Respiratory microbiology patterns within the first 24 h of ARDS diagnosis: influence on outcome.
BACKGROUND
Airway colonization and infection are frequent complications during the course of ARDS. The impact on outcomes of microbiological patterns recovered within the first 24 h after diagnosis has not been evaluated.


OBJECTIVE
To describe the incidence and patterns of bronchial colonization and lung infection within the first 24 h of ARDS diagnosis and to evaluate the influence on ICU outcomes.


METHODS
Prospective study of ARDS patients evaluated within 24 h of diagnosis. Patients were studied with tracheobronchial aspirate and right and left bronchoscopic protected specimen brush. All samples were cultured quantitatively.


RESULTS
Fifty-five consecutive patients were included. Twelve patients (22%) were clinically suspected of having nosocomial pneumonia (NP), which was confirmed microbiologically in 7 patients, a frequency of 13%. In those patients without suspected pneumonia, we also found potentially pathogenic microorganisms (PPMs) and potentially drug-resistant microorganisms (PDRMs) in 36% and 31%, respectively. Mortality was not significantly higher in those patients with recovery of a PPM (87% vs 73%, p = 0.31), PDRM (89% vs 74%, p = 0.18), or with NP (79% vs 85%, p = 1.0).


CONCLUSIONS
There is a strikingly high rate of PPM recovery in early ARDS. However, neither isolation of pathogenic microorganisms nor the confirmation of NP could be associated with an increased mortality.
Hospital Clìnic de Barcelona, Servei de Pneumologia i Cirogía Toracica, Villarroel 170, 08036 Barcelona, Spain.
Torsten T
TT
Bauer
Mauricio
M
Valencia
Joan R
JR
Badia
Santiago
S
Ewig
Julià
J
González
Miguel
M
Ferrer
Antoni
A
Torres
D018806:APACHE; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D016009:Chi-Square Distribution; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*
D000890:Anti-Infective Agents