RESPIRATORY INFECTION

Glucose in bronchial aspirates increases the risk of respiratory MRSA in intubated patients

B J Philips¹, J Redman², A Brennan¹, D Wood¹, R Holliman³, D Baines¹, E H Baker¹

¹ Glucose and Pulmonary Infection Group, Jenner Wing, St George’s Hospital Medical School, London SW17 0RE, UK
² Department of Anaesthesia, York Health Services NHS Trust, York YO31 8HE, UK
³ Department of Microbiology, Jenner Wing, St George’s Hospital Medical School, London SW17 0RE, UK

Correspondence to:
Correspondence to:
Dr B J Philips
Glucose and Pulmonary Infection Group, Jenner Wing, St George’s Hospital Medical School, London SW17 0RE, UK; bphilips{at}sghms.ac.uk

Background: The risk of nosocomial infection is increased in critically ill patients by stress hyperglycaemia. Glucose is not normally detectable in airway secretions but appears as blood glucose levels exceed 6.7–9.7 mmol/l. We hypothesise that the presence of glucose in airway secretions in these patients predisposes to respiratory infection.

Methods: An association between glucose in bronchial aspirates and nosocomial respiratory infection was examined in 98 critically ill patients. Patients were included if they were expected to require ventilation for more than 48 hours. Bronchial aspirates were analysed for glucose and sent twice weekly for microbiological analysis and whenever an infection was suspected.

Results: Glucose was detected in bronchial aspirates of 58 of the 98 patients. These patients were more likely to have pathogenic bacteria than patients without glucose detected in bronchial aspirates (relative risk 2.4 (95% CI 1.5 to 3.8)). Patients with glucose were much more likely to have methicillin resistant Staphylococcus aureus (MRSA) than those without glucose in bronchial aspirates (relative risk 2.1 (95% CI 1.2 to 3.8)). Patients who became colonised or infected with MRSA had more infiltrates on their chest radiograph (p<0.001), an increased C reactive protein level (p<0.05), and a longer stay in the intensive care unit (p<0.01). Length of stay did not determine which patients acquired MRSA.

Conclusion: The results imply a relationship between the presence of glucose in the airway and a risk of colonisation or infection with pathogenic bacteria including MRSA.

Abbreviations: ARDS, acute respiratory distress syndrome; GLUT, glucose transporter; MRSA, methicillin resistant Staphylococcus aureus; SGLT1, sodium glucose co-transporter-1; SOFA, sequential organ failure assessment; SSA, sensitive Staphylococcus aureus

Keywords: glucose; hyperglycaemia; methicillin resistant Staphylococcus aureus; respiratory tract infections; critical care

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