Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA 94143, USA.
Ann Pharmacother. 2009 Jan;43(1):28-35. doi: 10.1345/aph.1L210. Epub 2008 Nov 25.
Inappropriate antibacterial treatment of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is associated with increased mortality. Endotracheal aspirate (ETA) surveillance cultures potentially identify MDR pathogens, particularly MDR Pseudomonas aeruginosa, resulting in improved selection of therapy in patients who subsequently develop VAP.
To investigate the role of ETA surveillance cultures in the identification of MDR P. aeruginosa in newly intubated adults who subsequently develop VAP.
Daily ETA surveillance cultures for P. aeruginosa were collected in all adults newly intubated for 48 hours or more. Patients with preexisting lung disease or colonization or infection with P. aeruginosa were excluded. Risk factors and outcomes of patients newly colonized with MDR P. aeruginosa were assessed.
Seventy-five patients newly colonized with P. aeruginosa were identified. Twenty (27%) of these patients were colonized with a P. aeruginosa isolate that was MDR (resistant to > or = 3 classes of antibiotics). Six patients were colonized by an isolate resistant to all tested classes of antibiotics. Forty-five percent of patients colonized with MDR P. aeruginosa subsequently developed VAP. Prior receipt of fluoroquinolones was an independent predictor of colonization with MDR P. aeruginosa (OR 11.82; 95% CI 2.10 to 66.46; p = 0.005).
Performance of routine surveillance cultures may aid in the early detection of MDR P. aeruginosa, improving the initiation of early and appropriate antibiotic therapy for patients who subsequently develop VAP.
由于耐多药（MDR）病原体，呼吸机相关性肺炎（VAP）的不适当抗菌治疗与死亡率增加有关。气管内抽吸（ETA）监测培养物可能会识别 MDR 病原体，特别是 MDR 铜绿假单胞菌，从而改善随后发生 VAP 的患者的治疗选择。
研究 ETA 监测培养物在识别新插管的成年人中随后发生 VAP 的 MDR 铜绿假单胞菌中的作用。
对所有新插管 48 小时或更长时间的成年人进行每日 ETA 监测培养以分离铜绿假单胞菌。排除患有肺部疾病或定植或感染铜绿假单胞菌的患者。评估新定植 MDR 铜绿假单胞菌的患者的危险因素和结局。
共鉴定出 75 例新定植铜绿假单胞菌的患者。其中 20 例（27%）患者定植了 MDR 铜绿假单胞菌（对>或= 3 类抗生素耐药）。6 例患者定植了对所有测试类别的抗生素均耐药的分离株。45%的新定植 MDR 铜绿假单胞菌的患者随后发生了 VAP。先前使用氟喹诺酮类药物是定植 MDR 铜绿假单胞菌的独立预测因子（OR 11.82；95%CI 2.10 至 66.46；p = 0.005）。
常规监测培养物的性能可能有助于早期检测 MDR 铜绿假单胞菌，从而改善随后发生 VAP 的患者的早期和适当抗生素治疗的启动。
