Article
Bacterial airway colonizations and nosocomial pneumonia in a single neurosurgical intensive care unit
Bakterielle Atemwegskolonisationen und nosokomiale Pneumonien in einer neurochirurgischen Intensivstation
Search Medline for
Authors
Published: | May 8, 2006 |
---|
Outline
Text
Objective: In order to enhance current knowledge of nosocomial bacterial pneumonia in a single neurosurgical intensive care unit, a prospective study was conducted.
Methods: We evaluated upper and lower airway colonization patterns with or without the development of early (day 0 – 4 of ICU stay) or late (> day 4 of ICU stay) pneumonia in 113 patients. The incidence rates of microorganisms identified in upper and/or lower airway according to the types of pneumonia were studied. Swabs were taken twice a week with follow-up until discharge.
Results: Compared to 52 patients without pneumonia (group I), 45 patients developed an early onset (group II) and 16 patients a late onset (group III) pneumonia. A significant (p<0.01) longer ICU-stay (group I: 11.0 days; group II: 16.2 days; group III: 19.6 days) and a prolonged ventilation (group I: 7.2 days; group II: 12.0 days; group III: 15.0 days) were associated with pneumonia. The most important colonizations in the upper and and lower airways were Enterobakteriaceae (group B), Enterococci/non-hemolytic Streptococci (group D), Staphylococcus aureus (group G), coagulase-negative Staphylococci/Corynebacteria (group H) and Candida types (group L). The colonization rates of the upper airways were 27% - 54% in group I patients (no pneumonia), 22% - 69% in group II patients and 50% - 88% in group III patients. A significant difference of colonization rates with microorganisms of groups D, G and H was found in the lower airways with colonization rates of 21% - 29% in patients without pneumonia versus 44% - 56% in patients with late onset pneumonia.
Conclusions: Nosocomial early and late onset pneumonia were associated with duration of ICU stay and long-term ventilation. The upper airways seem to represent an important reservoir for lower airway colonization and nosocomial pneumonia in neurosurgical ICU patients.