Robert René, Grollier Ghislaine, Frat Jean-Pierre, Godet Cendrine, Adoun Michèle, Fauchère Jean-Louis, Doré Pierre
Service de Réanimation Médicale, Hôpital Jean Bernard CHU, 86021, Poitiers cedex, France.
Intensive Care Med. 2003 Jul;29(7):1062-8. doi: 10.1007/s00134-003-1729-8. Epub 2003 Apr 16.
To study lower respiratory tract colonization by anaerobic bacteria in ICU patients on prolonged mechanical ventilation using two types of protected tracheal sampling methods.
Prospective clinical investigation in the intensive care unit of a university hospital.
Twenty-six consecutive patients mechanically ventilated within 24 h after their admission in ICU and with expected duration of mechanical ventilation longer than 7 days.
Two types of protected tracheal sampling methods were obtained without the use of bronchoscopic guidance on the day following intubation and twice a week until extubation: protected tracheal aspiration and protected tracheal specimen brush. Specific methods for anaerobic isolation were used. Early colonization was defined if colonization occurred within the first 5 days after intubation. Of the 26 patients studied 22 were colonized by at least one bacterial strain. Twenty-one patients were colonized by aerobic and 15 by anaerobic bacteria. Twenty-eight anaerobic strains were identified, with bacterial counts higher than 10(3) cfu/ml in 11 cases. Of the 15 patients colonized by anaerobes 14 were also colonized by aerobic bacteria. The use of protected specimens ruled out oropharyngeal contamination. Early onset colonization occurred in 16 of 22 patients colonized by aerobes and in 8 of 15 patients colonized by anaerobes. Five patients developed ventilatory-acquired pneumonia following colonization (by anaerobic bacteria in two cases). In eight patients colonization by anaerobic bacteria occurred despite antimicrobial therapy.
These results show that anaerobic bacteria frequently colonize the lower respiratory tract of mechanically ventilated patients and underline the potential importance of the anaerobic bacteria in ventilatory acquired pneumonia.
采用两种类型的保护性气管采样方法，研究长期机械通气的重症监护病房（ICU）患者下呼吸道厌氧菌定植情况。
在一所大学医院的重症监护病房进行的前瞻性临床研究。
26例在入住ICU后24小时内接受机械通气且预计机械通气时间超过7天的连续患者。
在插管后的次日且在拔管前每周两次，不使用支气管镜引导获取两种类型的保护性气管采样方法：保护性气管吸引和保护性气管标本刷检。采用特定的厌氧菌分离方法。如果在插管后的前5天内发生定植，则定义为早期定植。在研究的26例患者中，22例至少被一种细菌菌株定植。21例患者被需氧菌定植，15例被厌氧菌定植。鉴定出28株厌氧菌，其中11例细菌计数高于10³cfu/ml。在15例被厌氧菌定植的患者中，14例也被需氧菌定植。使用保护性标本排除了口咽部污染。在22例被需氧菌定植的患者中，16例发生早期定植；在15例被厌氧菌定植的患者中，8例发生早期定植。5例患者在定植后发生呼吸机相关性肺炎（2例由厌氧菌引起）。8例患者尽管接受了抗菌治疗仍发生厌氧菌定植。
这些结果表明，厌氧菌经常定植于机械通气患者的下呼吸道，并强调了厌氧菌在呼吸机相关性肺炎中的潜在重要性。
