Ventilator-associated Pneumonia caused by commensal oropharyngeal Flora; [corrected] a retrospective Analysis of a prospectively collected Database.
BACKGROUND
The significance of commensal oropharyngeal flora (COF) as a potential cause of ventilator-associated pneumonia (VAP) is scarcely investigated and consequently unknown. Therefore, the aim of this study was to explore whether COF may cause VAP.


METHODS
Retrospective clinical, microbiological and radiographic analysis of all prospectively collected suspected VAP cases in which bronchoalveolar lavage fluid exclusively yielded ≥ 10(4) cfu/ml COF during a 9.5-year period. Characteristics of 899 recent intensive care unit (ICU) admissions were used as a reference population.


RESULTS
Out of the prospectively collected database containing 159 VAP cases, 23 patients were included. In these patients, VAP developed after a median of 8 days of mechanical ventilation. The patients faced a prolonged total ICU length of stay (35 days [P < .001]), hospital length of stay (45 days [P = .001]), and a trend to higher mortality (39 % vs. 26 %, [P = .158]; standardized mortality ratio 1.26 vs. 0.77, [P = .137]) compared to the reference population. After clinical, microbiological and radiographic analysis, COF was the most likely cause of respiratory deterioration in 15 patients (9.4 % of all VAP cases) and a possible cause in 2 patients.


CONCLUSIONS
Commensal oropharyngeal flora appears to be a potential cause of VAP in limited numbers of ICU patients as is probably associated with an increased length of stay in both ICU and hospital. As COF-VAP develops late in the course of ICU admission, it is possibly associated with the immunocompromised status of ICU patients.
Department of Intensive Care Medicine, Luzerner Kantonspital, 6000, Luzern 16, Switzerland. janscholte@hotmail.com.
Johannes B J
JB
Scholte
Department of Intensive Care Medicine, Maastricht University Medical Centre+, P.O. box 5800, 6202 AZ, Maastricht, The Netherlands. johan.vdvelde@gmail.com.
Johan I M
JI
van der Velde
Department of Medical Microbiology, Atrium Medical Centre, P.O. box 4446, 6401 CX, Heerlen, The Netherlands. k.linssen@atriummc.nl.
Catharina F M
CF
Linssen
Department of Medical Microbiology, Maastricht University Medical Centre+, P.O. box 5800, 6202 AZ, Maastricht, The Netherlands. h.van.dessel@mumc.nl.
Helke A
HA
van Dessel
Department of Intensive Care Medicine, Maastricht University Medical Centre+, P.O. box 5800, 6202 AZ, Maastricht, The Netherlands. d.bergmans@mumc.nl.
Dennis C J J
DC
Bergmans
Department of Intensive Care Medicine, Maastricht University Medical Centre+, P.O. box 5800, 6202 AZ, Maastricht, The Netherlands. paul.savelkoul@mumc.nl.
Paul H M
PH
Savelkoul
Department of Medical Microbiology, Maastricht University Medical Centre+, P.O. box 5800, 6202 AZ, Maastricht, The Netherlands. p.roekaerts@mumc.nl.
Paul M H J
PM
Roekaerts
Department of Intensive Care Medicine, Maastricht University Medical Centre+, P.O. box 5800, 6202 AZ, Maastricht, The Netherlands. w.van.mook@mumc.nl.
Walther N K A
WN
van Mook
D001419:Bacteria / Q000302:isolation & purification*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009960:Oropharynx / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors