Viral colonization in intubated patients: initial pathogen pattern and follow-up.
BACKGROUND
Colonization of the lower respiratory tract is an independent risk factor for ventilator-associated pneumonia. Little is known about the frequency of viral colonization on intubation and during mechanical ventilation.


METHODS
Overall, 65 eligible intubated patients with no initial signs of pulmonary infection were studied over a period of up to 7 days. Tracheobronchial aspirates were taken: (i) within 48 h after intubation; and (ii) when clinical signs of nosocomial tracheobronchitis were present, before extubation, or after 7 days. Presence of respiratory viruses was investigated using quantitative polymerase chain reaction.


RESULTS
Patients were 67 +/- 11 years old and had been in hospital for 5.1 +/- 8.4 days when intubated (major cause for intubation: cardio-pulmonary resuscitation 25/65, 38%). The average Acute Physiology and Chronic Evaluation II score was 27.3 +/- 4.9. Microbiology detected Candida spp. (17/65; 26%) and Staphylococcus aureus (methicillin sensitive: 11/65; 17%; methicillin resistant: 3/65; 5%) and only few respiratory viruses (4/65, 6%). Thirty-eight percent of the samples (25/65) were sterile. At the given endpoints, 27/65 (42%) patients were available for follow-up and only one aspirate became positive for respiratory syncytial virus (RSV).


CONCLUSIONS
After endotracheal intubation, fungi, but not viruses were most frequently isolated. Only one patient acquired RSV, therefore colonization with respiratory viruses does not seem to play a major role early after intubation.
Hauptmeier
Barbara Monika
BM
Medical Clinic III, University Hospital Bergmannsheil, Bochum, Germany.
Borg
Irmgard
I
Rohde
Gernot
G
Anders
Agnes
A
Kronsbein
Juliane
J
Gatermann
Sören
S
Bufe
Albrecht
A
Blum
Torsten
T
Schultze-Werninghaus
Gerhard
G
Bauer
Torsten Thomas
TT
D000368:Aged; D000369:Aged, 80 and over; D002176:Candida albicans / Q000302:isolation & purification; D002353:Carrier State / Q000382:microbiology / Q000821:virology*; D003428:Cross Infection / Q000382:microbiology / Q000821:virology*; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006785:Hospitals, University; D006801:Humans; D009980:Influenza A virus / Q000302:isolation & purification*; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000302:isolation & purification; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012229:Rhinovirus / Q000302:isolation & purification*
D012367:RNA, Viral