Prospective study of nosocomial colonization and infection due to Pseudomonas aeruginosa in mechanically ventilated patients

被引:101
作者
Berthelot, P [1 ]
Grattard, E
Mahul, P
Pain, P
Jospé, R
Venet, C
Carricajo, A
Aubert, G
Ros, A
Dumont, A
Lucht, F
Zéni, F
Auboyer, C
Bertrand, JC
Pozzetto, B
机构
[1] Bellevue Hosp Ctr, Infect Dis Unit, F-42055 St Etienne, France
[2] Univ St Etienne, Hop Nord, Microbiol Lab, St Etienne, France
[3] Univ St Etienne, Hop Nord, Intens Care Unit, St Etienne, France
[4] Bellevue Hosp Ctr, Intens Care Unit, F-42055 St Etienne, France
[5] Bellevue Hosp Ctr, Microbiol Lab, F-42055 St Etienne, France
关键词
pseudomonas aeruginosa; colonization; infection; nosocomial pneumonia; intensive care unit; environment; ventilator-associated pneumonia;
D O I
10.1007/s001340100870
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective:To investigate the respective contribution of endogenous and exogenous transmission of Pseudomonas aeruginosa in the colonization of lungs in the mechanically ventilated patient, to estimate the role of P. aeruginosa colonization in the occurrence of severe infections, and to extrapolate appropriate control measures for the prevention of P. aeruginosa ventilator-associated pneumonia. Design: Prospective study of the presence of P. aeruginosa tin stomach fluid, throat specimens, stool, and sputum) on admission, twice a week throughout the patient's stay, and in their environment. O-sero-typing, pulsed-field gel electro; phoresis, and arbitrarily-primed polymerase chain reaction were used to characterize the strains. Setting: The two intensive care units (ICUs 1 and 2) of a university hospital. Patients: During a 6-month period, 59 patients were included (21 in ICU 1 and 38 in ICU 2). Results: P. aeruginosa was isolated in 26 patients, including ten pneumonia cases and seven colonizations on admission. The incidence of acquired colonization was statistically different between the two ICUs: 5.5 and 20.5 per 1000 days of mechanical ventilation, in ICUs 1 and 2, respectively. Endogenous acquisition was the main origin of P. aeruginosa colonization (21 of 26 patients) and the upper respiratory tract was the main bacterial reservoir in bronchopulmonary colonization and infection. However, during the 6-month period of the study, a multidrug-resistant strain of P. aeruginosa 0:11, isolated in the sink of the room of 12 patients, was found responsible for two colonizations (1 digestive, 1 throat/lungs) and one pneumonia. As a whole, from 26 cases of colonization/infection with P. aeruginosa, 5 were related to an exogenous contamination (environmental reservoir in 4 patients and cross-contamination in one patient). Conclusions: These results emphasize the need for applying various infection control measures to prevent colonization of patients with II aeruginosa, including strategies to limit the potential of sinks from acting as a source or reservoir for this bacterium.
引用
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页码:503 / +
页数:10
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