title: Role of serial routine microbiologic culture results in the initial management of ventilator-associated pneumonia.
abstract: Results of routine microbiologic cultures of specimens obtained before the onset of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients might help to identify the causative microorganisms and thus to select effective initial antimicrobial therapy. To test this hypothesis, we prospectively studied 125 consecutive VAP episodes for which the causative microorganisms were determined using bronchoscopic techniques. Upon entry into the study, each patient's hospital chart was reviewed and culture results of all previously obtained microbiologic specimens were recorded (mean number +/- SD per patient, 45 +/- 38). A total of 220 microorganisms were cultured at significant concentrations (> or = 10(3)/10(4) colony-forming units [cfu]/ml) from bronchoscopic specimens and considered responsible for pneumonia. Of these 220 organisms, only 73 (33%) were recovered before VAP onset, sometimes from multiple sites in the same patient but mainly from prior respiratory secretion cultures (n = 53). Also previously isolated were 342 organisms that were not responsible for VAP, making prospective identifications of the true pathogens difficult. Among the 102 episodes for which prior respiratory secretion culture results had been obtained (mean time before VAP onset, 8 +/- 9 d), all the organisms ultimately responsible for pneumonia were previously recovered from only 36 (35%) of these specimens. Based on these data, the contribution of routine microbiologic specimens in guiding initial antimicrobial therapy decisions for patients with suspected VAP appears limited.
authors.affiliation: Service de Réanimation Médicale, and Service de Microbiologie, Hôpital Bichat-Cl-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Jan
authors.initials: J
authors.lastname: Hayon
authors.forename: Corinne
authors.initials: C
authors.lastname: Figliolini
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Najibi
authors.initials: N
authors.lastname: Kassis
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Dombret
authors.forename: Claude
authors.initials: C
authors.lastname: Gibert
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques / Q000592:standards*; D015982:Bias; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D003422:Critical Care / Q000379:methods; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology* / Q000401:mortality; D004351:Drug Resistance; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D018579:Patient Selection; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology* / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012680:Sensitivity and Specificity
chemical_list: D000900:Anti-Bacterial Agents