Concordance between Microorganisms Isolated from Subglottic Secretions and Bronchoalveolar Lavage Fluid in Patients with Ventilator Associated Pneumonia in Intensive Care Unit
Citation Information :
Chilana KA, Sarma L, Putti N, Sahu S, Chillana S. Concordance between Microorganisms Isolated from Subglottic Secretions and Bronchoalveolar Lavage Fluid in Patients with Ventilator Associated Pneumonia in Intensive Care Unit. Indian J Respir Care 2017; 6 (2):824-827.
Introduction: Nosocomial pneumonia is a common complication in critically ill patients. Mechanical ventilation has been consistently identified as the greatest risk factor for the development of nosocomial pneumonia.
Aims: The purpose of the current study is to find the concordance between microorganisms cultured from subglottic secretions and bronchoalveolar lavage fluid (BALF) and to assess the effectiveness of subglottic suctioning for prevention of ventilator-associated pneumonia (VAP).
Patients and Methods: This was a prospective, interventional, cohort study. Patients between 15 and 85 years who developed VAP after receiving mechanical ventilation were enrolled in the study. They were randomly divided into two groups: Group No Subglottic Secretion Drainage (NSSD) and Group Continuous Subglottic Secretion Drainage (CSSD).
Results: The mean age of the patients was 56 ± 13 years. Fifty-eight percent were males and 42% were females. The incidence of VAP among NSSD group was 41.7% and in CSSD group was 25%. The coefficient of correlation was calculated for the microorganisms cultured in subglottic and BALF using Pearson’s correlation. The correlation coefficient was 0.78 for the entire population (P = 0.01). In the NSSD group, it was 0.82 (P = 0.01), and in the CSSD group, it was 0.76 (P = 0.01). The mean Intensive Care Unit (ICU) stay is maximum in NSSD group (12.9 ± 1.84 days) compared to CSSD group (9.2 ± 1.17 days).
Conclusion: The concordance of organism grown in subglottic secretions and BALF culture is higher in NSSD group as compared to CSSD group. CSSD is an effective means of reducing the number of ventilator days and ICU stay.
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in Intensive Care Units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639-44.
Celis R, Torres A, Gatell JM, Almela M, Rodríguez-Roisin R, Agustí-Vidal A. Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest 1988;93:318-24.
Langer M, Cigada M, Mandelli M, Mosconi P, Tognoni G. Early onset pneumonia: A multicenter study in Intensive Care Units. Intensive Care Med 1987;13:342-6.
Chevret S, Hemmer M, Carlet J, Langer M. Incidence and risk factors of pneumonia acquired in intensive care units. Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia. Intensive Care Med 1993;19:256-64.
Cross AS, Roup B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 1981;70:681-5.
Cunnion KM, Weber DJ, Broadhead WE, Hanson LC, Pieper CF, Rutala WA. Risk factors for nosocomial pneumonia: Comparing adult critical-care populations. Am J Respir Crit Care Med 1996;153:158-62.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical Intensive Care Units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-92.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical Intensive Care Units in the United States. Infect Control Hosp Epidemiol 2000;21:510-5.
Eggimann P, Hugonnet S, Sax H, Touveneau S, Chevrolet JC, Pittet D. Ventilator-associated pneumonia: Caveats for benchmarking. Intensive Care Med 2003;29:2086-9.
Cook D, Guyatt G, Marshall J, Leasa D, Fuller H, Hall R, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med 1998;338:791-7.
Bouza E, Pérez MJ, Muñoz P, Rincón C, Barrio JM, Hortal J. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest 2008;134:938-46.
Torres A, Gatell JM, Aznar E, el-Ebiary M, Puig de la Bellacasa J, González J, et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995;152:137-41.
Berra L, De Marchi L, Panigada M, Yu ZX, Baccarelli A, Kolobow T. Evaluation of continuous aspiration of subglottic secretion in an in vivo study. Crit Care Med 2004;32:2071-8.
Ramirez P, Ferrer M, Torres A. Prevention measures for ventilator-associated pneumonia: A new focus on the endotracheal tube. Curr Opin Infect Dis 2007;20:190-7.
Ranjan N, Chaudhary U, Chaudhry D, Ranjan KP. Ventilator-associated pneumonia in a tertiary care Intensive Care Unit: Analysis of incidence, risk factors and mortality. Indian J Crit Care Med 2014;18:200-4.
Golia S, Sangeetha KT, Vasudha CL. Microbial profile of early and late onset ventilator associated pneumonia in the Intensive Care Unit of a tertiary care hospital in Bangalore, India. J Clin Diagn Res 2013;7:2462-6.
Bonten MJ, Kollef MH, Hall JB. Risk factors for ventilator-associated pneumonia: From epidemiology to patient management. Clin Infect Dis 2004;38:1141-9.
Jaimes F, De La Rosa G, Gómez E, Múnera P, Ramírez J, Castrillón S. Incidence and risk factors for ventilator-associated pneumonia in a developing country: Where is the difference? Respir Med 2007;101:762-7.
Huang KT, Tseng CC, Fang WF, Lin MC. An early predictor of the outcome of patients with ventilator-associated pneumonia. Chang Gung Med J 2010;33:274-82.
Yang CS, Qiu HB, Zhu YP, Huang YZ, Xu XT, Gao L. Effect of continuous aspiration of subglottic secretions on the prevention of ventilator-associated pneumonia in mechanically ventilated patients: A prospective, randomized, controlled clinical trial. Zhonghua Nei Ke Za Zhi 2008;47:625-9.
Alsaddique AA. Use of continuous subglottic suction in established ventilator associated pneumonia. Saudi J Anaesth 2009;3:20-4.
Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: Its relevance to developing effective strategies for prevention. Respir Care 2005;50:725-39.