Tracheal colonisation within 24 h of intubation in patients with head trauma: risk factor for developing early-onset ventilator-associated pneumonia.

OBJECTIVE

To investigate if tracheal colonisation within 24 h of intubation is a risk factor for developing early-onset ventilator-associated pneumonia (EP) in patients with head trauma.

DESIGN

A prospective study in an intensive care unit of a university hospital.

POPULATION

One hundred intubated patients were included with head trauma and Glasgow coma score at admission < or =12.

METHODS

We took tracheal aspirate samples within 24 h of intubation and performed a protected bronchoalveolar mini-lavage when clinical diagnosis of pneumonia was made.

MEASUREMENTS AND RESULTS

On admission time 68 patients (68%) were colonised in trachea, 22 patients were colonised by Staphylococcus aureus, 20 by Haemophilus influenzae, six by Streptococcus pneumoniae and 20 by gram-negative bacilli. The incidence of EP was 26%, and the microorganisms involved were Staph. aureus (44%), H. influenzae (31%), Strep. pneumoniae (12%), and gram-negative bacilli (13%). A multivariate logistic regression analysis showed that the tracheal colonization by Staph. aureus, H. influenzae or Strep. pneumoniae within 24 h of intubation was an independent risk factor for developing EP (odds ratio: 28.9; 95% confidence interval: 1.59-52.5).

CONCLUSION

Colonisation of the trachea within 24 h of intubation by Staphylococcus aureus, Haemophilus influenzae or Streptococcus pneumoniae is a risk factor for developing EP in patients with head trauma.