Patterns of colonization by Pseudomonas aeruginosa in intubated patients: a 3-year prospective study of 1,607 isolates using pulsed-field gel electrophoresis with implications for prevention of ventilator-associated pneumonia

Intensive Care Medicine
Jordi VallésJordi Rello

Abstract

To identify routes and patterns of colonization with Pseudomonas aeruginosa in intubated patients to design strategies of prevention for respiratory infection. Prospective and observational study in the 16-bed intensive care unit of a teaching hospital. Ninety-eight intubated patients were investigated over a 3-year period. Those ventilated less than 72 h were excluded. Samples from the tap water from each patient's room, stomach, oropharynx, subglottic secretions, trachea, and rectum were collected when the patient was intubated, and then three times per week. Pulsed-field gel electrophoresis was performed to type the strains. We identified 1,607 isolates pertaining to 35 different pulsotypes. Overall 54.2% of patients presented colonization, and tracheal colonization was present in 30.5%. Ten patients had colonization at intubation, and four of these developed ventilator-associated pneumonia (VAP) after a mean of 4+/-2 days. ICU-acquired colonization occurred in 31 patients, and 4 of these developed VAP after a median of 10+/-5 days. P. aeruginosa was isolated from the room's tap water in 62.4% of samples. More than 90% of tap water samples had pulsotypes 1 and 2, which were frequently isolated in the stomach (59%) but were o...Continue Reading

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