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.
Bauer
Torsten T
TT
Hospital Clìnic de Barcelona, Servei de Pneumologia i Cirogía Toracica, Villarroel 170, 08036 Barcelona, Spain.
Valencia
Mauricio
M
Badia
Joan R
JR
Ewig
Santiago
S
González
Julià
J
Ferrer
Miguel
M
Torres
Antoni
A
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