TY - JOUR
T1 - Patterns of colonization by Pseudomonas aeruginosa in intubated patients: A 3-year prospective study of 1,607 isolates using pulsed-field gel electrophoresis with implications for prevention of ventilator-associated pneumonia
AU - Vallés, Jordi
AU - Mariscal, Dolors
AU - Cortés, Pilar
AU - Coll, Pere
AU - Villagrá, Ana
AU - Díaz, Emili
AU - Artigas, Antonio
AU - Rello, Jordi
PY - 2004/9/1
Y1 - 2004/9/1
N2 - Objective: To identify routes and patterns of colonization with Pseudomonas aeruginosa in intubated patients to design strategies of prevention for respiratory infection. Design and setting: Prospective and observational study in the 16-bed intensive care unit of a teaching hospital. Patients and participants: Ninety-eight intubated patients were investigated over a 3-year period. Those ventilated less than 72 h were excluded. Measurements and results: Samples from the tap water from each patient's room, stomach, oropharynx, subglottic secretions, trachea, and rectum were collected when the patient was intubated, and then three times per week. Pulsed-field gel electrophoresis was performed to type the strains. We identified 1,607 isolates pertaining to 35 different pulsotypes. Overall 54.2% of patients presented colonization, and tracheal colonization was present in 30.5%. Ten patients had colonization at intubation, and four of these developed ventilator-associated pneumonia (VAP) after a mean of 4±2 days. ICU-acquired colonization occurred in 31 patients, and 4 of these developed VAP after a median of 10±5 days. P. aeruginosa was isolated from the room's tap water in 62.4% of samples. More than 90% of tap water samples had pulsotypes 1 and 2, which were frequently isolated in the stomach (59%) but were only rarely associated with VAP. Conclusions: Although colonization/infection with P. aeruginosa in intubated patients tends to be endogenous, exogenous sources should not be ruled out. A combination of early identification (and eradication) of airways colonization by P. aeruginosa plus infection control measures targeted to reduce cross-contamination should be the basis to prevent pulmonary infection.
AB - Objective: To identify routes and patterns of colonization with Pseudomonas aeruginosa in intubated patients to design strategies of prevention for respiratory infection. Design and setting: Prospective and observational study in the 16-bed intensive care unit of a teaching hospital. Patients and participants: Ninety-eight intubated patients were investigated over a 3-year period. Those ventilated less than 72 h were excluded. Measurements and results: Samples from the tap water from each patient's room, stomach, oropharynx, subglottic secretions, trachea, and rectum were collected when the patient was intubated, and then three times per week. Pulsed-field gel electrophoresis was performed to type the strains. We identified 1,607 isolates pertaining to 35 different pulsotypes. Overall 54.2% of patients presented colonization, and tracheal colonization was present in 30.5%. Ten patients had colonization at intubation, and four of these developed ventilator-associated pneumonia (VAP) after a mean of 4±2 days. ICU-acquired colonization occurred in 31 patients, and 4 of these developed VAP after a median of 10±5 days. P. aeruginosa was isolated from the room's tap water in 62.4% of samples. More than 90% of tap water samples had pulsotypes 1 and 2, which were frequently isolated in the stomach (59%) but were only rarely associated with VAP. Conclusions: Although colonization/infection with P. aeruginosa in intubated patients tends to be endogenous, exogenous sources should not be ruled out. A combination of early identification (and eradication) of airways colonization by P. aeruginosa plus infection control measures targeted to reduce cross-contamination should be the basis to prevent pulmonary infection.
KW - Colonization
KW - Intensive care
KW - Mechanical ventilation
KW - Pneumonia
KW - Pseudomonas aeruginosa
U2 - https://doi.org/10.1007/s00134-004-2382-6
DO - https://doi.org/10.1007/s00134-004-2382-6
M3 - Article
VL - 30
SP - 1768
EP - 1775
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
ER -