Am. J. Respir. Crit. Care Med., Volume 157, Number 3, March 1998, 912-916

Recurrent Pseudomonas aeruginosa Pneumonia in Ventilated Patients
Relapse or Reinfection?

JORDI RELLO, DOLORS MARISCAL, FRANCESCA MARCH, PAOLA JUBERT, FERRAN SANCHEZ, JORDI VALLES, and PERE COLL

Hospital de Sabadell and Hospital de la S. Creu i S. Pau, Universitat Autonoma de Barcelona, Barcelona, Spain

A prospective observational study was performed to determine whether recurrent episodes of pneumonia caused by Pseudomonas aeruginosa in ventilated patients were due to a relapse of the previous clone or to reinfection with a new one. Diagnosis was based on quantitative cultures of secretions obtained by bronchoscopy. Comparison of strains was made by chromosomal fingerprinting based on pulsed field gel electrophoresis (PFGE). Thirty-three (89.1%) of 37 patients survived the initial week after pneumonia diagnosis; six survivors (18.1%) had multiple episodes caused by the same species. Presence of adult respiratory distress syndrome (83.3% versus 22.2%, p = 0.02) was the only factor significantly associated with clinical recurrences. The 16 isolates from five patients (nine recurrences) were analyzed by PFGE. All new isolates from recurrent episodes, excepting one, were considered as relapses. These data suggest that most recurrent episodes of P. aeruginosa pneumonia in ventilated patients occur due to persistence of strains present in a prior infection.

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