Frequency of transient streptococcal bacteremia following urgent orotracheal intubation in critically ill patients.
OBJECTIVE
To examine whether urgent orotracheal intubation (OI) can induce bacteremia. To find predictive factors for post-intubation bacteremia.


METHODS
Prospective observational study.


METHODS
Seventeen-bed medical intensive care unit in a university hospital.


METHODS
Sixty-eight adult intensive care patients undergoing urgent OI.


RESULTS
Patients in need of OI could be included if no cardiopulmonary resuscitation was performed. A blood culture was taken immediately before, as soon as possible after, and 60 min after intubation. The indication for intubation, ease of intubation, and the antibiotics used before intubation were registered. Six patients (6/68 or 9%) had streptococcal bacteremia immediately (mean 10.8 min) after intubation. No patient (0/62) had streptococcal bacteremia 60 min after intubation (P = 0.01). Four of the six patients showing streptococcal bacteremia after intubation were intubated by a second doctor because of difficulties during intubation, whereas this was the case in only 9/62 in those without streptococcal bacteremia (P = 0.01). Four of the 13 patients (31%) who needed to be intubated by a second doctor showed transient streptococcal bacteremia. Of the 20 patients not receiving antibiotics at the time of intubation, four (20%) had streptococcal bacteremia compared with 2/47 (4.2%) patients receiving antibiotics (P = 0.06).


CONCLUSIONS
Urgent intubation can cause transient bacteremia with streptococci in a significant proportion of intensive care patients. The observed frequency of bacteremia is higher than previously reported after elective intubation. The difficulty of intubation is probably a predisposing factor.
Rijnders
B J
BJ
Interne Geneeskunde, Universitaire Ziekenhuizen Leuven, Herestraat 49, 3000 Leuven, Belgium. bart.rijnders@uz.kuleuven.ac.be
Wilmer
A
A
Van Eldere
J
J
Van Wijngaerden
E
E
D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D003422:Critical Care; D004630:Emergencies; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000209:etiology