Glucose in bronchial aspirates increases the risk of respiratory MRSA in intubated patients.
BACKGROUND
The risk of nosocomial infection is increased in critically ill patients by stress hyperglycaemia. Glucose is not normally detectable in airway secretions but appears as blood glucose levels exceed 6.7-9.7 mmol/l. We hypothesise that the presence of glucose in airway secretions in these patients predisposes to respiratory infection.


METHODS
An association between glucose in bronchial aspirates and nosocomial respiratory infection was examined in 98 critically ill patients. Patients were included if they were expected to require ventilation for more than 48 hours. Bronchial aspirates were analysed for glucose and sent twice weekly for microbiological analysis and whenever an infection was suspected.


RESULTS
Glucose was detected in bronchial aspirates of 58 of the 98 patients. These patients were more likely to have pathogenic bacteria than patients without glucose detected in bronchial aspirates (relative risk 2.4 (95% CI 1.5 to 3.8)). Patients with glucose were much more likely to have methicillin resistant Staphylococcus aureus (MRSA) than those without glucose in bronchial aspirates (relative risk 2.1 (95% CI 1.2 to 3.8)). Patients who became colonised or infected with MRSA had more infiltrates on their chest radiograph (p<0.001), an increased C reactive protein level (p<0.05), and a longer stay in the intensive care unit (p<0.01). Length of stay did not determine which patients acquired MRSA.


CONCLUSIONS
The results imply a relationship between the presence of glucose in the airway and a risk of colonisation or infection with pathogenic bacteria including MRSA.
Philips
B J
BJ
Glucose and Pulmonary Infection Group, Jenner Wing, St George's Hospital Medical School, London SW17 0RE, UK. bphilips@sghms.ac.uk
Redman
J
J
Brennan
A
A
Wood
D
D
Holliman
R
R
Baines
D
D
Baker
E H
EH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000382:microbiology; D003422:Critical Care; D016638:Critical Illness; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D005947:Glucose / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013312:Stress, Physiological / Q000209:etiology
D005947:Glucose