Abstract
BACKGROUND: The significance of commensal oropharyngeal flora (COF) as a potential cause of ventilator-associated pneumonia (VAP) is scarcely investigated and consequently unknown. Therefore, the aim of this study was to explore whether COF may cause VAP. METHODS: Retrospective clinical, microbiological and radiographic analysis of all prospectively collected suspected VAP cases in which bronchoalveolar lavage fluid exclusively yielded >/= 10(4) cfu/ml COF during a 9.5-year period. Characteristics of 899 recent intensive care unit (ICU) admissions were used as a reference population. RESULTS: Out of the prospectively collected database containing 159 VAP cases, 23 patients were included. In these patients, VAP developed after a median of 8 days of mechanical ventilation. The patients faced a prolonged total ICU length of stay (35 days [P < .001]), hospital length of stay (45 days [P = .001]), and a trend to higher mortality (39 % vs. 26 %, [P = .158]; standardized mortality ratio 1.26 vs. 0.77, [P = .137]) compared to the reference population. After clinical, microbiological and radiographic analysis, COF was the most likely cause of respiratory deterioration in 15 patients (9.4 % of all VAP cases) and a possible cause in 2 patients. CONCLUSION: Commensal oropharyngeal flora appears to be a potential cause of VAP in limited numbers of ICU patients as is probably associated with an increased length of stay in both ICU and hospital. As COF-VAP develops late in the course of ICU admission, it is possibly associated with the immunocompromised status of ICU patients.
Original language | English |
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Article number | 86 |
Number of pages | 15 |
Journal | BMC Pulmonary Medicine |
Volume | 15 |
Issue number | 1 |
DOIs | |
Publication status | Published - 12 Aug 2015 |
Keywords
- Ventilator-associated pneumonia
- Bronchoalveolar lavage
- Commensal oropharyngeal flora
- Intensive care unit
- MALDI-TOF-MS
- BRONCHOALVEOLAR LAVAGE FLUID
- INTENSIVE-CARE UNITS
- CRITICALLY-ILL PATIENTS
- ANTIBIOTIC-THERAPY
- PULMONARY INFECTIONS
- NEUTROPENIC PATIENTS
- CYSTIC-FIBROSIS
- SOFA SCORE
- DIAGNOSIS
- METAANALYSIS