Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria

Intensive Care Med (2005) 31:14881494

DOI 10.1007/s00134-005-2697-y ORIGINALElpis GiantsouNikolaos Liratzopoulos

Eleni Efraimidou

Maria Panopoulou

Eleonora Alepopoulou

Sofia Kartali-Ktenidou

George I. Minopoulos

Spyros Zakynthinos

Konstantinos I. ManolasBoth early-onset and late-onset

ventilator-associated pneumonia are caused

mainly by potentially multiresistant bacteriaReceived: 5 November 2004Accepted: 27 May 2005Published online: 7 September 2005

Springer-Verlag 2005This article refers to the editorial available

at http://dx.doi.org/10.1007/s00134-2696-zE. Giantsou ())Sampsountos 25, Ampelokipi, 11522Athens, Greecee-mail: [email protected]

Tel.: [phone]Fax: [phone]E. Giantsou N. Liratzopoulos E. Efraimidou G. I. Minopoulos K. I. ManolasIntensive Care Unit,Department of Surgery, Medical School,

Demokritus University of Thrace,

68100 Alexandroupolis, GreeceM. Panopoulou E. Alepopoulou S. Kartali-KtenidouDepartment of Microbiology,

Medical School,Demokritus University of Thrace,

68100 Alexandroupolis, GreeceS. ZakynthinosMedical School of Athens University,

Department of Critical Careand Pulmonary Services,Evangelismos Hospital,4547 Ipsilandou Str, 10675, Athens,

GreeceAbstract Objective: To compare the

causative pathogens of early-onset

and late-onset ventilator-associated

pneumonia (VAP) diagnosed by

bronchoalveolar lavage quantitative

cultures. Most previous reports have

been based on endotracheal aspirate

cultures and gave uncertain findings.

Design: Prospective evaluation of

consecutive patients with clinical

suspicion for VAP. Setting: Multidisciplinary intensive care unit of a

university hospital. Patients and

participants: During a 3-year period

473 patients with clinical suspicion of

VAP entered the study. Diagnosis of

VAP was confirmed by cultures of

bronchoalveolar lavage (>104 cfu/ml)

specimens in 408 patients. Interventions: Protected bronchoalveolar lavage samples were taken. Initial antibiotic therapy was modified upon

bronchoalveolar lavage culture results. Measurements and results:

Among 408 patients 191 had earlyonset (<7 days mechanical ventilation) and 217 late-onset (!7 days)

VAP. Potentially multiresistant bacteria, mainly Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), were

the most commonly isolated pathogens in both types of VAP. No difference was noted in the contribution

of potentially multiresistant pathogens (79% vs. 85%), P. aeruginosa

(42% vs. 47%), or MRSA (33% vs.

30%) between early-onset and lateonset VAP. Initial antibiotic therapy

was modified in 58% of early-onset

VAP episodes and in 36% of lateonset VAP episodes. No difference in

mortality was found between the two

types of VAP. Conclusions: Both

early-onset and late-onset VAP were

mainly caused by potentially multiresistant bacteria, most commonlyP. aeruginosa and MRSA. Antimicrobial agents against these pathogens should be prescribed empirically, at least in our institution.Keywords Ventilator-associated

pneumonia Resistant bacteria

Mechanical ventilation

Bronchoalveolar lavageIntroductionThe initial, empirical antibiotic therapy of ventilator-associated pneumonia (VAP)...