilator-associated pneumonia; incidence; TA; outcome; APACHE; Human; Lung disease; Nosocomial infection; Ventilator; Pneumonia; Prognosis; Respiratory disease; Psendomonas aeruginosa; Artificial ventilation; Tracheotomy; Epidemiology; Incidence; Percutaneous route; Treatment; Etiology; Surgery; Anesthesia; Evolution; Circulatory system; Cardiology; Mechanical ventilation
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.124.6.2239

To determine the epidemiology of pneumonia in patients with tracheotomy receiving short-term mechanical ventilation. Observational prospective study. A 14-bed medical-surgical ICU. Ninety-nine critically ill acute patients requiring percutaneous dilatational tracheotomy for mechanical ventilation. Tracheal aspirate obtained 48 h before tracheotomy. Eighteen patients (18.1%) acquired pneumonia (median of 7 days after tracheotomy). Pseudomonas aeruginosa was the most frequently identified pathogen, found in eight of the episodes (four not documented by prior tracheal colonization), followed by other Gram-negative bacilli. The development of ventilator-associated pneumonia (VAP) was not anticipated by any clinical variable. A positive tracheal aspirate (TA) culture result obtained before tracheotomy was associated with a risk of acquiring pneumonia of 19.7%, whereas sterile TA cultures were associated with a risk of 14.3% (p > 0.20). VAP prolonged ICU stay or the ventilation period for a median of 19 days and 15 days, respectively. Overall mortality was 34.3%, but the presence of VAP did not increase the mortality rate. Percutaneous tracheotomy in patients receiving short-term mechanical ventilation predisposes to pneumonia. Pneumonia was associated with prolonged ventilation and ICU stay, but was not associated with increased mortality. Pseudomonas is a common pathogen after tracheotomy, and this observation should be considered in selecting an antibiotic regimen, because TA obtained prior to the tracheotomy often failed to identify this pathogen.