title: Multidrug-resistant Pseudomonas aeruginosa ventilator-associated pneumonia: the role of endotracheal aspirate surveillance cultures.
abstract: BACKGROUND
  Inappropriate antibacterial treatment of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is associated with increased mortality. Endotracheal aspirate (ETA) surveillance cultures potentially identify MDR pathogens, particularly MDR Pseudomonas aeruginosa, resulting in improved selection of therapy in patients who subsequently develop VAP.
  
  
  OBJECTIVE
  To investigate the role of ETA surveillance cultures in the identification of MDR P. aeruginosa in newly intubated adults who subsequently develop VAP.
  
  
  METHODS
  Daily ETA surveillance cultures for P. aeruginosa were collected in all adults newly intubated for 48 hours or more. Patients with preexisting lung disease or colonization or infection with P. aeruginosa were excluded. Risk factors and outcomes of patients newly colonized with MDR P. aeruginosa were assessed.
  
  
  RESULTS
  Seventy-five patients newly colonized with P. aeruginosa were identified. Twenty (27%) of these patients were colonized with a P. aeruginosa isolate that was MDR (resistant to > or = 3 classes of antibiotics). Six patients were colonized by an isolate resistant to all tested classes of antibiotics. Forty-five percent of patients colonized with MDR P. aeruginosa subsequently developed VAP. Prior receipt of fluoroquinolones was an independent predictor of colonization with MDR P. aeruginosa (OR 11.82; 95% CI 2.10 to 66.46; p = 0.005).
  
  
  CONCLUSIONS
  Performance of routine surveillance cultures may aid in the early detection of MDR P. aeruginosa, improving the initiation of early and appropriate antibiotic therapy for patients who subsequently develop VAP.
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA 94143, USA. yangk@pharmacy.ucsf.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Yang
authors.forename: Hanjing
authors.initials: H
authors.lastname: Zhuo
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Guglielmo
authors.forename: Jeanine
authors.initials: J
authors.lastname: Wiener-Kronish
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D015331:Cohort Studies; D015169:Colony Count, Microbial / Q000379:methods; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000382:microbiology*; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000382:microbiology*; D011550:Pseudomonas aeruginosa