Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome

Abstract

The aim of this study was to determine the incidence, the organisms responsible for and the impact on outcome of nosocomial tracheobronchitis (NTB) in the intensive care unit (ICU).This prospective observational cohort study was conducted in a 30-bed medical/ surgical ICU over a period of 6.5 yrs. All patients ventilated for w48 h were eligible. Patients with nosocomial pneumonia (NP) without prior NTB were excluded. Patients with first episodes of NTB were compared with those without NTB by univariate analysis.The study diagnosed 201 (10.6%) cases of NTB. Pseudomonas aeruginosa was the most common bacteria. NP rates were similar in patients with NTB compared with patients without NTB. Even in the absence of subsequent NP, NTB was associated with a significantly higher length of ICU stay and duration of mechanical ventilation in both surgical and medical populations. Mortality rates were similar in NTB patients without subsequent NP compared with patients without NTB. Antimicrobial treatment in NTB patients was associated with a trend to a better outcome.Nosocomial tracheobronchitis is common in mechanically ventilated intensive care unit patients. In this population, nosocomial tracheobronchitis was associated with longer durations of intensive care unit stay and mechanical ventilation. Further studies are needed to determine the impact of antibiotics on outcomes of patients with nosocomial tracheobronchitis.

Neutrophil extracellular traps in bronchial aspirates: a quantitative analysis

“…PCT is commonly used as an inflammatory marker and is useful for predicting the prognosis and deciding whether to use antibiotics in pneumonia [28,29]. Nosocomial tracheobronchitis is common in mechanically ventilated ICU patients [30]. A recent paper reported that approximately one third of ventilator-associated tracheobronchitis (VAT) patients later developed ventilator-associated pneumonia (VAP) [31].…”

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

“…In mechanically ventilated patients, nosocomial tracheobronchitis has been associated with a longer ICU stay and time on the ventilator, without increased mortality (158). In one randomized trial of intubated patients with communityacquired tracheobronchitis, antibiotic therapy resulted in a decreased incidence of subsequent pneumonia and mortality (156).…”

Ventilator‐associated pneumonia

“…Purulent sputum may be caused by tracheobronchitis and does not always signify parenchymal involvement. 48 Infiltrates on the chest Risk factors for the development of ventilator associated pneumonia N Age >60 years N Severity of illness (APACHE II score .16) N Acute or chronic lung disease N Excessive sedation N Enteral nutrition N Severe burns N Supine body position N Glasgow coma scale,9 N Use of muscle relaxants N Cigarette smoking radiograph can be caused by a number of non-infective conditions including pulmonary oedema, haemorrhage, and contusions. 49 A study by Meduri and colleagues highlighted some of these difficulties.…”