Chest
Clinical Investigations in Critical CareThe Role of Anaerobes in Patients With Ventilator-associated Pneumonia and Aspiration Pneumonia: A Prospective Study
Section snippets
Materials and Methods
This study was conducted between June 1996 and August 1997 in the Medical and Surgical ICUs at St. Vincent Hospital, Worcester, MA. This study was approved by our Institutional Review Board. As both blind PSB sampling and mini-BAL are considered to be within the standard of care in our ICUs, the Institutional Review Board waived the need for informed consent. Patients were eligible for inclusion in this study if they had been mechanically ventilated for more than 48 h and were suspected to have
Results
During the study period, 185 paired specimens from 143 patients with suspected VAP and 25 paired specimens from 25 patients with AP were obtained. One patient with bacteriologically proven AP subsequently underwent blind PSB sampling/mini-BAL for suspected VAP (the cultures were negative). The clinical characteristics of both groups of patients are listed in Table 1. Blind PSB sampling and mini-BAL were performed within 24 h of the suspected episode of aspiration in the patients with AP. Blind
Discussion
Anaerobic bacteria are considered to be common pulmonary pathogens, and they are believed to play a major role in aspiration and nosocomial pneumonia.8, 23, 25, 32 These beliefs are based on a handful of studies conducted in the 1970s, when transtracheal aspiration was used for the collection of “uncontaminated” respiratory secretions19, 20, 21, 22, 32 Consequently, antimicrobial agents with anaerobic coverage have been recommended in patients with aspiration pneumonia and nosocomial pneumonia.7
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For editorial comment see page 8.
Supported by the St. Vincent Hospital Critical Care Research Fund. Theauthors have no financial involvement with any of the productsmentioned.