烧伤、吸入性损伤和呼吸机相关性肺炎：常规监测性培养的价值

Purpose:

Burn patients with inhalation injury are at particular risk for ventilator-associated pneumonia (VAP). Routine endotracheal surveillance cultures may provide information about the causative pathogen in subsequent VAP, improving antibiotic therapy. Our objective was to assess the incidence of VAP in burn patients with inhalation injury, and the benefit of routine surveillance cultures to predict multidrug resistant (MDR) pathogens.

Procedures:

Historical cohort (n=53) including all burn patients with inhalation injury requiring mechanical ventilation, admitted to the Ghent burn unit (2002–2010).

Main Findings:

Median (interquartile range) age and total burned surface area were 44y (39–55y) and 35% (19–50%). Overall, 70 episodes of VAP occurred in 46 patients (86.8%). Median mechanical ventilation days (MVD) prior to VAP onset were 7d (4–9d). The incidence was 55 episodes/1000 MVD. In 23 episodes (32.9%) at least one MDR causative pathogen was involved, mostly Pseudomonas aeruginosa and Enterobacter spp. The sensitivity and specificity of surveillance cultures to predict MDR etiology in subsequent VAP was respectively 83.0% and 96.2%. The positive and negative predictive value was 87.0% and 95.0%, respectively.

Conclusions:

The incidence of VAP in burn patients with inhalation injury is high. In this cohort routine surveillance cultures had excellent operating characteristics to predict MDR pathogen involvement.