Adult Critical Care, University Hospital of Wales, Cardiff, CF14 4XW, UK.
Intensive Care Med. 2009 Nov;35(11):1970-3. doi: 10.1007/s00134-009-1586-1. Epub 2009 Jul 31.
Surgical tracheostomy in critically ill adults has largely been replaced by physicians performing percutaneous dilatational tracheostomy (PDT) at the bedside. Complications associated with this technique include haemorrhage, wound infection, barotrauma, false passage, ruptured tracheal ring and bacteraemia. Prophylactic antibiotics are not generally used with this procedure, however the incidence of bacteraemia following PDT has not been extensively studied.
Prospective observational study.
Adult intensive care unit of a university medical centre.
Peripheral venous blood cultures were obtained immediately before and after PDT in 118 consecutive patients. Surveillance cultures of potential respiratory pathogens were also recorded using routine non-directed broncholalveolar lavage.
Forty-three female and 75 male patients underwent PDT. Fifty-seven patients (48.3%) were not receiving antibiotics on the day of PDT, whilst the remaining 61 individuals (51.7%) were on antibiotic therapy at the time of the procedure. Bacteraemia following PDT occurred in six out of 113 patients (5.3%), five of which occurred in patients not receiving antibiotics (9.2%). Unexpected bacteraemia (positive pre-and post PDT blood cultures) was identified in five patients, two of whom were on antibiotic therapy.
The incidence of bacteraemia following a single stage PDT was similar to other manipulations of the aerodigestive tract such as intubation, insertion of an LMA or tooth brushing. We suggest that routine antibiotic prophylaxis is unnecessary for this procedure.
在危重症成人中，外科气管切开术在很大程度上已被医生在床边进行经皮扩张气管切开术（PDT）所取代。该技术相关的并发症包括出血、伤口感染、气压伤、假道、气管环破裂和菌血症。一般不预防性使用抗生素，但 PDT 后菌血症的发生率尚未得到广泛研究。
前瞻性观察研究。
大学医疗中心的成人重症监护病房。
在 118 例连续患者中，在 PDT 前后立即采集外周静脉血培养。还使用常规非定向支气管肺泡灌洗记录潜在呼吸道病原体的监测培养物。
43 名女性和 75 名男性患者接受了 PDT。57 名患者（48.3%）在 PDT 当天未接受抗生素治疗，而其余 61 名患者（51.7%）在该程序时接受抗生素治疗。113 例患者中有 6 例（5.3%）在 PDT 后发生菌血症，其中 5 例未接受抗生素治疗（9.2%）。5 名患者出现意外菌血症（预 PDT 和 post PDT 血培养均为阳性），其中 2 名患者正在接受抗生素治疗。
单次 PDT 后菌血症的发生率与气管插管、插入 LMA 或刷牙等其他气道操作相似。我们建议该程序无需常规抗生素预防。
