Screening for resistant gram-negative microorganisms to guide empiric therapy of subsequent infection
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To define the potential of resistant gram-negative colonization surveillance to predict etiology of subsequent infection and improve adequacy of empiric antimicrobial treatment.
Retrospective cohort study.
A mixed medical–surgical six-bed intensive care unit (ICU), from November 2003 to December 2006.
All patients having at least one episode of ventilator-associated pneumonia (VAP) or bloodstream infection (BSI) caused by a resistant gram-negative pathogen during the study period.
Colonization surveillance of the respiratory tract and gastrointestinal tract was systematically performed in all ICU patients. Tracheal aspirates were obtained twice weekly and rectal swabs once weekly. Both tracheal and rectal samples were cultured in antibiotic-enriched media (containing ceftazidime, ciprofloxacin, imipenem or piperacillin/tazobactam), to focus on resistant gram-negative pathogen isolation.
Measurements and results
Colonization concordance between resistant, gram-negative pathogens of infectious episodes and previous, recent (≤7 days) colonization of the respiratory and gastrointestinal tract was determined, based on species identity and antimicrobial susceptibility. Concordance was 82% in VAP and 86% in BSI cases and was further confirmed by molecular testing of 15 randomly selected cases by REP-PCR. Previous colonization had high sensitivity and specificity in VAP, but was less specific in BSI cases. Knowledge of previous colonization improved the rate of adequate empiric antimicrobial treatment (91 vs. 40% in VAP and 86 vs. 50% in BSI cases, P < 0.05).
Colonization surveillance for resistant gram-negative microorganisms is predictive of subsequent infection etiology and can improve empiric antimicrobial treatment adequacy in a critical care setting.
- Kollef MH (2000) Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 31(Suppl 4):S131–S138 CrossRef
- American Thoracic Society Documents (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416 CrossRef
- Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30:536–555 CrossRef
- Bonten MJ, Weinstein RA (1996) The role of colonization in the pathogenesis of nosocomial infections. Infect Control Hosp Epidemiol 17:193–200
- Delclaux C, Roupie E, Blot F, Brochard L, Lemaire F, Brun-Buisson C (1997) Lower respiratory tract colonization and infection during acute respiratory distress syndrome. Am J Resp Crit Care Med 156:1092–1098
- Hayon J, Figliolini C, Combes A, Trouillet JL, Kassis N, Dombret MC, Gibert C, Chastre J (2002) Role of serial routine microbiologic culture results in the initial management of ventilator-associated pneumonia. Am J Resp Crit Care Med 165:41–46
- Bouza E, Perez A, Munoz P, Perez J, Rincon C, Sanchez C, Martin-Rabadan P, Riesgo M, the Cardiovascular Infection Study Group (2003) Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med 31:1964–1970 CrossRef
- Blot S, Depuydt P, Vogelaers D, Decruyenaere J, De Waele J, Hoste E, Peleman R, Claeys G, Verschraegen G, Colardyn F, Vandewoude K (2005) Colonization status and appropriate antibiotic therapy for nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in an intensive care unit. Infect Control Hosp Epidemiol 26:575–579 CrossRef
- Michel F, Franceschini B, Berger P, Arnal JM, Gainnier M, Sainty JM, Papazian L (2005) Early antibiotic treatment for BAL-confirmed ventilator-associated pneumonia. Chest 127:589–597 CrossRef
- Galoisy-Guibal L, Soubirou JL, Desjeux G, Dusseau JY, Eve O, Escarment J, Ecochard R (2006) Screening for multidrug-resistant bacteria as a predictive test for subsequent onset of nosocomial infection. Infect Control Hosp Epidemiol 27:1233–1241 CrossRef
- Depuydt P, Benoit D, Vogelaers D, Claeys G, Verschraegen G, Vandewoude K, Decruyenaere J, Blot S (2006) Outcome in bacteremia associated with nosocomial pneumonia and the impact of pathogen prediction by tracheal surveillance cultures. Intensive Care Med 32:1773–1781 CrossRef
