Nosocomial pneumonia with isolation of anaerobic bacteria in ICU patients: therapeutic considerations and outcome.
OBJECTIVE
Evaluate the influence of the anti-anaerobic antimicrobial therapy in the outcome of patients with nosocomial pneumonia.


METHODS
The population study included 53 intensive care unit patients with nosocomial pneumonia in whom, using a protected specimen brush, anaerobic bacteria were isolated, which were associated or not with aerobes. Current and empirical antibiotherapies were retrospectively analyzed, regarding their efficacy against anaerobic bacteria. Since it was debated, sensitivity to cefotaxime, ceftazidime, and ciprofloxacin was determined in 38 strains of Prevotella species. Outcome was evaluated 10 days after the day of protected specimen brushes. Improvement was defined as a decrease of Murray score or ventilator weaning.


RESULTS
The most frequently isolated bacteria were Prevotella species, which were more frequently resistant to cefotaxime (37%), ceftazidime (50%), and ciprofloxacine (32%) than usually reported in the literature. Sixty-six percent of these strains produced beta-lactamase. The effect of empirical anti-anaerobic antibiotherapy on the outcome at day 10 was evaluable in 39 patients. Twenty-nine patients were improved and 10 patients worsened. Interestingly, patients who had received well-adapted antibiotics against anaerobes had a better outcome after 10 days (P < .02).


CONCLUSIONS
This study suggests that specific antianaerobic therapy may be considered in the choice of empirical antibiotherapy in patients with nosocomial pneumonia.
Robert
R
R
Service de Réanimation Médicale, Centre Hospitalier Régional et Universitaire de Poitiers, France.
Grollier
G
G
Doré
P
P
Hira
M
M
Ferrand
E
E
Fauchère
J L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001421:Bacteria, Anaerobic / Q000187:drug effects* / Q000302:isolation & purification; D002439:Cefotaxime / Q000494:pharmacology / Q000627:therapeutic use; D002442:Ceftazidime / Q000494:pharmacology / Q000627:therapeutic use; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D018720:Prevotella / Q000187:drug effects / Q000302:isolation & purification; D012189:Retrospective Studies; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D002442:Ceftazidime; D002439:Cefotaxime