Tracheal colonisation within 24 h of intubation in patients with head trauma: risk factor for developing early-onset ventilator-associated pneumonia.
OBJECTIVE
To investigate if tracheal colonisation within 24 h of intubation is a risk factor for developing early-onset ventilator-associated pneumonia (EP) in patients with head trauma.


METHODS
A prospective study in an intensive care unit of a university hospital.


METHODS
One hundred intubated patients were included with head trauma and Glasgow coma score at admission < or =12.


METHODS
We took tracheal aspirate samples within 24 h of intubation and performed a protected bronchoalveolar mini-lavage when clinical diagnosis of pneumonia was made.


RESULTS
On admission time 68 patients (68%) were colonised in trachea, 22 patients were colonised by Staphylococcus aureus, 20 by Haemophilus influenzae, six by Streptococcus pneumoniae and 20 by gram-negative bacilli. The incidence of EP was 26%, and the microorganisms involved were Staph. aureus (44%), H. influenzae (31%), Strep. pneumoniae (12%), and gram-negative bacilli (13%). A multivariate logistic regression analysis showed that the tracheal colonization by Staph. aureus, H. influenzae or Strep. pneumoniae within 24 h of intubation was an independent risk factor for developing EP (odds ratio: 28.9; 95% confidence interval: 1.59-52.5).


CONCLUSIONS
Colonisation of the trachea within 24 h of intubation by Staphylococcus aureus, Haemophilus influenzae or Streptococcus pneumoniae is a risk factor for developing EP in patients with head trauma.
Sirvent
J M
JM
Intensive Care Unit, Hospital Universitari de Girona Doctor Josep Trueta, Spain. uci@htrueta.scs.es
Torres
A
A
Vidaur
L
L
Armengol
J
J
de Batlle
J
J
Bonet
A
A
D000328:Adult; D015169:Colony Count, Microbial; D006259:Craniocerebral Trauma / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D018410:Pneumonia, Bacterial / Q000209:etiology* / Q000382:microbiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D014132:Trachea / Q000382:microbiology*