- Depuydt PO, Blot SI, Benoit DD, Claeys GW, Verschraegen GL, Vandewoude KH, Vogelaers DP, Decruyenaere JM, Colardyn FA (2006) Antimicrobial resistance in nosocomial bloodstream infection associated with pneumonia and the value of systematic surveillance cultures in an adult intensive care unit. Crit Care Med 34:653–659 CrossRef
- Malacarne P, Corini M, Maremmani P, Viaggi B, Verdigi S (2007) Diagnostic characteristics of routine surveillance cultures of endotracheal aspirate samples in cases of late-onset ventilator-associated pneumonia due to Acinetobacter baumannii. Infect Control Hosp Epidemiol 28:867–869 CrossRef
- Reddy P, Malczynski M, Obias A, Reiner S, Jin N, Huang J, Noskin GA, Zembower T (2007) Screening for extended spectrum β-lactamase producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia. Clin Infect Dis 45:846–852 CrossRef
- Graham P, Della-Latta P, Wu F, Zhou J, Saiman L (2007) The gastrointestinal tract serves as the reservoir for gram-negative pathogens in very low birth weight infants. Pediatr Infect Dis J 26:1153–1156 CrossRef
- Sanders K, Adhikari N, Friedrich J, Day A, Jiang X, Heyland D, for the Canadian Critical Care Trials Group (2008) Previous cultures are not clinically useful for guiding empiric antibiotics in suspected ventilator-associated pneumonia: secondary analysis from a randomized trial. J Crit Care 23:58–63 CrossRef
- Boots RJ, Philips GE, George N, Faoagali JL (2008) Surveillance culture utility and safety using low-volume blind bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia. Respirology 13:87–96
- Depuydt P, Benoit D, Vogelaers D, Decruyenaere J, Vandijck D, Claeys G, Verschraegen G, Blot S (2008) Systematic surveillance cultures as a tool to predict involvement of multidrug antibiotic resistant bacteria in ventilator-associated pneumonia. Intensive Care Med 34:675–682 CrossRef
- Papadomichelakis E, Kontopidou F, Kopterides P, Mavrou I, Paramythiotou E, Poulakou G, Antoniadou A, Giamarellou H, Armaganidis A (2007) A three-year retrospective study of systematic colonization surveillance in the ICU. Poster presented in the 20th ESICM Annual Congress, Berlin. Intensive Care Med 33(Suppl 2):S131
- Poulakou G, Plachouras D, Kontopidou F, Antoniadou A, Papadomichelakis E, Armaganidis A, Giamarellou H (2008) Rapid surveillance of multidrug resistance in ICU patients, by use of antibiotic-containing agar plates. Poster presented in the 18th ECCMID, Barcelona. Clin Microbiol Infect 14(Suppl 4):S609–S610
- Nijssen S, Boetsma M, Bonten M (2006) Potential confounding in evaluating infection-control interventions in hospital settings: changing antibiotic prescription. Clin Infect Dis 43:616–623 CrossRef
- Vincent JL (2000) Microbial resistance: lessons from the EPIC study. Intensive Care Med 26:S3–S8 CrossRef
- Vincent JL, Suter P, Bihari D, Bruining H (1997) Organization of intensive care units in Europe: lessons from the EPIC study. Intensive Care Med 23:1181–1184 CrossRef
- Dima S, Kritsotakis EI, Roumbelaki M, Metalidis S, Karabinis A, Maguina N, Klouva F, Levidiotou S, Zakynthinos E, Kioumis J, Gikas A (2007) Device-associated nosocomial infection rates in intensive care units in Greece. Infect Control Hosp Epidemiol 28:602–605 CrossRef
- Screening for resistant gram-negative microorganisms to guide empiric therapy of subsequent infection
Intensive Care Medicine
Volume 34, Issue 12 , pp 2169-2175
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Multidrug-resistant bacteria
- Gram-negative bacteria
- Ventilator-associated pneumonia
- Industry Sectors
- Author Affiliations
- 1. 2nd Critical Care Department, Athens University Medical School, University General Hospital “ATTIKON”, Rimini 1, Athens, 12462, Greece
- 2. 4th Department of Internal Medicine, Athens University Medical School, University General Hospital “ATTIKON”, Athens, Greece