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Erschienen in: Intensive Care Medicine 4/2008

01.04.2008 | Original

Effects of systemic antibiotic therapy on bacterial persistence in the respiratory tract of mechanically ventilated patients

verfasst von: Stefan Visscher, Carolina A. M. Schurink, Wilhelmina G. Melsen, Peter J. F. Lucas, Marc J. M. Bonten

Erschienen in: Intensive Care Medicine | Ausgabe 4/2008

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Abstract

Objective

Bacterial respiratory tract colonization predisposes critically ill patients to intensive care unit (ICU)-acquired infections. It is unclear to what extent systemic antibiotics affect colonization persistence. Persistence of respiratory tract colonization, and the effects of systemic antibiotics hereon, were determined in a cohort of ICU patients.

Design

Clinical and microbiological data were collected from 715 admitted mechanically ventilated ICU patients with bacterial growth documented in respiratory tract samples. First day of colonization, persistence of colonization and antibiotic effects hereon were analyzed for six groups of pathogens: Pseudomonas aeruginosa, Acinetobacter species, Enterobacteriaceae, Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae. Systemic antibiotics were grouped into ‘effective’ and ‘ineffective’ antibiotics, based on in-vitro susceptibility data for the relevant bacteria. The effects of antibiotics were quantified as relative risk (RR) of bacterial persistence in the absence of effective antibiotics.

Measurements and results

Persistence of colonization differed significantly between pathogens, ranging from 4 days (median) for H. influenzae and Strep. pneumoniae to 8 days for P. aeruginosa. Systemic antibiotics were administered on 7,102 (61%) of patient days. Antibiotic use was associated with non-persistence for all pathogens, except Acinetobacter species and P. aeruginosa. RR for non-persistence (as compared to ineffective or no antibiotics) ranged from 3.1 (95% CI 1.4–6.6) for H. influenzae to 0.5 (0.3–1.0) for Acinetobacter species.

Conclusions

In mechanically ventilated patients, persistence dynamics of bacterial respiratory tract colonization, and the effects of (in-vitro) effective antibiotics hereon, are pathogen-specific.
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Metadaten
Titel
Effects of systemic antibiotic therapy on bacterial persistence in the respiratory tract of mechanically ventilated patients
verfasst von
Stefan Visscher
Carolina A. M. Schurink
Wilhelmina G. Melsen
Peter J. F. Lucas
Marc J. M. Bonten
Publikationsdatum
01.04.2008
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 4/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0984-5

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