title: Systematic surveillance cultures as a tool to predict involvement of multidrug antibiotic resistant bacteria in ventilator-associated pneumonia.
abstract: OBJECTIVE
  To assess prediction of multidrug resistant (MDR) pathogens in ventilator-associated pneumonia (VAP) by systematic surveillance cultures (SC) and to assess the contribution of SC to initial antibiotic therapy.
  
  
  METHODS
  Prospective cohort study of patients with microbiologically confirmed VAP. Comparison of actual early antibiotic coverage with three hypothetical empirical schemes.
  
  
  METHODS
  A 50-bed university hospital ICU. SC consisted of oral, nasal, urinary and rectal samples upon admission, 3-weekly urinary and 1-weekly oral, nasal, and rectal samples in all patients, 3-weekly tracheal aspirates in intubated patients.
  
  
  RESULTS
  MDR pathogens were found in 86 of 199 VAP episodes. Sensitivity of SC to predict MDR pathogens was 69% (tracheal SC) and 82% (all SC); specificity was 96% (tracheal) and 91% (all), respectively. Appropriate antibiotic coverage within 24 h and 48 h following MDR VAP was 77% and 89%, respectively. A carbapenem-based empirical scheme would have been equally appropriate (83% vs. 77% at 24 h; 83% vs. 89% at 48 h), but a beta-lactam-fluoroquinolone empirical therapy would have been less (59% vs. 77% at 24 h; 59% vs. 89% at 48 h) as would have been beta-lactam-aminoglycoside therapy (68% vs. 77% at 24 h; 68% vs. 89% at 48 h). Empirical comparators would have resulted in significantly more prescription of broad-spectrum antibiotics within the first 48 h.
  
  
  CONCLUSIONS
  With MDR pathogens highly prevalent, systematic SC predicted MDR pathogens causing VAP in 69% to 82% and may have contributed to high rates of early appropriate antibiotic therapy with limited use of broad-spectrum antimicrobials.
authors: Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. pieter.depuydt@ugent.be
authors: P
authors: P
authors: Depuydt
authors: D
authors: D
authors: Benoit
authors: D
authors: D
authors: Vogelaers
authors: J
authors: J
authors: Decruyenaere
authors: D
authors: D
authors: Vandijck
authors: G
authors: G
authors: Claeys
authors: G
authors: G
authors: Verschraegen
authors: S
authors: S
authors: Blot
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001431:Bacteriological Techniques; D001530:Belgium / Q000453:epidemiology; D002478:Cells, Cultured; D003661:Decision Support Techniques; D018432:Drug Resistance, Multiple; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000900:Anti-Bacterial Agents