Robert Alexandre, Danin Pierre-Éric, Quintard Hervé, Degand Nicolas, Martis Nihal, Doyen Denis, Pulcini Céline, Ruimy Raymond, Ichai Carole, Bernardin Gilles, Dellamonica Jean
Service de Réanimation Médicale, Hôpital l'Archet 1, CHU de Nice, 151 Route Saint Antoine de Ginestière, CS 23079, 06202, Nice Cedex 3, France.
Service de réanimation polyvalente, Hôpital l'Archet 2, CHU de Nice, 151 Route Saint Antoine de Ginestière, CS 23079, 06202, Nice Cedex 3, France.
Ann Intensive Care. 2017 Dec;7(1):45. doi: 10.1186/s13613-017-0267-4. Epub 2017 Apr 26.
Pneumonia is one of the major complications of drowning, but the optimal empirical antibiotic treatment is not clearly defined. Multidrug-resistant (MDR) bacteria and fungi have been identified in a recent series of freshwater drowning-associated pneumonia. However, microbial data in seawater drowning are scarce. The objective of the study is to describe the microorganisms isolated in early respiratory specimens obtained from seawater drowning-associated pneumonia and to provide their antibiotic susceptibility pattern.
All patients admitted for seawater drowning between 2003 and 2013 to two intensive care units, from the region in France with the highest drowning rate, were retrospectively included. Demographics, antimicrobial therapy and microbiological data from respiratory samples collected within the first 48 h after admittance were analyzed.
Seventy-four drowned patients were included, of which 36 (49%) were diagnosed by the clinician as having early pneumonia. Concerning the overall population, the median simplified acute physiology score (version 2) was 45 (30-65), and the mortality was 26%. Twenty-four respiratory samples from different patients were obtained within the first 48 h. Sixteen were positive. The main microorganisms found were Enterobacteriaceae (Enterobacter spp., Klebsiella spp. and Escherichia coli) and Gram-positive aerobic cocci (Streptococcus pneumonia and Staphylococcus aureus) with a low rate of antimicrobial resistance. No MDR bacteria or fungi were identified. However, among the positive respiratory samples collected, 5/16 (31%) grew bacteria with natural resistance to amoxicillin-clavulanate, the first-line antibiotic commonly used in our cohort. Resistance was only found among Gram-negative bacteria and from respiratory samples of patients with a higher drowning grade at admission (p = 0.01).
This 10-year descriptive study, the largest cohort to date, provides early respiratory samples from seawater drowning patients. The microorganisms retrieved were either mostly part of the human oro-pharyngeal flora or Enterobacteriaceae and displayed low rates of antimicrobial resistance. Respiratory samples should nonetheless be collected at admittance to the ICU to avoid inappropriate treatment. Empiric use of cephalosporin could be restricted to severe patients or if Gram-negative bacilli are found after direct examination.
肺炎是溺水的主要并发症之一，但最佳经验性抗生素治疗尚不明确。近期一系列与淡水溺水相关的肺炎中已发现多重耐药（MDR）细菌和真菌。然而，海水溺水的微生物数据稀缺。本研究的目的是描述从海水溺水相关肺炎患者早期呼吸道标本中分离出的微生物，并提供其抗生素敏感性模式。
回顾性纳入2003年至2013年期间入住法国溺水率最高地区的两个重症监护病房的所有海水溺水患者。分析患者人口统计学、抗菌治疗以及入院后48小时内采集的呼吸道样本的微生物学数据。
纳入74例溺水患者，其中36例（49%）被临床医生诊断为早期肺炎。总体而言，简化急性生理学评分（第2版）中位数为45（30 - 65），死亡率为26%。在入院后48小时内从不同患者获取了24份呼吸道样本。16份呈阳性。主要发现的微生物为肠杆菌科细菌（肠杆菌属、克雷伯菌属和大肠杆菌）和革兰氏阳性需氧球菌（肺炎链球菌和金黄色葡萄球菌），抗菌耐药率较低。未发现多重耐药细菌或真菌。然而，在采集的阳性呼吸道样本中，5/16（31%）培养出对阿莫西林 - 克拉维酸天然耐药的细菌，阿莫西林 - 克拉维酸是我们队列中常用的一线抗生素。耐药仅在革兰氏阴性细菌以及入院时溺水程度较高患者的呼吸道样本中发现（p = 0.01）。
这项为期10年的描述性研究是迄今为止最大的队列研究，提供了海水溺水患者的早期呼吸道样本。所检出的微生物大多要么是人类口咽菌群的一部分，要么是肠杆菌科细菌，且抗菌耐药率较低。尽管如此，仍应在患者入住重症监护病房时采集呼吸道样本，以避免不恰当的治疗。经验性使用头孢菌素可限于重症患者或直接检查发现革兰氏阴性杆菌的情况。
