Impact of microbial ecology on accuracy of surveillance cultures to predict multidrug resistant microorganisms causing ventilator-associated pneumonia

Autores de IIS La Fe

• Cristina Lopez Ferraz

  Autor

• Paula Ramírez Galleymore

  Autor

• Mónica Gordón Sahuquillo

  Autor

• Verónica Martí Alcarria

  Autor

• Sara María García Gil-Perotín

  Autor

• Esther Villarreal Tello

  Autor

• Rosario Menéndez Villanueva

  Autor

• Juan Manuel Bonastre Mora

  Autor

• Antonio Torres Marti

  Autor

Participantes ajenos a IIS La Fe

• Gonzalez E
• Alvarez-Lerma F

Grupos

• Infecciones Respiratorias

• Investigación en Neuroinmunología y Esclerosis Múltiple

• Medicina Intensiva

Abstract

Objectives: The objective of this study was to assess surveillance cultures (SC) prediction accuracy in two periods and settings of the same Department with a different microbiological epidemiology (high and low prevalence of multi-drug resistant microorganisms (MDRM)). Methods: Prospective and observational study. SC were obtained twice a week in consecutive mechanically ventilated patients. Patients fulfilling VAP criteria were analyzed. Results: 440 patients were followed up, 71 patients had VAP (50 in period I and 21 in period II). MDRM causing VAP were more prevalent in the first period (48% vs. 19%; p = 0.033). The rate of empirical appropriate treatment in period I was lower than in period II (52% vs. 76%; p = 0.031). SC prediction accuracy was similar in the two periods (80% vs. 81%; p = 0.744). However, if antibiotic treatment had been guided by SC, the percentage of appropriate treatment would have increased by 28% in the first period but only by 5% in the second; p = 0.024. Conclusions: SC were able to predict VAP etiology in 80% of cases regardless the prevalence of MDRM. However, the potential benefit of SC in terms of appropriate empirical treatment could be only observed when MDRM were prevalent. (C) 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Keywords

• Ventilator-associated pneumonia; Surveillance cultures; Multidrug resistant microorganism; Appropriate treatment; Acinetobacter baumannii; Pseudomonas aeruginosa