Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients - A prospective study based on genomic DNA analysis
Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients - A prospective study based on genomic DNA analysis
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DOI：
10.1164/ajrccm.156.5.96-04076
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发表时间：
1997-11-01
影响因子：
24.7
通讯作者：
Schlemmer, B
中科院分区：
文献类型：
--
作者：
GarrousteOrgeas, M;Chevret, S;Schlemmer, B
消化道的定植被认为是许多医院获得性感染的来源，特别是医院获得性肺炎。为了评估口咽和胃定植与随后发生的医院获得性肺炎之间的关系，我们前瞻性研究了86例重症监护室（ICU）通气患者。在入院时和ICU住院期间每周两次检测口咽或胃定植并进行定量。当临床上怀疑医院获得性肺炎时（新的胸部X线浸润和脓性气管分泌物），通过纤维支气管镜检查进行诊断，使用受保护的标本刷采样和/或堵塞的伸缩导管采样进行定量培养，至少产生大于或等于10（3）cfu/ml的微生物。使用脉冲场电泳比较了导致定植和感染的细菌菌株（鲍曼不动杆菌、铜绿假单胞菌、肠杆菌科和金黄色葡萄球菌）。共有31例（36%）被诊断为肺炎。与胃定植相比，在入院时或从随后的样本中检测到的口咽定植是医院获得性肺炎的主要因素。例如，口咽定殖A.与尚未定植或定植不完全相同的患者相比，鲍曼不动杆菌肺炎的风险估计增加了7.45倍（p = 0.0004）。DNA基因组分析表明，除了三例肺炎病例外，所有病例的口咽或胃样本和支气管样本中均分离到了相同的菌株。金黄色。这些发现提供了更好的了解机械通气患者院内获得性肺炎的病理生理学。
Colonization of the digestive tract has been supposed to be the source of many hospital-acquired infections, especially nosocomial pneumonia. To assess the relationship between oropharyngeal and gastric colonization and subsequent occurrence of nosocomial pneumonia, we prospectively studied 86 ventilated, intensive care unit (ICU) patients. Oropharyngeal or gastric colonizations were detected and quantified on admission and twice weekly during ICU stay. When nosocomial pneumonia was suspected on clinical grounds (new chest X-ray infiltrate and purulent tracheal secretions), diagnosis was assessed on fiberoptic bronchoscopy with quantitative cultures of a protected specimen brush sampling and/or a plugged telescoping catheter sampling yielding greater than or equal to 10(3) cfu/ml of at least one microorganism. Bacterial strains responsible for colonization and infection (Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriaceae, and Staphylococcus aureus) were compared using pulsed-field electrophoresis. A total of 31 cases (36%) of pneumonia were diagnosed. Oropharyngeal colonization, detected either on admission or from subsequent samples, was a predominant factor of nosocomial pneumonia as compared with gastric colonization. For instance, oropharyngeal colonization with A. baumannii yielded a 7.45-fold estimated increased risk of pneumonia as compared with patients not yet or not identically colonized (p = 0.0004). DNA genomic analysis demonstrated that an identical strain was isolated from oropharyngeal or gastric samples and bronchial samples in all but three cases of pneumonia, due to S. aureus. These findings provide better knowledge of the pathophysiology of nosocomial pneumonia in mechanically ventilated patients.