The incidence and microbial spectrum of ventilator-associated pneumonia after tracheotomy in a selective decontamination of the digestive tract-setting.
OBJECTIVE
Tracheotomy is considered to be an independent risk factor for ventilator-associated pneumonia (VAP). Antimicrobial prophylaxis, in particular with coverage of Pseudomonas aeruginosa, is presently advocated. Selective decontamination of the digestive tract (SDD) aims to prevent VAP in critically ill patients, including those after tracheotomy. We determined the incidence and microbial spectrum of VAP after tracheotomy in a SDD-setting.


METHODS
Retrospective analysis of 231 tracheotomized patients during a 2-year period.


RESULTS
Thirteen patients (5.6%) developed VAP. The median [IQR] day of onset was 8.0 [3.0-10.5] days after tracheotomy. The most predominant causative pathogen was Methicillin-sensitive Staphylococcus aureus (MSSA). Timing of tracheotomy was not different between patients developing VAP and those who did not. The type of tracheotomy (percutaneous or surgical, 84.6% versus 15.4%) had no significant influence on the incidence of VAP.


CONCLUSIONS
The incidence of VAP after tracheotomy in a SDD-setting is low, with MSSA as the predominant causative pathogen. Accordingly, if antimicrobial prophylaxis is considered, it may be advisable to cover MSSA in an SDD-setting.
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. d.p.veelo@amc.uva.nl
Denise P
DP
Veelo
Tomas
T
Bulut
Dave A
DA
Dongelmans
Johanna C
JC
Korevaar
Peter E
PE
Spronk
Marcus J
MJ
Schultz
D000278:Administration, Buccal; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D003091:Colistin / Q000008:administration & dosage*; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D003666:Decontamination; D004750:Enteral Nutrition; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D014031:Tobramycin / Q000008:administration & dosage*; D014140:Tracheotomy / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D000666:Amphotericin B; D008712:Methicillin; D014031:Tobramycin; D003091:Colistin