Am. J. Respir. Crit. Care Med., Volume 165, Number 1, January 2002, 41-46

Role of Serial Routine Microbiologic Culture Results in the Initial Management of Ventilator-associated Pneumonia

JAN HAYON, CORINNE FIGLIOLINI, ALAIN COMBES, JEAN-LOUIS TROUILLET, NAJIBI KASSIS, MARIE CHRISTINE DOMBRET, CLAUDE GIBERT, and JEAN CHASTRE

Service de Réanimation Médicale, and Service de Microbiologie, Hôpital Bichat-Cl-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France

Results of routine microbiologic cultures of specimens obtained before the onset of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients might help to identify the causative microorganisms and thus to select effective initial antimicrobial therapy. To test this hypothesis, we prospectively studied 125 consecutive VAP episodes for which the causative microorganisms were determined using bronchoscopic techniques. Upon entry into the study, each patient's hospital chart was reviewed and culture results of all previously obtained microbiologic specimens were recorded (mean number ± SD per patient, 45 ± 38). A total of 220 microorganisms were cultured at significant concentrations ( 10³/10⁴ colony-forming units [cfu]/ml) from bronchoscopic specimens and considered responsible for pneumonia. Of these 220 organisms, only 73 (33%) were recovered before VAP onset, sometimes from multiple sites in the same patient but mainly from prior respiratory secretion cultures (n = 53). Also previously isolated were 342 organisms that were not responsible for VAP, making prospective identifications of the true pathogens difficult. Among the 102 episodes for which prior respiratory secretion culture results had been obtained (mean time before VAP onset, 8 ± 9 d), all the organisms ultimately responsible for pneumonia were previously recovered from only 36 (35%) of these specimens. Based on these data, the contribution of routine microbiologic specimens in guiding initial antimicrobial therapy decisions for patients with suspected VAP appears limited.

This article has been cited by other articles:

				K. Yang, H. Zhuo, B J. Guglielmo, and J. Wiener-Kronish Multidrug-Resistant Pseudomonas aeruginosa Ventilator-Associated Pneumonia: The Role of Endotracheal Aspirate Surveillance Cultures Ann. Pharmacother., January 1, 2009; 43(1): 28 - 35. [Abstract] [Full Text] [PDF]

				S. M. Koenig and J. D. Truwit Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention Clin. Microbiol. Rev., October 1, 2006; 19(4): 637 - 657. [Abstract] [Full Text] [PDF]

				Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 388 - 416. [Full Text] [PDF]

				F. Michel, B. Franceschini, P. Berger, J.-M. Arnal, M. Gainnier, J.-M. Sainty, and L. Papazian Early Antibiotic Treatment for BAL-Confirmed Ventilator-Associated Pneumonia: A Role for Routine Endotracheal Aspirate Cultures Chest, February 1, 2005; 127(2): 589 - 597. [Abstract] [Full Text] [PDF]

				J. Rello, C. Lorente, E. Diaz, M. Bodi, C. Boque, A. Sandiumenge, and J. M. Santamaria Incidence, Etiology, and Outcome of Nosocomial Pneumonia in ICU Patients Requiring Percutaneous Tracheotomy for Mechanical Ventilation Chest, December 1, 2003; 124(6): 2239 - 2243. [Abstract] [Full Text] [PDF]

				J-Y. Fagon and J. Chastre Diagnosis and treatment of nosocomial pneumonia in ALI/ARDS patients Eur. Respir. J., August 1, 2003; 22(42_suppl): 77s - 83s. [Abstract] [Full Text] [PDF]

				M. J. Tobin Critical Care Medicine in AJRCCM 2002 Am. J. Respir. Crit. Care Med., February 1, 2003; 167(3): 294 - 305. [Full Text] [PDF]

				J. Chastre and J.-Y. Fagon Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., April 1, 2002; 165(7): 867 - 903. [Abstract] [Full Text] [PDF]