Incidence, etiology, and outcome of nosocomial pneumonia in ICU patients requiring percutaneous tracheotomy for mechanical ventilation.
OBJECTIVE
To determine the epidemiology of pneumonia in patients with tracheotomy receiving short-term mechanical ventilation.


METHODS
Observational prospective study.


METHODS
A 14-bed medical-surgical ICU.


METHODS
Ninety-nine critically ill acute patients requiring percutaneous dilatational tracheotomy for mechanical ventilation.


METHODS
Tracheal aspirate obtained 48 h before tracheotomy.


RESULTS
Eighteen patients (18.1%) acquired pneumonia (median of 7 days after tracheotomy). Pseudomonas aeruginosa was the most frequently identified pathogen, found in eight of the episodes (four not documented by prior tracheal colonization), followed by other Gram-negative bacilli. The development of ventilator-associated pneumonia (VAP) was not anticipated by any clinical variable. A positive tracheal aspirate (TA) culture result obtained before tracheotomy was associated with a risk of acquiring pneumonia of 19.7%, whereas sterile TA cultures were associated with a risk of 14.3% (p > 0.20). VAP prolonged ICU stay or the ventilation period for a median of 19 days and 15 days, respectively. Overall mortality was 34.3%, but the presence of VAP did not increase the mortality rate.


CONCLUSIONS
Percutaneous tracheotomy in patients receiving short-term mechanical ventilation predisposes to pneumonia. Pneumonia was associated with prolonged ventilation and ICU stay, but was not associated with increased mortality. Pseudomonas is a common pathogen after tracheotomy, and this observation should be considered in selecting an antibiotic regimen, because TA obtained prior to the tracheotomy often failed to identify this pathogen.
Rello
Jordi
J
Critical Care Department, Joan XXIII University Hospital, University Rovira & Virgili, Carrer Dr Mallafre Guasch 4, 43007 Tarragona, Spain. jrc@hjxxiii.scs.es
Lorente
Carmen
C
Diaz
Emili
E
Bodi
Maria
M
Boque
Carmen
C
Sandiumenge
Albert
A
Santamaria
Josep Maria
JM
D018806:APACHE; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification* / Q000472:pathogenicity; D012121:Respiration, Artificial / Q000009:adverse effects*; D014140:Tracheotomy