An erratum to this article can be found at http://dx.doi.org/10.1186/s12890-015-0098-8.
An erratum to this article is available at http://dx.doi.org/10.1186/s12890-015-0098-8.
The authors declare that they have no competing interest.
CFML initiated the study together with WNKAvM. JBJS, JIMvdV, and CFML prospectively collected and managed the database. JBJS and JIMvdV performed all statistical and initial interpretation of the results, wrote the first drafts of the manuscript and coordinated the implementation of suggestions from the other authors. The COF-VAP likelihood was evaluated by JBJS, JIMvdV, CFML, and WNKAvM. All authors actively participated in discussions on previous drafts and provided multiple qualitative comments resulting in the final approved manuscript.
JBJS, DCJJB and WNKAvM are all consultants in internal medicine and intensive care medicine. WNKAvM is also an associate professor in medical education and chair of the professional behaviour committee at Maastricht University. JIMvdV is a resistant in anaesthesiology. CFML and HAvD are consultants in medical microbiology. PHMS is professor and chair of the department of medical microbiology and PMHJR is professor and chair of the department of intensive care medicine.
The significance of commensal oropharyngeal flora (COF) as a potential cause of ventilator-associated pneumonia (VAP) is scarcely investigated and consequently unknown. Therefore, the aim of this study was to explore whether COF may cause VAP.
Retrospective clinical, microbiological and radiographic analysis of all prospectively collected suspected VAP cases in which bronchoalveolar lavage fluid exclusively yielded ≥ 104 cfu/ml COF during a 9.5-year period. Characteristics of 899 recent intensive care unit (ICU) admissions were used as a reference population.
Out of the prospectively collected database containing 159 VAP cases, 23 patients were included. In these patients, VAP developed after a median of 8 days of mechanical ventilation. The patients faced a prolonged total ICU length of stay (35 days [P < .001]), hospital length of stay (45 days [P = .001]), and a trend to higher mortality (39 % vs. 26 %, [P = .158]; standardized mortality ratio 1.26 vs. 0.77, [P = .137]) compared to the reference population. After clinical, microbiological and radiographic analysis, COF was the most likely cause of respiratory deterioration in 15 patients (9.4 % of all VAP cases) and a possible cause in 2 patients.
Commensal oropharyngeal flora appears to be a potential cause of VAP in limited numbers of ICU patients as is probably associated with an increased length of stay in both ICU and hospital. As COF-VAP develops late in the course of ICU admission, it is possibly associated with the immunocompromised status of ICU patients.
Novosel TJ, Hodge LA, Weireter LJ, Britt RC, Collins JN, Reed SF, et al. Ventilator-associated pneumonia: depends on your definition. Am Surg. 2012;78(8):851–4. PubMed
Grossman RF, Fein A. Evidence-based assessment of diagnostic tests for ventilator-associated pneumonia. Executive Summary Chest. 2000;117(4 Suppl 2):177S–81S. PubMed
American Thoracic S, Infectious Diseases Society of A. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416. CrossRef
Murray PR, Rosenthal KS, Pfaller MA, editors. Medical Microbiology. Seventh Edition. Elsevier; 2012. ISBN: 978-0-323-08692-9 [ http://www.elsevier.com/books/medical-microbiology/murray/978-0-323-08692-9].
el-Ebiary M, Torres A, Fabregas N, de la Bellacasa JP, Gonzalez J, Ramirez J, et al. Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. An immediate postmortem histologic study. Am J Respir Crit Care Med. 1997;156(2 Pt 1):583. CrossRefPubMed
Canadian Critical Care Trials G. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355(25):2619–30. CrossRef
Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800. CrossRefPubMed
De Brauwer EI, Jacobs JA, Nieman F, Bruggeman CA, Wagenaar SS, Drent M. Cytocentrifugation conditions affecting the differential cell count in bronchoalveolar lavage fluid. Anal Quant Cytol Histol. 2000;22(5):416–22. PubMed
Van de Voort PHJ, van Saene HKF, editors. Selective Digestive Tract Decontamination in Intensive Care Medicine. A Practical Guide to Controlling Infection. 1st Edition. Italy: Springer-Verlag Italia; 2008.
Schnabel RM, Scholte JB, Van Der Velden KE, Roekaerts PM, Bergmans DC. Ventilator-associated pneumonia rates after introducing selective digestive tract decontamination. Infect Dis. 2015;1–4.
Scholte JB, van Dessel HA, Linssen CF, Bergmans DC, Savelkoul PH, Roekaerts PM, et al. Endotracheal aspirate and bronchoalveolar lavage fluid analysis: interchangeable diagnostic modalities in suspected ventilator-associated pneumonia? J Clin Microbiol. 2014;52(10):3597–604. CrossRefPubMedPubMedCentral
Pileggi C, Bianco A, Flotta D, Nobile CG, Pavia M. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Crit Care. 2011;15(3):R155. CrossRefPubMedPubMedCentral
- Ventilator-associated Pneumonia caused by commensal oropharyngeal Flora: a retrospective Analysis of a prospectively collected Database
Johannes B. J. Scholte
Johan I. M. van der Velde
Catharina F. M. Linssen
Helke A. van Dessel
Dennis C. J. J. Bergmans
Paul H. M. Savelkoul
Paul M. H. J. Roekaerts
Walther N. K. A. van Mook
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II