Respiratory microbiology patterns within the first 24 h of ARDS diagnosis : Influence on outcome

• Published in: Chest Vol. 128; no. 1; pp. 273 - 279
• Main Authors: BAUER, Torsten T, VALENCIA, Mauricio, BADIA, Joan R, EWIG, Santiago, GONZALEZ, Julia, FERRER, Miguel, TORRES, Antoni
• Format: Journal Article
• Language: English
• Published: Northbrook, IL American College of Chest Physicians 01.07.2005; Elsevier B.V
• Subjects: Acute respiratory distress syndrome; Anti-Infective Agents - therapeutic use; APACHE; Bacterial pneumonia; Biological and medical sciences; Bronchoscopy; Cardiology. Vascular system; Chi-Square Distribution; Diagnosis; Drug resistance; Drug Resistance, Microbial; Female; General aspects; Human infectious diseases. Experimental studies and models; Humans; Infectious diseases; Male; Medical sciences; Microorganisms; Middle Aged; Mortality; Patient outcomes; Physiology; Pneumology; Pneumonia; Prospective Studies; Respiratory Distress Syndrome, Adult - diagnosis; Respiratory Distress Syndrome, Adult - drug therapy; Respiratory Distress Syndrome, Adult - microbiology; Staphylococcus infections; Streptococcus infections; Ventilators; United States; Lung disease; Nosocomial infection; Pneumonia; Prognosis; Microbiology; pulmonary infiltrates; Respiratory disease; nosocomial pneumonia; Cardiovascular disease; Respiratory tract; Infiltrate; Evolution; Diagnosis; Colonization; ARDS
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.128.1.273

Airway colonization and infection are frequent complications during the course of ARDS. The impact on outcomes of microbiological patterns recovered within the first 24 h after diagnosis has not been evaluated. To describe the incidence and patterns of bronchial colonization and lung infection within the first 24 h of ARDS diagnosis and to evaluate the influence on ICU outcomes. Prospective study of ARDS patients evaluated within 24 h of diagnosis. Patients were studied with tracheobronchial aspirate and right and left bronchoscopic protected specimen brush. All samples were cultured quantitatively. Fifty-five consecutive patients were included. Twelve patients (22%) were clinically suspected of having nosocomial pneumonia (NP), which was confirmed microbiologically in 7 patients, a frequency of 13%. In those patients without suspected pneumonia, we also found potentially pathogenic microorganisms (PPMs) and potentially drug-resistant microorganisms (PDRMs) in 36% and 31%, respectively. Mortality was not significantly higher in those patients with recovery of a PPM (87% vs 73%, p = 0.31), PDRM (89% vs 74%, p = 0.18), or with NP (79% vs 85%, p = 1.0). There is a strikingly high rate of PPM recovery in early ARDS. However, neither isolation of pathogenic microorganisms nor the confirmation of NP could be associated with an increased mortality.