Intensive Care Medicine

, Volume 32, Issue 11, pp 1773–1781

Outcome in bacteremia associated with nosocomial pneumonia and the impact of pathogen prediction by tracheal surveillance cultures

  • Pieter Depuydt
  • Dominique Benoit
  • Dirk Vogelaers
  • Geert Claeys
  • Gerda Verschraegen
  • Koenraad Vandewoude
  • Johan Decruyenaere
  • Stijn Blot
Original

Abstract

Objective

To assess whether pathogen prediction in bacteremia associated with nosocomial pneumonia (NP) by tracheal surveillance cultures improves adequacy of early antibiotic therapy and impacts mortality.

Design and setting

A retrospective observational study of a prospectively gathered cohort. This cohort included all adult patients admitted to the ICU of a tertiary care hospital from 1992 through 2001 and who developed bacteremia associated with NP.

Measurements and main results

128 episodes of bacteremia associated with NP were identified. In 110 episodes a tracheal surveillance culture 48–96 h prior to bacteremia was available: this culture predicted the pathogen in 67 episodes (61%). Overall rates of appropriate empiric antibiotic therapy within 24 and 48 h were 62 and 87%, respectively. Pathogen prediction was associated with a significantly higher rate of appropriate antibiotic therapy within 24 h (71 vs 45%; p = 0.01), but not within 48 h (91 vs 82%; p = 0.15). Crude in-hospital mortality was 50%. Pathogen prediction was associated with increased survival in univariate (OR 0.43; CI 0.19–0.93; p = 0.04) and multivariate analysis (OR 0.32; CI 0.12–0.82; p = 0.02). Multivariate analysis further identified age (OR 1.04; CI 1.01–1.07; p = 0.02), increasing APACHE II score (OR 1.08; CI 1.02–1.15; p = 0.01), and methicillin-resistant Staphylococcus aureus (OR 5.90; CI 1.36–25.36; p = 0.01) and Pseudomonas aeruginosa (OR 3.30; CI 1.04–10.4; p = 0.04) as independent risk factors for mortality.

Conclusion

Pathogen prediction in bacteremia associated with NP by tracheal surveillance cultures is associated with a higher rate of adequate empiric antibiotic therapy within 24 h and with increased survival.

Keywords

Nosocomial pneumonia Bacteremia Bacterial drug resistance Surveillance cultures Pseudomonas aeruginosa Methicillin resistance Mortality 

Abbreviations

APACHE II

acute physiology and chronic health evaluation II

CAZ-R

ceftazidime resistant Enterobacteriaceae

CI

confidence interval

ESBL

extended spectrum beta lactamase

FiO2

fraction of inspired oxygen

MDR

multidrug resistant

MSSA

methicillin-sensitive Staphylococcus aureus

MRSA

methicillin-resistant S. aureus

NF

nonfermenting organism

OR

Odds ration

PEEP

positive end-expiratory pressure

VAP

ventilator-associated pneumonia

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Pieter Depuydt
    • 1
  • Dominique Benoit
    • 1
  • Dirk Vogelaers
    • 2
  • Geert Claeys
    • 3
  • Gerda Verschraegen
    • 3
  • Koenraad Vandewoude
    • 1
  • Johan Decruyenaere
    • 1
  • Stijn Blot
    • 1
  1. 1.Department of Intensive CareGhent University HospitalGhentBelgium
  2. 2.Department of Internal Medicine and Infectious DiseasesGhent University HospitalGhentBelgium
  3. 3.Department of Medical MicrobiologyGhent University HospitalGhentBelgium

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