title: Management of ventilator-associated pneumonia in a multidisciplinary intensive care unit: does trauma make a difference?
abstract: OBJECTIVE
  Antibiotic exposure and timing of pneumonia onset influence ventilator-associated pneumonia (VAP) isolates. The first goal of this investigation was to evaluate whether trauma also influences prevalence of microorganisms.
  
  
  METHODS
  A retrospective, single-center, observational cohort study.
  
  
  METHODS
  Multidisciplinary teaching ICU.
  
  
  METHODS
  Adult patients requiring mechanical ventilation identified as having VAP.
  
  
  METHODS
  Retrospective evaluation of a prospective manual database.
  
  
  RESULTS
  VAP isolates in a multidisciplinary ICU documented by quantitative respiratory cultures and recorded in a 42-month database were compared, based on the presence or absence of trauma. Causative microorganisms were classified in four groups, based on mechanical ventilation duration (> 5 days), and previous antibiotic exposure. One hundred eighty-three patients developed 196 episodes of VAP (98 trauma). Methicillin-sensitive Staphylococcus aureus (MSSA) was more frequent (34.5% vs. 11.5%, p < 0.01) in trauma, whereas methicillin-resistant Staphylococcus aureus (MRSA) was more frequent (2% vs. 11.5%, p < 0.01) in non-trauma. No significant differences were found between trauma and non-trauma patients regarding prevalence of other microorganisms. In trauma patients, MSSA episodes were equally distributed between early- and late-onset VAP (51% vs. 49%), but no MRSA episode occurred in the early-onset group.
  
  
  CONCLUSIONS
  Trauma influences the microbiology of pneumonia and it should be considered in the initial antibiotic regimen choice. Our data demonstrate that patients with trauma had a higher prevalence of MSSA, but the overall prevalence was sufficiently high to warrant S. aureus coverage for both groups. On the other hand, since no MRSA was isolated during the first 10 days of mechanical ventilation on trauma patients, MRSA coverage in these patients becomes necessary only 10 days after admission.
authors.affiliation: CIBER - Enfermedades Respiratorias, University of Rovira & Virgili, Critical Care Department, Joan XXIII University Hospital, Institut Pere Virgili, Carrer Dr. Mallafre Guasch 4, 43007 Tarragona, Spain.
authors.forename: Kemal
authors.initials: K
authors.lastname: Agbaht
authors.forename: Thiago
authors.initials: T
authors.lastname: Lisboa
authors.forename: Angel
authors.initials: A
authors.lastname: Pobo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Alberto
authors.initials: A
authors.lastname: Sandiumenge
authors.forename: Emili
authors.initials: E
authors.lastname: Diaz
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000187:drug effects; D014947:Wounds and Injuries / Q000150:complications*