Izvorni znanstveni članak
https://doi.org/10.22514/SV141.052018.5
Microbial colonization of the lower airways after insertion of a cuffed endotracheal tube in pediatric patients
TOMAS KONDRATAS
; Paediatric Intensive Care Unit, Department of Paediatrics, Lithuanian University of Health Sciences Eiveniu str. 2, LT-50009 Kaunas, Lithuania
VAIDOTAS GURSKIS
RIMANTAS KEVALAS
ASTRA VITKAUSKIENE
DOVILE EVALDA GRINKEVICIUTE
LAIMUTE VAIDELIENE
Sažetak
Background. Ventilator-associated pneumonia
(VAP) still remains a common device-associated
hospital acquired infection
in pediatric and adult intensive care units.
Te aim of our study was to determine
ways of microbial transmission to the lower
airways in intubated patients admitted
to a single tertiary-care pediatric intensive
care unit.
Methods. Tis was a prospective observational
study. A total of 284 sample sets
(oropharyngeal swabs, swabs from the lumen
of the proximal tip of an endotracheal
tube, and bronchoalveolar lavage samples)
were collected from 62 consecutive pediatric
patients intubated for > 24 hours.
Pulsed-feld gel electrophoresis was performed
on all isolated pathogens, which
were later identifed by MALDI biotyper
(MALDI-TOF mass spectrometry).
Results. Overall colonization rates were
high and did not difer signifcantly at
diferent time points in the oropharynx
(75%–100%) and the lower airways (50%–
76.5%). Te endotracheal tube was colonized
at lower rates: on day 1–3 (28.8%),
on day 4–6 (52.7%), on day 7–9 (61.8%)
and on day 10-12 (52.9%) (P < 0.001). A
total of 191 matched sample sets from the
lower airways and at least one site above
were collected from 46 (74.2%) patients.
In the oropharynx-lower airways group,
Candida spp. (76.9%) and upper airway
bacteria (63.2%); in the endotracheal tubelower
airway group, S. aureus (15.7%)
and upper airway bacteria (21.1%); in the
oropharynx-endotracheal tube-lower airway
group, Enterobacteriaceae (70.8%)
prevailed (P < 0.001). Te mean survival
(entrance) time to lower airways for the
Acinetobacter / Pseudomonas / Stenotrophomonas
group was 8.28 ± 0.81 days;
for the Enterobacteriaceae group, 5.63 ±
0.41; and for Candida spp. group, 3.00 ±
0.82 days (P < 0.005).
Conclusions. Oropharyngeal contamination
of the lower airways is the most important
route of colonization. Diferent
pathogens enter the lower airways at different
time intervals from the insertion of
an endotracheal tube.
Ključne riječi
colonization; airway; intubation; mechanical ventilation; bronchoalveolar lavage; ventilator-associated pneumonia
Hrčak ID:
200422
URI
Datum izdavanja:
1.6.2018.
Posjeta: 682 *