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

Fecha de publicación: 01/10/2014

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

Investigador Principal

Raúl Méndez Ocaña
Investigación en Neuroinmunología y Esclerosis Múltiple

Leader

Bonaventura Casanova Estruch
Medicina Intensiva

Leader

Álvaro Castellanos Ortega

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.

Datos de la publicación

ISSN/ISSNe:: 0163-4453, 1532-2742
Tipo:: Article
Páginas:: 333-340
DOI:: 10.1016/j.jinf.2014.05.011
Factor de Impacto:: 2,081 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Lopez-Ferraz C:: Intensive Care Medicine, Hospital Universitari i Politecnic la Fe, Valencia, Spain
Ramírez P:: Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Instituto de Salud Carlos III, Spain.
Gordon M:: Intensive Care Medicine, Hospital Universitari i Politecnic la Fe, Valencia, Spain
Marti V:: Intensive Care Medicine, Hospital Universitari i Politecnic la Fe, Valencia, Spain
Gil-Perotin S:: Intensive Care Medicine, Hospital Universitari i Politecnic la Fe, Valencia, Spain
Gonzalez E:: Department of Microbiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
Villarreal E:: Intensive Care Medicine, Hospital Universitari i Politecnic la Fe, Valencia, Spain
Alvarez-Lerma F:: Intensive Care Medicine, Hospital del Mar, Barcelona, Spain
Menendez R:: Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Instituto de Salud Carlos III, Spain

Department of Pneumology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
Bonastre J:: Intensive Care Medicine, Hospital Universitari i Politecnic la Fe, Valencia, Spain
Torres A:: Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Instituto de Salud Carlos III, Spain

Department of Pneumology, Hospital Clinic, Barcelona, Spain