Management of ventilator-associated pneumonia in a multidisciplinary intensive care unit: does trauma make a difference?

Byline: Kemal Agbaht (1), Thiago Lisboa (1), Angel Pobo (1), Alejandro Rodriguez (1), Alberto Sandiumenge (1), Emili Diaz (1), Jordi Rello (1) Keywords: Ventilator-associated pneumonia; Trauma; Antibiotics; Methicillin resistance; Staphylococcus aureus Abstract: Objective Antibiotic exposure and timing of pneumonia onset influence ventilator-associated pneumonia (VAP) isolates. The first goal of this investigation was to evaluate whether trauma also influences prevalence of microorganisms. Design A retrospective, single-center, observational cohort study. Setting Multidisciplinary teaching ICU. Patients Adult patients requiring mechanical ventilation identified as having VAP. Interventions Retrospective evaluation of a prospective manual database. Measurements and main results VAP isolates in a multidisciplinary ICU documented by quantitative respiratory cultures and recorded in a 42-month database were compared, based on the presence or absence of trauma. Causative microorganisms were classified in four groups, based on mechanical ventilation duration (>a-5 days), and previous antibiotic exposure. One hundred eighty-three patients developed 196 episodes of VAP (98 trauma). Methicillin-sensitive Staphylococcus aureus (MSSA) was more frequent (34.5% vs. 11.5%, pa- Conclusions Trauma influences the microbiology of pneumonia and it should be considered in the initial antibiotic regimen choice. Our data demonstrate that patients with trauma had a higher prevalence of MSSA, but the overall prevalence was sufficiently high to warrant S. aureus coverage for both groups. On the other hand, since no MRSA was isolated during the first 10 days of mechanical ventilation on trauma patients, MRSA coverage in these patients becomes necessary only 10 days after admission. Author Affiliation: (1) Critical Care Department, Joan XXIII University Hospital, Institut Pere Virgili, CIBERa---a-Enfermedades Respiratorias, University of Rovira & Virgili, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain Article History: Registration Date: 09/05/2007 Received Date: 18/12/2006 Accepted Date: 08/05/2007 Online Date: 12/06/2007 Article note: Supported by Fondo de Investigaciones Sanitarias (CIBERes 06/06/0036 and PI05/2410) and AGAUR (2005/SGR/920).